[rasheed]

The classic popular mnemonic
NAVEL
Going from lateral to medial we have
N = femoral nerve
A = femoral artery
V = femoral vein
E = Empty space (which is the inguinal ring)
L = Lacunar ligament

According to my copy of First Aid 2008, there's a mistake in this book, in which they mention L as lymphatics! Please don't rely on First Aid in this particular point.

Here's a nice diagram that shows what goes beneath the inguinal ligament


Copyright notice: this image is in the public domain in USA and is copied from wikimedia commons

Note in the image that the femoral sheath does not include the femoral nerve. Also pay attention to the location of the Iliacus, Psoas major, and Pecitneus in the image (as they also serve as landmarks and can be asked about in the exam).

So Femoral hernias goes through the femoral ring (see image above) and therefore, unlike inguinal hernias which slide above the inguinal ligament, femoral hernias (more common in females) slide below the inguinal ligament. Most surgeons are aware that trying to reduce a femoral hernia will risk crushing the intestines against the lateral sharp edge of the lacunar ligament and thereby risking incarceration.

Note that the boundaries of the femoral triangle are different which are:

• The inguinal ligament superiorly
• The sartorius laterally
• The adductor longus medially (not gracilis)
• Floored by the muscles iliopsoas, pectineus, and adductor longus
• Roofed by the fascia lata

 

[khanar]

Woow that's a great article Rasheed

By the way not only there's a mistake in First Aid about the medial boundry but also it's not mentioned at all in Kaplan Lecture Notes!

Yet in USMLEasy bank there's a question specifically about the lacunar ligament

Thanks for the help man