Signs of Femoral Incarceration
The key signs of femoral incarceration include a painful groin bulge or mass, often with local tenderness, that is non-compressible and non-reducible, accompanied by diminished femoral pulses and potential signs of intestinal obstruction if bowel is involved. 1
Clinical Presentation
Physical Examination Findings
- A palpable, tender mass or bulge in the femoral region, below the inguinal ligament and medial to the femoral vessels 1
- Non-compressible femoral vein on ultrasound examination, indicating external compression from the hernia sac 2
- Diminished or absent femoral pulses compared to the contralateral side 2
- Local tenderness and erythema over the hernia site 1
- Inability to reduce the hernia contents manually 1, 3
Systemic Manifestations
- Symptoms of intestinal obstruction if bowel is incarcerated, including nausea, vomiting, and abdominal distension 4
- Severe pain that may worsen with time as ischemia develops 1
- Signs of systemic infection if strangulation has occurred, including fever and leukocytosis 1
- In rare cases, chronic cyclical pain coinciding with menstruation if fallopian tube is incarcerated (in women) 5
Diagnostic Considerations
Ultrasound Findings
- Direct visualization of non-compressible tissue within the femoral canal 2
- Inability to completely compress the femoral vein due to external compression 2
- Potentially visible hernia contents (bowel, omentum, or reproductive organs) 5
Risk Factors and Complications
- Higher incidence in women than men 1, 3
- Extremely high rate of strangulation (up to 36% in some series) compared to other hernias 1
- Potential for rapid progression to tissue necrosis if circulation is compromised 6
- Risk of permanent tissue damage within 4-6 hours if intervention is delayed 6
Differential Diagnosis
Conditions to Consider
- Inguinal hernia (located above the inguinal ligament rather than below it) 2
- Lymphadenopathy (usually multiple nodes rather than a single mass) 1
- Femoral artery aneurysm or pseudoaneurysm (pulsatile mass) 2
- Saphenous vein varix (compressible and changes with Valsalva) 2
Unusual Presentations
- Incarceration of the appendix (De Garengeot hernia) presenting as a painful groin mass with or without signs of appendicitis 7
- Incarceration of the fallopian tube in women, sometimes presenting with cyclical pain during menstruation 5, 3
- Abscess formation if strangulation has led to perforation of incarcerated bowel 1
Clinical Pitfalls
- Femoral hernias are frequently misdiagnosed, leading to delayed treatment and increased risk of strangulation 1
- Patients without regular medical care are at higher risk for developing strangulation due to delayed diagnosis 1
- Femoral hernias may be mistaken for inguinal hernias, leading to inappropriate surgical approach 1
- Patients with incarcerated femoral hernias require urgent surgical evaluation as they represent potential vascular emergencies 2
Remember that femoral incarceration represents a surgical emergency requiring prompt diagnosis and intervention to prevent strangulation and tissue necrosis.