Inguinal and femoral hernias
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2024-079531 (Published 15 July 2024) Cite this as: BMJ 2024;386:e079531
- Theo Pelly, general surgery registrar1,
- Robert Hwang, foundation year trainee2,
- Prajeshan Nirmalan, general practitioner3,
- Zane Perkins, consultant trauma and upper GI surgeon1
- 1Royal London Hospital, London E1 1FR, UK
- 2Newham University Hospital, London E13 8SL, UK
- 3The Roehampton Surgery, London SW15 4HN, UK
- Correspondence to: Theo Pelly h.pelly{at}nhs.net
What you need to know
Ask patients about associated symptoms, such as fever, nausea, or change in stooling to help identify whether their hernia is obstructed or strangulated
If a hernia is suspected on examination, there is no routine requirement to differentiate whether it is direct or indirect, or to request further imaging, before referral
Refer suspected femoral hernias for routine or urgent surgical evaluation; refer painful, newly irreducible hernias or hernias with skin colour changes for urgent surgical assessment
An 82 year old man with a background of hypertension, ischaemic heart disease, gout, and previous prostatectomy presents with a right sided lump in the groin. This has been present for several months but has become increasingly painful. On examination, there is a soft, non-tender 5 cm lump in the groin extending towards the scrotum. There are no skin changes, and, although there is a cough impulse, it does not fully reduce on lying down or with manual pressure.
Groin hernias are a common presentation in primary care.1 They occur as a result of tissue, usually intestine, protruding through the lower abdominal wall on either side of the groin (inguinal hernia) or below the level of the inguinal ligament (femoral hernia).2
The estimated UK incidence of inguinal hernias was 247 per 100 000 patients in 1995, based on a national general practitioner morbidity survey.3 More recent data from an observational study measuring elective admissions for inguinal hernia in English NHS hospitals estimated the 2011 admission rate to be 217 per 100 000 of the male population and 9.4 per 100 000 of the female population.4
This article provides a guide to the assessment of inguinal and femoral hernias, including history, examination, and management. Consider the above case and whether this patient might require further investigation or onward referral in accordance with the relevant guidelines where …
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