Children's Health Ireland at Crumlin, Cooley Rd, Crumlin D12 N512, Dublin, Ireland.
Children's Health Ireland at Tallaght, Tallaght University Hospital, Tallaght D24 NR0A, Dublin, Ireland.
J Pediatr Surg. 2021 Jul;56(7):1132-1135. doi: 10.1016/j.jpedsurg.2021.03.032. Epub 2021 Mar 24.
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.
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.
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).
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.
在儿科人群中，股疝（FH）是一种罕见且常被误诊的疾病。本研究旨在回顾我们在爱尔兰儿科外科服务中治疗儿童 FH 的经验。
回顾性分析 2004 年至 2019 年间在爱尔兰儿科外科服务就诊并接受 FH 手术的所有患者的病历。收集的数据包括人口统计学、术前诊断、手术细节、并发症和随访。
研究期间，26 名患者（18 名男性）接受了 FH 修复手术，手术时的中位年龄为 6.9 岁（3-16 岁）。同期，5693 名患者接受了腹股沟疝修补术，FH 与腹股沟疝（IH）的比例为 1:219，FH 在所有腹股沟疝中的发生率为 0.45%。右侧受累 18 例（69.2%），均为单侧。16 例（61.5%）患者术前诊断正确，8 例（30.8%）误诊为 IH，2 例（7.7%）诊断不明确。所有手术均为择期进行。在误诊组的 3 例患者中，首次手术时在腹股沟探查阴性后发现 FH。其余 5 例患者因疑似 IH 接受了先前的腹股沟探查，表现为腹股沟疝复发的临床症状。所有术前诊断正确的患者均通过腹股沟或腹股沟下入路进行 FH 修复。疝囊内容物为腹膜前脂肪 18 例，淋巴结 2 例，大网膜 1 例，空囊 1 例。无术后并发症或复发。中位随访时间为 6 周（0-2.5 年）。
在儿科人群中，FH 是一种罕见的疾病，诊断具有挑战性。FH 常被误诊为 IH，可能需要多次手术才能正确识别和治疗。对于 IH 阴性的腹股沟探查患者，如果术前明确诊断为腹股沟疝，应保持对 FH 的高度怀疑。对于 IH 似乎复发的患者，也应考虑 FH 作为鉴别诊断。
