Herniation of abdominal contents throught the femoral ring into the femoral canal. The femoral ring is small and generally unyielding, but once bowel has entered it may strangulate as there is no space for expansion.
It is less common than inguinal herniae, but when it does occur, it is more common in females. The traditional explanation that the shape of the pelvis gives more space for it to occur in females seems reasonably plausible.
Low Approach (Lockwood)
Oblique incision just below hernia, i.e. a short distance below inguinal ligament. Identify sac. Dissect down to neck. Open sac and reduce contents. Transfix neck.
Either repair by suturing inguinal ligament to pectineal ligament, or by fixing a mesh-plug into the space and securing it in position.
Inguinal Approach (Lothiessen)
Incision as per inguinal hernia repair. The floor of the inguinal canal is divided and the femoral ring approached from above.
High Approach (McEvedy)
Pre-peritoneal approach from above. Anterior rectus sheath opened. Rectus muscle retracted medially. Gives access from behind abdominal muscles. Allows inspection of bowel if required.