Many femoral herniae are asymptomatic until incarceration or strangulation occurs. There may be just an occasional dragging or aching sensation at the site. A small, firm, grape-like lump can be felt below the inguinal ligament, lateral to its medial attachment to the pubic tubercle. It may be difficult to detect a cough impulse because of the small size of the femoral canal. Frequently, the hernia is irreducible and dull to percussion. It may be bilateral.
Femoral hernias are more likely to become strangulated than inguinal hernias.
Occasionally, the hernia may pass anteriorly through the fossa ovalis femoris and then superiorly. It may present as a visible or palpable mass at or above the inguinal ligament where it can be confused with an inguinal hernia.
Pressure on the femoral or long saphenous vein around the fossa ovalis may produce visible venous distention.
Rarely, the antimesenteric border of a section of bowel may become caught in the hernia giving rise to a Richter's hernia.
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