High-yield map
Key points before the detail
- 01
Femoral hernia lies below the inguinal ligament and medial to the femoral vein.
- 02
The femoral ring is bounded by inguinal ligament, pectineal ligament, lacunar ligament and femoral vein.
- 03
Richter hernia can strangulate without complete obstruction.
- 04
A groin lump in a woman warrants timely specialist assessment.
- 05
Acute complicated femoral hernia is a surgical emergency.
1. Femoral ring anatomy
| Boundary | Structure |
|---|---|
| Anterior | Inguinal ligament |
| Posterior | Pectineal (Cooper) ligament and pectineus fascia |
| Medial | Lacunar ligament |
| Lateral | Femoral vein |
2. Why femoral hernia is dangerous
- The narrow rigid ring can compress the neck and compromise bowel early.
- Femoral hernias are proportionally more frequent in women and older patients.
- A small deep lump can be missed; obstruction may be the presenting feature.
- Richter-type hernia can strangulate only part of the bowel wall while luminal continuity remains.
3. Presentation and differential
- Small painful lump below the inguinal ligament, often inferolateral to the pubic tubercle and medial to the femoral pulse.
- Acute tenderness, erythema and irreducibility suggest threatened contents.
- Bowel obstruction or systemic toxicity may be the first presentation.
- Differentials include inguinal hernia, lymph node, saphena varix, femoral aneurysm and psoas abscess.
4. Acute assessment
| Situation | Action |
|---|---|
| Stable but anatomy uncertain | Dynamic ultrasound; CT/MRI if uncertainty persists. |
| Pain, irreducibility or obstruction | A–E, analgesia, IV access, bloods/lactate and urgent contrast CT if it does not delay surgery. |
| Peritonism, shock, skin change or bowel ischaemia | Emergency operation with antibiotics and preparation for possible bowel resection. |
5. Repair options
| Approach | Use |
|---|---|
| Low (Lockwood) | Elective below-ligament access; limited if bowel viability must be assessed. |
| Inguinal (Lotheissen) | Access through the inguinal canal; may weaken a previously intact inguinal region. |
| High/preperitoneal (McEvedy-type) | Useful when strangulated bowel or resection is anticipated. |
| TEP/TAPP | Covers the myopectineal orifice and identifies occult femoral defects; suitable in elective and selected emergency expert practice. |
6. Technical cautions
- Close or cover the defect without narrowing the femoral vein.
- Mesh is usual in a clean elective field; emergency use depends on contamination.
- If the lacunar ligament must be divided to enlarge the ring, remember a possible aberrant obturator vessel/corona mortis.
Active recall
Close the notes and answer these
Try each question from memory before revealing the answer. These public prompts are a small preview of the integrated retrieval system inside SurgAtlas.
01Where is a femoral hernia relative to the inguinal ligament and femoral vein?
Below the inguinal ligament and medial to the femoral vein.
02State the four boundaries of the femoral ring.
Anterior inguinal ligament; posterior pectineal/Cooper ligament and pectineus fascia; medial lacunar ligament; lateral femoral vein.
03What is a Richter hernia?
Only part of the bowel wall is trapped and may strangulate while the lumen remains partly patent.
04Why is femoral hernia particularly important in women?
It is proportionally more common and may be clinically mistaken for an inguinal hernia, with a high emergency risk.
05What vascular variant matters if the lacunar ligament is divided?
An aberrant obturator vessel, commonly discussed as corona mortis.
Sources & editorial basis
References & editorial basis
- SurgAtlas production source. General Surgery — Femoral Hernia. Public lesson curated from the corresponding production chapter.
- HerniaSurge. International groin hernia guidance and update used by the SurgAtlas source register.
This lesson is derived from the corresponding SurgAtlas production teaching material. Where the source makes current management or guideline claims, the public lesson uses the cited contemporary guidance. It is written for education and examination preparation, not as patient-specific clinical advice.
Editorial details
Medical Doctor (MD) · MRCS Part A · Physician · Surgical Educator
SurgAtlas is an educational resource. For patient care, verify current national guidance, local antimicrobial and transfusion policies, specialty pathways and individual patient factors.
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