True about femoral hernia:

Ans C. (Richter's hernia is its variant). (Ref. Bailey & Love surgery 25th/977)FEMORAL HERNIAS# Account for 1% of all abdominal wall hernia (third most common type of primary hernia).# Female: male ratio is 4:1# Commonest in middle aged and elderly women, More common in parous# Rare in children# Much less common than inguinal hernias but are as common as inguinal hernias in older women# Anatomy of the femoral canal- Anterior border is the inguinal ligament- Posterior border is the pectineal ligament- Medial border is the lacunar ligament- Lateral border is the femoral vein# Management of femoral hernia# All uncomplicated femoral hernias should be repaired as an urgent elective procedure# Three classical approaches to the femoral canal have been described- Low (Lockwood)- Transinguinal (Lotheissen)- High (McEvedy)# Irrespective of approach used the following will be achieved- Dissection of the sac- Reduction/inspection of the contents- Ligation of the sac# Approximation of the inguinal and pectineal ligamentsAlso remember:The relationships of an indirect inguinal and a femoral hernia to the pubic tubercle; the inguinal hernia emerges above and medial to the tubercle whereas the femoral hernia lies below and lateral to it.Although inguinal hernia may be 10 times more common than femoral hernia, a femoral hernia is more likely to strangulate because of the narrowness of the neck and its rigid surrounds. Femoral hernias should be operated on as soon as possible.Surgical anatomyThe femoral canal occupies the most medial compartment of the femoral sheath and extends from the femoral ring above to the saphenous opening below. It is 1.25 cm long and 1.25 cm wide at its base, which is directed upwards. The femoral canal contains fat, lymphatic vessels and the lymph node of Cloquet. It is closed above by the septum crurale, a condensation of extraperitoneal tissue.Special types of hernia# Richter's hernia Partial enterocele (circumference of intestine involved), presents with strangulation and obstruction# Maydl's hernia W loop strangulation, strangulated bowel within abdominal cavity.# Littre's hernia Strangulated Meckel's diverticulum, can cause small bowel fistula.