Expansion
Inguinal is above and medial to the pubic tubercle; femoral is below and lateral
Expansion
Palpate the pubic tubercle, then decide where the neck of the sac lies:
- Inguinal hernia - above and medial to the tubercle
- Femoral hernia - below and lateral to the tubercle
The difference follows directly from the anatomy. The superficial inguinal ring lies just above and lateral to the pubic tubercle, while the femoral canal lies beneath the inguinal ligament, medial to the femoral vein.
Practical points:
- Femoral hernias are commoner in women, though inguinal hernias are still the commonest hernia in women overall
- Femoral hernias have a much higher rate of strangulation and should be repaired promptly
- A large femoral hernia can ride upwards over the inguinal ligament and mimic an inguinal hernia, so identify the neck, not the fundus