 Now, coming to the femoral hernias, as we know they occur inferior to the inguinal ligament and they lie medial to this femoral vein. So, this is femoral vein, this is femoral artery and these are the femoral naus. So, V-A-N and hernia occur medial to it, they are more common in the woman and compared to inguinal hernias, the obstruction is more common in femoral hernias, why? Because they have a narrower orifice. This is one case of femoral hernia and this is the hernia and we can see the femoral vein and then artery and then laterally will be the, this will be the naus. This is another case where we can see this is the femoral hernia which is causing displacement of the femoral veins laterally and this is the inguinal ligament and this is the femoral hernia which is going below it. Now, the question is how to differentiate all three types of hernias which are femoral hernia, direct hernia and indirect inguinal hernias. The first thing to be seen is relation with the inferior epigastric arteries. If you can see this is the hernia and inferior epigastric arteries seen later to it, okay. So, these are the direct inguinal hernia, this is the inguinal hernia and inferior epigastric arteries are seen medial to it. So, this becomes indirect inguinal hernia and this is the femoral hernia and the inferior epigastric arteries are seen later to it. The second thing we have to see is the relation with the inguinal ligament. This is the inguinal ligament and this hernia is occurring below it. So, it becomes femoral hernia, but if the hernia will be seen above it then it will be called as inguinal hernia. The third thing to be seen is something called as lateral crescent sign. Now, how to see this is the level of the pubic bone and we can see the scrotal cords anterior to it. This is the normal scrotal cord appearance which is rounded. In case of direct inguinal hernia, it projects medial to this inguinal cords and the inguinal cord is pushed laterally by this hernia and then scrotal cord acquires somewhat moon like appearance or crescent like appearance and this is called as lateral crescent sign and they are only seen in direct inguinal hernias and they are not seen in indirect inguinal hernias. So, that was the third thing to be seen. The fourth thing which is usually seen is femoral vein. Now, if we can see this is the femoral hernia and this is the inguinal hernia. This is also inguinal hernia. Now, this femoral vein is significantly or moderately compressed by this femoral hernia whereas this is even larger hernia than this hernia but this is inguinal hernia even though this hernia is so large it is not causing any compression of the femoral vein. So, this is the one criteria to differentiate between femoral and inguinal hernias. And the fifth thing is to be seen of the hernia sac with relation to the pubic tubercle. So, this is the pubic bone and this is the pubic tubercle. We draw two lines perpendicular to it and it is said that the inguinal indirect hernias may cross this pubic tubercle. So, these are the indirect inguinal hernias dilaterally and they can be seen crossing over the pubic tubercle. Whereas, direct inguinal hernia may not cross this pubic tubercle. This is the direct inguinal hernia and there is that is not crossing the pubic tubercle and femoral hernia may pass behind the pubic tubercle. So, this is the pubic tubercle and we can see the hernia passing behind the pubic tubercle region among all the five signs this is somewhat less reliable. Now, this is a case of right sided inguinal scrotal hernia and this is a case of left sided inguinal large inguinal scrotal hernia. This is a case of inguinal scrotal hernia with also bladder projecting within it. In this case with femoral hernia because you are seeing the femoral vein and in this femoral hernia we can see appendix lying within it. So, this becomes degerringout's hernia whereas, this is inguinal hernia with appendix within it and it becomes amiens hernia.