# Femoral Hernia

> Femoral hernia for NEET-PG Surgery: femoral canal boundaries, female preponderance, strangulation risk, differential diagnosis and McVay or mesh repair.

- Canonical URL: https://prepelephant.com/topics/neet-pg/surgery/femoral-hernia
- Exam / course: NEET-PG · Subject: Surgery
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Femoral Hernia", PrepElephant, https://prepelephant.com/topics/neet-pg/surgery/femoral-hernia

## Direct answer

A femoral hernia descends through the femoral canal into the groin below and lateral to the pubic tubercle, and although inguinal hernias remain commoner even in women, femoral hernias show a strong female preponderance owing to the wider female pelvis and canal. The canal is a rigid, narrow space bounded by the inguinal ligament in front, the pectineal (Cooper) ligament and pectineus behind, the lacunar (Gimbernat) ligament medially and the femoral vein laterally, containing fat and the node of Cloquet. This rigidity makes femoral hernias the most dangerous of the common groin hernias — many present already strangulated, commonly quoted at around a fifth to two-fifths in various series — frequently of the Richter type, and repair is surgical, by Cooper ligament (McVay) repair or mesh, urgently when complicated.

## What you must remember

- Landmark: the lump lies below and lateral to the pubic tubercle, unlike an inguinal hernia which is above and medial to it; a femoral hernia becomes irreducible early and does not typically reach the scrotum.
- Femoral canal boundaries (the examined set): anterior — inguinal ligament; posterior — pectineal ligament (of Cooper) over pectineus; medial — lacunar ligament (of Gimbernat); lateral — femoral vein.
- The canal normally contains extraperitoneal fat and Cloquet's node, the lymph node of the femoral canal.
- Strangulation risk is the highest of groin hernias due to the sharp rigid lacunar ligament and narrow neck; Richter-type entrapment (part of the bowel wall) is characteristic, so obstruction may be absent despite strangulation.
- Differential diagnosis of a groin lump: inguinal hernia, saphena varix (disappears on lying, blue tinge, cough impulse), femoral artery aneurysm, enlarged Cloquet or inguinal node, lipoma of the cord, undescended testis and psoas abscess.
- Repair approaches: low (Lockwood), high (McEvedy) for strangulation with possible bowel resection, and transinguinal (Lotheissen-McVay); laparoscopic preperitoneal repair covers the whole myopectineal orifice including the femoral defect.
- Division of the lacunar ligament may release an incarcerated sac, taking care to avoid an accessory obturator artery.

## Common confusion

The exam's favourite trap is 'commonest hernia in women' — the answer remains inguinal, with femoral merely showing the highest female-to-male ratio. A second trap is a strangulated Richter hernia presenting with a tender lump but no obstruction and normal bowel sounds; missing it because 'there is no vomiting' causes gangrene of the entrapped wall. Saphena varix disappears on elevation and shows a venous hum.

## Exam-focused takeaway

Learn the canal boundaries as a fixed list (Gimbernat and Cooper ligaments are named answers) and the below-and-lateral landmark. Stems describe an elderly woman with a small hard tender lump below the inguinal ligament, vomiting or not, and ask the diagnosis or the approach when bowel viability is in doubt — McEvedy or a laparotomy-capable incision. Also revise why femoral hernias strangulate.

## Frequently asked questions

### Why do femoral hernias strangulate more often?
The canal is narrow with an unyielding lacunar ligament medially, so the neck constricts contents tightly, and patients often present late with an easily ignored lump.

### How is a femoral hernia distinguished from an inguinal hernia?
By its position below and lateral to the pubic tubercle, its irreducibility, absence of descent into the scrotum, and, at surgery, its course through the femoral canal medial to the femoral vein.

### What is a Richter hernia and why does it matter here?
Herniation of only part of the circumference of the bowel wall, so lumen patency is preserved; strangulation of the entrapped wall occurs without signs of obstruction, a classic femoral scenario.

### Which repair is classic for femoral hernia?
The Cooper ligament (McVay) repair approximating transversus abdominis and conjoint tendon to the pectineal ligament, or a preperitoneal mesh repair covering the femoral defect; strangulated cases need an approach allowing bowel resection.