Femoral hernia in children.

During a period of ten years, 20 children with femoral hernias were treated at Alder Hey Children's Hospital, Liverpool, England. Unfamiliarity with the occurrence of femoral hernias in children resulted in a correct diagnosis in only three (15%) of the 20 cases by the referring physician and in only 13 (65%) of the cases by the first surgeon to see the child. Misdiagnosis included inguinal hernia (four cases), lymphadenitis (two cases), and lymphangioma (one case). In two cases, misdiagnosis resulted in mistreatment; one child had the wrong operation performed, and delay in surgery in another resulted in strangulation of the omentum in the hernial sac. Treatment is by operation, which, despite the wide variety of procedures employed, was successful in 18 of the 20 cases. The two recurrences were due to the performance of inadequate operations; recurrence was really persistent, as the femoral pad of fat was removed but the sac was missed. The positive identification of the hernial sac is imperative.