title: Paediatric femoral hernia--the diagnostic challenge.
abstract: BACKGROUND
  Femoral herniae are uncommon in childhood and pre-operative misdiagnosis is common. This can result in increased complications or inappropriate inguinal exploration. The aim of this retrospective study was to assess a tertiary centre's experience with paediatric femoral hernia over a 12 year period.
  
  
  METHODS
  Children who underwent femoral hernia repair at a single centre were identified from a prospectively maintained database. Casenotes were reviewed for demographic data and details of presentation, operation and recurrence.
  
  
  RESULTS
  Sixteen children with a median age of 7 (range 3-16) years were identified. One patient developed bilateral femoral herniae. All children were referred with a groin lump but in only one instance did the referring clinician establish the diagnosis of femoral hernia. Emergency repair was required in 2 patients (12%). Eleven femoral herniae were diagnosed following clinical assessment ultrasound. The remainder were identified intra-operatively following negative inguinal exploration. Intra-operatively the femoral canal was closed with sutures (n = 16) or mesh plug (n = 1). Only one patient had a laparoscopic repair. Two other patients underwent laparoscopy to confirm bowel viability (n = 1) and for inguinal canal assessment with subsequent open femoral hernia repair (n = 1). All patients were reviewed in surgical clinic and no morbidity or hernia recurrences were reported.
  
  
  CONCLUSIONS
  Femoral herniae are a diagnostic challenge and a high index of clinical suspicion is necessary. Ultrasonography or laparoscopy may be appropriate in equivocal cases. The long-term results of paediatric femoral hernia surgery are excellent.
authors.affiliation: Paediatric Medicine, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK.
authors.forename: M F A
authors.initials: MF
authors.lastname: Wright
authors.forename: J M
authors.initials: JM
authors.lastname: Scollay
authors.forename: A J
authors.initials: AJ
authors.lastname: McCabe
authors.forename: F D
authors.initials: FD
authors.lastname: Munro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013536:Suture Techniques