A rare and frequently unrecognised pathology in children: femoral hernia

Abstract

A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

Single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia in children and adolescents: case series

“…A femoral hernia is defined as the protrusion of the abdominal contents through the annulus femoralis to the fossa ovalis [2]. This type of hernia had been described the first time by Franz Caspar Hesselbach in 1798 [11].…”

“…Incarcerations of the omentum and bowel may occur [14, 15]. In children, the rate of preoperative misdiagnosis has been reported in more than three-thirds of cases [2, 8, 15, 16]. …”

“…In the pre-laparoscopic era, misinterpretation as inguinal hernia was frequent and led to unnecessary attempts for inguinal hernia repair [1, 2]. This situation changed completely with introduction of the laparoscopy for pediatric hernia repair [3].…”

Pediatric femoral hernia in the laparoscopic era

“…Femoral hernia is uncommon in childhood . It is defined as a protrusion of the abdominal contents through the femoral ring, and it can be associated with an inguinal lipoma in up to 78% of cases . The etiology of this type of groin hernia remains unknown, although several congenital and acquired factors have been identified as causes of femoral hernias.…”

“…A femoral hernia consists of a protrusion of a peritoneal sac through the femoral ring, which is bounded laterally by the femoral vein, medially by the lacunar ligament (Gimbernat's ligament), anteriorly by the inguinal ligament, and posteriorly by the pectineal ligament (Cooper's ligament) . Misdiagnosis in children, in whom this surgical entity is uncommon, has been well documented.…”