Inguinal and Femoral Hernias - Emergency Medicine
Summary
- Groin hernias occur when intra‑abdominal contents (usually small bowel or omentum) protrude through a weakness in the lower anterior abdominal wall.
- Femoral hernias are more common in women and carry a higher risk of incarceration and strangulation because of the narrow femoral canal.
- Any incarcerated, strangulated or obstructed hernia is a time‑critical surgical problem and requires immediate surgical review (RCEM). For definitions and elective/operative considerations see NICE TA83 / MIB9.
Anatomy and types
- Inguinal canal: transmits the spermatic cord (men) or round ligament (women). The deep inguinal ring lies lateral to the inferior epigastric vessels; the superficial ring is more anterior.
Indirect inguinal hernia
- Passes through the deep ring lateral to the inferior epigastric vessels.
- Follows the cord/round ligament and may extend into the scrotum.
- More common overall and more likely to strangulate at the deep ring.
Direct inguinal hernia
- Protrudes through a weakened posterior wall (Hesselbach’s triangle) medial to the inferior epigastric vessels.
- Tends to be more easily reducible.