A 52 year old female presents with groin pain. Physical examination reveals a bulge in the groin area immediately inferior to the inguinal canal. The physician suspects that the patient has a femoral hernia containing a loop of small intestine. Which of the following structures is located immediately medial to the hernia sac?

A femoral hernia exits the abdominal cavity through the femoral ring to enter the femoral canal. The femoral ring is bounded medially by the lacunar ligament. Compression of the herniated intestine against the sharp edge of the lacunar ligament may cause strangulation of the intestine. The other borders of the femoral ring are the inguinal ligament anteriorly, the pubis posteriorly, and the femoral vein laterally.The femoral aery is within the femoral sheath along with the femoral hernia, but is lateral to the femoral vein, which separates the aery from the hernia. The femoral nerve is not inside of the femoral sheath, but is lateral to the sheath. The femoral vein is lateral to the femoral canal within the femoral sheath. Ref: Deveney K.E. (2010). Chapter 32. Hernias & Other Lesions of the Abdominal Wall. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.