From the Guidelines
Femoral hernia clinical assessment findings should prioritize early detection of strangulation, as delayed diagnosis can lead to high morbidity and mortality rates, and patients with suspected bowel strangulation should undergo immediate surgical intervention, as the benefits outweigh the risks of surgery 1.
Clinical Assessment Findings
Femoral hernia clinical assessment findings typically include:
- A palpable lump or bulge in the groin area, specifically below the inguinal ligament and medial to the femoral vessels
- The hernia may be reducible, meaning it can be pushed back into the abdomen, or irreducible if it cannot
- Patients often report pain or discomfort in the groin that worsens with physical activity, coughing, or straining
- On examination, the hernia becomes more prominent when the patient stands, coughs, or performs a Valsalva maneuver
Risk Factors and Complications
Femoral hernias are more common in women than men and carry a higher risk of incarceration or strangulation compared to other hernia types, with risk factors for bowel resection including lack of health insurance, obvious peritonitis, and femoral hernia 1.
Diagnostic Challenges
Early detection of progression from an incarcerated hernia to a strangulated hernia is difficult to achieve by either clinical or laboratory means, and signs of SIRS, including fever, tachycardia, and leukocytosis, as well as abdominal wall rigidity, are considered common indicators of strangulated obstruction, but may not be reliable for early diagnosis 1.
Laboratory and Imaging Tests
Laboratory parameters such as lactate level, CPK, and D-dimer levels, as well as imaging tests like CT scans, can be useful in predicting bowel strangulation, with lactate level being a significant predictor of non-viable bowel strangulation 1, and CT findings of reduced wall enhancement being a significant independent predictor of bowel strangulation 1.
From the Research
Femoral Hernia Clinical Assessment Findings
- Clinical examination is a crucial step in diagnosing femoral hernia, and diagnosis is often straightforward 2.
- Femoral hernias can present with groin pain, and ultrasound can be used to give a differential diagnosis of a recurrent inguinal hernia or a femoral hernia 3.
- The clinical assessment findings for femoral hernia may include a palpable mass in the groin area, pain, and tenderness 4.
- In cases of incarcerated femoral hernia, clinical assessment findings may also include signs of bowel obstruction or strangulation, such as nausea, vomiting, and abdominal tenderness 5, 6.
Diagnostic Challenges
- Femoral hernias can be difficult to diagnose, especially in obese patients or those with a history of previous hernia repairs 3.
- Clinical examination may not always be able to distinguish between a femoral hernia and other types of groin hernias, such as inguinal hernias 4.
- Imaging studies, such as ultrasound or CT scans, may be necessary to confirm the diagnosis of a femoral hernia 3, 6.
Surgical Management
- The surgical management of femoral hernia depends on the severity of the condition and the presence of any complications, such as bowel strangulation 2, 5, 6.
- Laparoscopic repair of femoral hernia is a feasible and safe option, but it requires specialized skills and equipment 3, 5.
- Open surgical repair is still the mainstay of treatment for femoral hernia, especially in emergency situations 2, 4.