Skip to main content
SpringerLink
Log in

Femoral hernia in pediatric population: a diagnostic and surgical challenge

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management.

Methods

A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed.

Results

In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6%) were female. The mean age at time of surgery was 5.8 years (range 0.5–17.1 years). The rate of pre-operative misdiagnosis was 35.5% and open approach was adopted in all cases (16.1% with mesh application). Only two patients (6.4%) experienced surgical complications: one recurrence (repaired six months later) and one post-operative hematoma (treated successfully with conservative method).

Conclusion

Due to the high rate of misdiagnosis, the variety of surgical approaches proposed, and the potential for intraoperative complications, FH poses a challenge for pediatric surgeons and urologists, as confirmed by the literature. It is essential to underline the importance of a proper clinical examination in order to correctly diagnose FH, make the best surgical plan for the patient and prevent post-operative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

References

  1. Temiz A, Akcora B, Temiz M, Canbolant E (2008) A rare and frequently unrecognised pathology in children: femoral hernia. Hernia 12:553–556. https://doi.org/10.1007/s10029-008-0360-6

    Article  CAS  PubMed  Google Scholar 

  2. Al-Shanafey S, Giacomantonio M (1999) Femoral hernia in children. J Pediatr Surg 34:1104–1106. https://doi.org/10.1016/s0022-3468(99)90576-6

    Article  CAS  PubMed  Google Scholar 

  3. Ollero Fresno JC, Alvarez M, Sanchez M, Rollan V (1997) Femoral hernia in childhood: review of 38 cases. Pediatr Surg Int 12:520–521. https://doi.org/10.1007/BF01258716

    Article  CAS  PubMed  Google Scholar 

  4. Muntean A, Stoica I, McLaughlin D, Gillick J, Tareen FK (2021) Femoral hernias: a paediatric surgical enigma. J Pediatr Surg 56:1132–1135. https://doi.org/10.1016/j.jpedsurg.2021.03.032

    Article  PubMed  Google Scholar 

  5. Giseke S, Glass M, Tapadar P, Matthyssens L, Philippe P (2010) A true laparoscopic herniotomy in children: evaluation of long-term outcome. J Laparoendosc Adv Surg Tech A 20:191–194. https://doi.org/10.1089/lap.2009.0069

    Article  PubMed  Google Scholar 

  6. De Caluwe D, Chertin B, Puri P (2003) Childhood femoral hernia: a commonly misdiagnosed condition. Pediatr Surg Int 19:608–609. https://doi.org/10.1007/s00383-003-1060-z

    Article  PubMed  Google Scholar 

  7. Wright MFA, Scollay JM, McCabe AJ, Munro FD (2011) Paediatric femoral hernia – The diagnostic challenge. Int J Surg 9:472–474. https://doi.org/10.1016/j.ijsu.2011.05.004

    Article  CAS  PubMed  Google Scholar 

  8. Matthyssens LEM, Philippe P (2009) A new minimally invasive technique for the repair of femoral hernia in children. J Pediatr Surg 44:967–971. https://doi.org/10.1016/j.jpedsurg.2009.01.029

    Article  PubMed  Google Scholar 

  9. Gul Y (2000) Femoral hernia in children. Ir Med J 93:183–184

    CAS  PubMed  Google Scholar 

  10. Haggui B, Hidouri S, Ksia A, Mosbahi S, Messaoud M, Sahnoun L, Mekki M, Belghith M, Nouri A (2021) Femoral hernia in children: how to avoid misdiagnosis? Afr J Paediatr Surg 18:164–167. https://doi.org/10.4103/ajps.AJPS_74_20

    Article  PubMed  PubMed Central  Google Scholar 

  11. Schier F (2006) Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg 41:1081–1084. https://doi.org/10.1016/j.jpedsurg.2006.02.028

    Article  PubMed  Google Scholar 

  12. Aneiros Castro B, Cano Novillo I, García Vázquez A, López Díaz M, Benavent Gordo MI, Gómez Fraile A (2018) Pediatric femoral hernia in the laparoscopic era. Asian J Endosc Surg 11:233–237. https://doi.org/10.1111/ases.12448

    Article  PubMed  Google Scholar 

  13. Nayeem N (1990) Femoral hernia in children. Br J Clin Pract 44:383

    Article  CAS  PubMed  Google Scholar 

  14. Dattola P, Alberti A, Dattola A, Giannetto G, Basile G, Basile M (2002) Inguino-crural hernias: preoperative diagnosis and post-operative follow-up by high-resolution ultrasonography. A personal experience. Ann Ital Chir 73:65–68

    CAS  PubMed  Google Scholar 

  15. Depasquale R, Landes C, Doyle G (2009) Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol 64:608–614. https://doi.org/10.1016/j.crad.2008.11.006

    Article  CAS  PubMed  Google Scholar 

  16. Chen KC, Chu CC, Chou TY, Wu CJ (1998) Ultrasonography for inguinal hernias in boys. J Pediatr Surg 33:1784–1787. https://doi.org/10.1016/s0022-3468(98)90284-6

    Article  CAS  PubMed  Google Scholar 

  17. Burke J (1967) Femoral hernia in childhood. Ann Surg 166:287–289. https://doi.org/10.1097/00000658-196708000-00017

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Anderas P, Jona JZ, Glicklich M, Cohen RD (1987) Femoral hernias in children. An infrequent problem. Arch Surg 122:950–951. https://doi.org/10.1001/archsurg.1987.01400200100019

    Article  CAS  PubMed  Google Scholar 

  19. Fosburg RG, Mahin HP (1965) Femoral hernia in children. Am J Surg 109:470–475. https://doi.org/10.1016/s0002-9610(65)80179-9

    Article  CAS  PubMed  Google Scholar 

  20. Chapman WH, Barcia PJ (1991) Femoral hernia in children: an infrequent problem revisited. Mil Med 156:631–633

    Article  CAS  PubMed  Google Scholar 

  21. Sorelli PG, El-Masry NS, Garrett WV (2009) Open femoral hernia repair: one skin incision for all. World J Emerg Surg 4:44–44. https://doi.org/10.1186/1749-7922-4-44

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee SL, Dubois JJ (2000) Laparoscopic diagnosis and repair of pediatric femoral hernia: initial experience of four cases. Surg Endosc 14:1110–1113. https://doi.org/10.1007/s004640000237

    Article  CAS  PubMed  Google Scholar 

  23. Esposito C, Escolino M, Turra F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A (2016) Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 25:232–240. https://doi.org/10.1053/j.sempedsurg.2016.05.006

    Article  PubMed  Google Scholar 

  24. Tainaka T, Uchida H, Ono Y, Tanano A, Shirota C, Yokota K, Murase N, Makita S, Shirotsuki R (2015) A new modification of laparoscopic percutaneous extraperitoneal closure procedure for repairing pediatric femoral hernias involving a special needle and a wire loop. Nagoya J Med Sci 77:531–535

    PubMed  PubMed Central  Google Scholar 

  25. Tam PK, Lister J (1984) Femoral hernia in children. Arch Surg 119:1161–1164. https://doi.org/10.1001/archsurg.1984.01390220045010

    Article  CAS  PubMed  Google Scholar 

  26. Tsushimi T, Takahashi T, Gohra H, Fukuda S, Furukawa S, Oda T, Inoue T, Hamano K (2005) A case of incarcerated femoral hernia in an infant. J Pediatr Surg 40:581–583. https://doi.org/10.1016/j.jpedsurg.2004.11.017

    Article  PubMed  Google Scholar 

  27. Graf JL, Caty MG, Martin DJ, Glick PL (2002) Pediatric hernias. Semin Ultrasound CT MR 23:197–200. https://doi.org/10.1016/s0887-2171(02)90006-5

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, Rome, Italy

    Cristina Martucci, Simone Frediani, Antonella Accinni, Ivan Pietro Aloi, Arianna Bertocchini, Valerio Pardi & Alessandro Inserra

  2. Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Alessandro Crocoli, Silvia Madafferi & Giorgio Persano

Authors
  1. Cristina Martucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Frediani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonella Accinni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivan Pietro Aloi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arianna Bertocchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandro Crocoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Silvia Madafferi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Valerio Pardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giorgio Persano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alessandro Inserra
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CM and SF conceived the study, reviewed the literature, and wrote the first draft of the manuscript. All the authors contributed to study design, worked on the drafts and re-edits of the manuscript reviewed the final manuscript, and agreed with the decision to submit for publication.

Corresponding author

Correspondence to Cristina Martucci.

Ethics declarations

Conflict of interest

This work was supported also by the Italian Ministry of Health with "Current Research funds”. Authors are required to disclose financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Ethics statement

The present study received authorization for publication from the scientific board in the authors’ institution.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was waived by the local Ethics Committee of Bambino Gesù Children's Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martucci, C., Frediani, S., Accinni, A. et al. Femoral hernia in pediatric population: a diagnostic and surgical challenge. Hernia 28, 593–597 (2024). https://doi.org/10.1007/s10029-023-02953-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-023-02953-2

Keywords

Search

Navigation