Femoral hernias: A paediatric surgical enigma
Ancuta Muntean1, Ionica Stoica2, Danielle McLaughlin3
1Children's Health Ireland at Crumlin, Cooley Rd, Crumlin D12 N512, Dublin, Ireland.
Insights
Femoral hernia (FH) is rare in children and often misdiagnosed as inguinal hernia (IH). Early suspicion and diagnosis are key for effective management, as FH can be mistaken for recurrent IH.
Area of Science:
- Pediatric Surgery
- Surgical Pathology
- Hernia Repair
Background:
- Femoral hernia (FH) is an uncommon and frequently misdiagnosed condition in the pediatric population.
- Accurate diagnosis and timely management of FH are crucial for preventing complications and ensuring optimal outcomes in children.
Purpose of the Study:
- To review the clinical experience with the management of femoral hernia (FH) in children.
- To analyze the diagnostic challenges, surgical approaches, and outcomes associated with pediatric FH.
Main Methods:
- Retrospective review of medical records for pediatric patients who underwent FH repair over a 15-year period (2004-2019) in Ireland.
- Data collected included demographics, preoperative diagnosis, operative details, complications, and follow-up.
- Comparison of FH incidence with inguinal hernia (IH) rates.
Main Results:
- Twenty-six pediatric patients underwent FH repair, with a median age of 6.9 years.
- The incidence of FH was 0.45% of all groin hernias (1:219 ratio with IH).
- A correct preoperative diagnosis was made in 61.5% of cases; 30.8% were misdiagnosed as IH, with some requiring multiple operations.
Conclusions:
- Pediatric femoral hernia (FH) is rare, challenging to diagnose, and often misdiagnosed as inguinal hernia (IH).
- A high index of suspicion is necessary for FH, especially after negative groin explorations for suspected IH or in cases of apparent IH recurrence.
- Consideration of FH in the differential diagnosis is vital for appropriate surgical management in children.
Purpose:
In the paediatric population, femoral hernia (FH) represents an uncommon and often misdiagnosed pathology. This study aimed to review our experience with the management of FH in children.
Methods:
Medical records were retrospectively reviewed for all patients presenting to the paediatric surgical service in Ireland over a 15-year period (2004-2019), who were operated on for FH. Collected data included demographics, preoperative diagnosis, operative details, complications and follow-up.
Results:
During the study period, n = 26 patients (n = 18 males) underwent FH repair, with a median age at surgery 6.9 years (range 3-16 years). During the same period n = 5693 patients underwent inguinal herniotomy, resulting in a FH to inguinal hernia (IH) ratio of 1:219 and a FH incidence of 0.45% of all groin hernias. The right side was affected in n = 18 (69.2%) cases and all cases were unilateral. A correct preoperative diagnosis was established in n = 16 (61.5%) cases, n = 8 (30.8%) cases were misdiagnosed as IH and the diagnosis was equivocal in 2 cases (7.7%). All operations were performed on an elective basis. In 3 patients from the misdiagnosed group, FH was found at first operation following negative groin exploration for IH. The remaining 5 patients underwent previous groin exploration for suspected IH and represented with clinical picture of groin hernia recurrence. All patients with a correct preoperative diagnosis underwent a FH repair via an inguinal or infra-inguinal approach. The content of the hernia sac was preperitoneal fat in n = 18 cases, lymph nodes in n = 2 cases, omentum in n = 1 and an empty sac in n = 1. There were no postoperative complications or recurrences. Median follow-up time was 6 weeks (range 0-2.5 years).
Conclusion:
In the paediatric population, FH is a rare pathology and can be a challenging diagnosis. FH is commonly misdiagnosed as IH and may require more than one operation to correctly identify and treat. A high index of suspicion of FH should be maintained in patients who have a negative groin exploration for IH in the setting of a clear pre-operative diagnosis of a groin hernia. FH should also be considered in the differential diagnosis when an IH appears to recur.
