Patients often come to see the doctor with lumps in the groin area. These lumps can be quite difficult to diagnose just on the basis of examination findings alone, because there are quite a few conditions that can cause lumps in the groin and often enough, they look clinically very similar. Two conditions, which are known to create such confusion, are a Femoral Hernia and a Saphena Varix and it can be a disaster if the two are not differentiated soon enough.
What is a Femoral Hernia?
A Femoral hernia is a common condition where the inside lining of the abdomen (called the peritoneum) can slide out of the abdomen through a weak point at the top of the leg. Usually a femoral hernia presents as a soft lump at the top of the leg, about the same size as a walnut. Initially the lump is quite soft and non-tender and can be pushed back. A femoral hernia usually disappears when the patient lies down flat. The lump will usually have a ‘cough impulse’ – in other words, if a hand is placed on the lump and the patient coughs, the hand will feel the lump move out a little with the cough.
Occasionally, a loop of the small bowel can slide into the hernia. Sometimes this loop of bowel can get stuck and this is called a ‘strangulated hernia’. In such a scenario, the lump at the top of the leg becomes hard and painful to the touch and can’t be pushed back in.
A strangulated femoral hernia is a surgical emergency and needs an urgent operation to repair it. Delay can cause serious damage to the bowel and possible obstruction of the intestines – in extreme cases, this can be life threatening. For this reason we usually repair a femoral hernia as soon as possible after it has been diagnosed.
What is a Saphena Varix?
A Saphena Varix is a localised ‘blow out’ of the saphenous vein at the top of the leg where it joins the deep femoral vein – essentially, it is a localised varicose vein. It presents as a lump at the top of the leg which is soft and non-tender and can easily be pushed back – very similar in size and position to a femoral hernia. It also disappears when the patient lies flat and may have a cough impulse like a hernia as well!
A saphena varix is usually more prominent in reasonably slim people.
Sometimes the varix can become thrombosed, where the blood inside it suddenly clots. When this happens the varix becomes hard and sore to touch and cannot be pushed back – very similar to a strangulated femoral hernia. It can be quite difficult to distinguish between the two just by observation alone. When in doubt, an ultrasound scan can be helpful in determining the difference.
The Final Words
It is important to know which is which – the treatment for a strangulated femoral hernia is an emergency operation. The treatment for a thrombosed saphena varix is anti-inflammatory medication and sometimes anti-coagulant injections for a large one to reduce the risk of the thrombus spreading into the femoral vein and causing a Deep Vein Thrombosis.