Where is a femoral hernia located in relation to the inguinal ligament and the VAN (vein, artery, nerve)?

• A. Lateral to VAN and above inguinal ligament
• B. Medial to artery and below inguinal ligament
• C. Lateral to VAN and below inguinal ligament
• D. Medial to VAN and below inguinal ligament

Answer: (D)

A femoral hernia enters through the femoral canal, which sits in the femoral sheath just below the inguinal ligament and is the most medial compartment. Because the femoral canal lies medial to the femoral vein and artery (and those vessels are part of the VAN arrangement, from lateral to medial), a femoral hernia ends up appearing medial to the entire VAN. So its position is medial to VAN and below the inguinal ligament. This also helps explain why femoral hernias present lower in the groin and can be more prone to strangulation, unlike inguinal hernias that occur above the inguinal ligament through the inguinal canal.