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Paediatric femoral hernia--the diagnostic challenge
M F A Wright1, J M Scollay, A J McCabe
1Paediatric Medicine, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK.
Insights
Pediatric femoral hernia diagnosis is challenging, often requiring imaging like ultrasound or laparoscopy. Surgical repair yields excellent long-term outcomes with no reported recurrences in this study.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Surgery
Background:
- Femoral herniae are rare in children, frequently misdiagnosed pre-operatively.
- Misdiagnosis can lead to complications and unnecessary inguinal surgery.
Purpose of the Study:
- To evaluate a tertiary center's experience with pediatric femoral hernia over 12 years.
- To assess diagnostic challenges and surgical outcomes for pediatric femoral hernia.
Main Methods:
- Retrospective review of a prospectively maintained database of children undergoing femoral hernia repair.
- Analysis of demographic data, clinical presentation, operative details, and recurrence rates.
Main Results:
- Sixteen pediatric patients with femoral hernia were identified (median age 7 years).
- Only one case was correctly diagnosed pre-operatively; 11/16 diagnosed with ultrasound.
- No surgical morbidity or hernia recurrences were reported during follow-up.
Conclusions:
- Pediatric femoral hernia presents diagnostic difficulties, necessitating high clinical suspicion.
- Imaging (ultrasound, laparoscopy) is valuable for equivocal cases.
- Surgical management of pediatric femoral hernia demonstrates excellent long-term results.
Introduction:
Femoral herniae are uncommon in childhood and pre-operative misdiagnosis is common. This can result in increased complications or inappropriate inguinal exploration. The aim of this retrospective study was to assess a tertiary centre's experience with paediatric femoral hernia over a 12 year period.
Methods:
Children who underwent femoral hernia repair at a single centre were identified from a prospectively maintained database. Casenotes were reviewed for demographic data and details of presentation, operation and recurrence.
Results:
Sixteen children with a median age of 7 (range 3-16) years were identified. One patient developed bilateral femoral herniae. All children were referred with a groin lump but in only one instance did the referring clinician establish the diagnosis of femoral hernia. Emergency repair was required in 2 patients (12%). Eleven femoral herniae were diagnosed following clinical assessment ultrasound. The remainder were identified intra-operatively following negative inguinal exploration. Intra-operatively the femoral canal was closed with sutures (n = 16) or mesh plug (n = 1). Only one patient had a laparoscopic repair. Two other patients underwent laparoscopy to confirm bowel viability (n = 1) and for inguinal canal assessment with subsequent open femoral hernia repair (n = 1). All patients were reviewed in surgical clinic and no morbidity or hernia recurrences were reported.
Conclusion:
Femoral herniae are a diagnostic challenge and a high index of clinical suspicion is necessary. Ultrasonography or laparoscopy may be appropriate in equivocal cases. The long-term results of paediatric femoral hernia surgery are excellent.
