Eur J Pediatr Surg 2017; 27(06): 484-494
DOI: 10.1055/s-0037-1608684
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Femoral, Direct, and Rare Inguinal Hernias in Children—An Update

Jan Gödeke
1   Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University, Mainz, Germany
,
Oliver J. Muensterer
1   Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University, Mainz, Germany
› Author Affiliations
Further Information

Publication History

15 October 2017

18 October 2017

Publication Date:
15 November 2017 (online)

Abstract

Pediatric surgeons deal with inguinal hernias on a regular basis. While most of these are straightforward in terms of diagnosis and therapy, occasionally what initially sounds like a routine case turns out to be a perplexing conundrum. This review discusses rare and unusual findings in the groin area that may mimic an indirect inguinal hernia, but are not. To provide good and effective care, pediatric surgeons should be readily familiar with the possible differential diagnosis of these entities, along with their specific management. In general, laparoscopy is one of the most useful interventions to discern unusual groin pathology from standard indirect inguinal hernias and in many cases provides an effective treatment option at the same time.

 
  • References

  • 1 Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML. Laparoscopic evaluation of the pediatric inguinal hernia--a meta-analysis. J Pediatr Surg 1998; 33 (06) 874-879
  • 2 Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Semin Pediatr Surg 2007; 16 (01) 50-57
  • 3 Brisson P, Patel H, Feins N. Cremasteric muscle hypertrophy accompanies inguinal hernias in children. J Pediatr Surg 1999; 34 (09) 1320-1321
  • 4 Wright JE. Direct inguinal hernia in infancy and childhood. Pediatr Surg Int 1994; 9 (03) 161-164
  • 5 Tam PKH, Lister J. Femoral hernia in children. Arch Surg 1984; 119 (10) 1161-1164
  • 6 Schier F, Klizaite J. Rare inguinal hernia forms in children. Pediatr Surg Int 2004; 20 (10) 748-752
  • 7 Esposito C, Montinaro L, Alicchio F. , et al. Technical standardization of laparoscopic herniorraphy in pediatric patients. World J Surg 2009; 33 (09) 1846-1850
  • 8 Gause CD, Casamassima MG, Yang J. , et al. Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial. Pediatr Surg Int 2017; 33 (03) 367-376
  • 9 Feng S, Zhao L, Liao Z, Chen X. Open versus laparoscopic inguinal herniotomy in children: a systematic review and meta-analysis focusing on postoperative complications. Surg Laparosc Endosc Percutan Tech 2015; 25 (04) 275-280
  • 10 Wright JE, Gill AW. Direct inguinal hernias in the newborn. Aust N Z J Surg 1991; 61 (01) 78-81
  • 11 Stephens BJ, Rice WT, Koucky CJ, Gruenberg JC. Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome. World J Surg 1992; 16 (05) 952-956
  • 12 Gahukamble DB, Khamage AS. Early versus delayed repair of reduced incarcerated inguinal hernias in the pediatric population. J Pediatr Surg 1996; 31 (09) 1218-1220
  • 13 Goldman RD, Balasubramanian S, Wales P, Mace SE. Pediatric surgeons and pediatric emergency physicians' attitudes towards analgesia and sedation for incarcerated inguinal hernia reduction. J Pain 2005; 6 (10) 650-655
  • 14 Esposito C, Alicchio F, Giurin I, Castellano M, Settimi A. Technical standardization of laparoscopic direct hernia repair in pediatric patients. J Laparoendosc Adv Surg Tech A 2012; 22 (01) 113-116
  • 15 Esposito C, Escolino M, Cortese G. , et al. Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surg Endosc 2017; 31 (03) 1461-1468
  • 16 Turial S, Saied A, Schier F. Microlaparoscopic hernia repair in children: initial experiences. Surg Innov 2011; 18 (04) 368-372
  • 17 Zöller B, Ji J, Sundquist J, Sundquist K. Shared and nonshared familial susceptibility to surgically treated inguinal hernia, femoral hernia, incisional hernia, epigastric hernia, and umbilical hernia. J Am Coll Surg 2013; 217 (02) 289-99.e1
  • 18 Al-Shanafey S, Giacomantonio M. Femoral hernia in children. J Pediatr Surg 1999; 34 (07) 1104-1106
  • 19 Ollero Fresno JC, Alvarez M, Sanchez M, Rollán V. Femoral hernia in childhood: review of 38 cases. Pediatr Surg Int 1997; 12 (07) 520-521
  • 20 Gul Y. Femoral hernia in children. Ir Med J 2000; 93 (06) 183-184
  • 21 Radcliffe G, Stringer MD. Reappraisal of femoral hernia in children. Br J Surg 1997; 84 (01) 58-60
  • 22 McVay CB, Savage LE. Etiology of femoral hernia. Ann Surg 1961; 154 (Suppl. 06) 25-32
  • 23 Chapman WHH, Barcia PJ. Femoral hernia in children: an infrequent problem revisited. Mil Med 1991; 156 (11) 631-633
  • 24 Lickley HLA, Trusler GA. Femoral hernia in children. J Pediatr Surg 1966; 1 (04) 338-341
  • 25 Wright JE. Femoral hernia in childhood. Pediatr Surg Int 1994; 9: 167-169
  • 26 De Caluwé D, Chertin B, Puri P. Childhood femoral hernia: a commonly misdiagnosed condition. Pediatr Surg Int 2003; 19 (08) 608-609
  • 27 Robinson P, Hensor E, Lansdown MJ, Ambrose NS, Chapman AH. Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features. Am J Roentgenol 2006; 187 (05) 1168-1178
  • 28 Chen KC, Chu CC, Chou TY, Wu CJ. Ultrasonography for inguinal hernias in boys. J Pediatr Surg 1998; 33 (12) 1784-1787
  • 29 Temiz A, Akcora B, Temiz M, Canbolant E. A rare and frequently unrecognised pathology in children: femoral hernia. Hernia 2008; 12 (05) 553-556
  • 30 Ceran C, Köylüoğlu G, Sönmez K. Femoral hernia repair with mesh-plug in children. J Pediatr Surg 2002; 37 (10) 1456-1458
  • 31 Tan SY, Stevens MJ, Mueller CM. A novel laparoscopic-assisted approach to the repair of pediatric femoral hernias. J Laparoendosc Adv Surg Tech A 2013; 23 (11) 946-948
  • 32 Adibe OO, Hansen EN, Seifarth FG, Burnweit CA, Muensterer OJ. Laparoscopic-assisted repair of femoral hernias in children. J Laparoendosc Adv Surg Tech A 2009; 19 (05) 691-694
  • 33 Tainaka T, Uchida H, Ono Y. , et al. 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 2015; 77 (03) 531-535
  • 34 Matthyssens LE, Philippe P. A new minimally invasive technique for the repair of femoral hernia in children: about 13 laparoscopic repairs in 10 patients. J Pediatr Surg 2009; 44 (05) 967-971
  • 35 Tröbs RB, Yilmaz B, Bahr M, Cernaianu G, Vahdad RM. Single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia in children and adolescents: case series. Hernia 2017; 21 (03) 443-447
  • 36 Schier F. Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg 2006; 41 (06) 1081-1084
  • 37 Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb III GW. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech A 2014; 24 (11) 811-818
  • 38 Brandt-Kerkhof A, van Mierlo M, Schep N, Renken N, Stassen L. Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study. Surg Endosc 2011; 25 (05) 1624-1629
  • 39 Lloyd DM, Karmand KJ, Norwood MG. An inguinal hernia of a third kind?. Hernia 2009; 13 (01) 77-79
  • 40 Houben CH, Chan KW, Mou JW, Tam YH, Lee KH. Irreducible inguinal hernia in children: how serious is it?. J Pediatr Surg 2015; 50 (07) 1174-1176
  • 41 Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 2006; 41 (05) 980-986
  • 42 Erdoğan D, Karaman I, Aslan MK, Karaman A, Cavuşoğlu YH. Analysis of 3,776 pediatric inguinal hernia and hydrocele cases in a tertiary center. J Pediatr Surg 2013; 48 (08) 1767-1772
  • 43 Ezomike UO, Ekenze SO, Amah CC. Irreducible inguinal hernias in the paediatric age group. Niger J Med 2013; 22 (03) 230-233
  • 44 Lao OB, Fitzgibbons Jr RJ, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin North Am 2012; 92 (03) 487-504 , vii
  • 45 Ksia A, Braiki M, Ouaghnan W. , et al. Male gender and prematurity are risk factors for incarceration in pediatric inguinal hernia: a study of 922 children. J Indian Assoc Pediatr Surg 2017; 22 (03) 139-143
  • 46 Clatworthy Jr WH, Thompson AG. Incarcerated and strangulated inguinal hernia in infants: a preventable risk. J Am Med Assoc 1954; 154 (02) 123-126
  • 47 Esposito C, Turial S, Alicchio F. , et al. Laparoscopic repair of incarcerated inguinal hernia. A safe and effective procedure to adopt in children. Hernia 2013; 17 (02) 235-239
  • 48 Choi KH, Baek HJ. Incarcerated ovarian herniation of the canal of Nuck in a female infant: ultrasonographic findings and review of literature. Ann Med Surg (Lond) 2016; 9: 38-40
  • 49 Hyun PM, Jung AY, Lee Y, Yang I, Yang DH, Hwang JY. CT and US findings of ovarian torsion within an incarcerated inguinal hernia. Emerg Radiol 2015; 22 (01) 91-94
  • 50 Stylianos S, Jacir NN, Harris BH. Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg 1993; 28 (04) 582-583
  • 51 Abdulhai SA, Glenn IC, Ponsky TA. Incarcerated pediatric hernias. Surg Clin North Am 2017; 97 (01) 129-145
  • 52 Nah SA, Giacomello L, Eaton S. , et al. Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open?. Eur J Pediatr Surg 2011; 21 (01) 8-11
  • 53 Kaya M, Hückstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg 2006; 41 (03) 567-569
  • 54 Novotny NM, Puentes MC, Leopold R, Ortega M, Godoy-Lenz J. The burnia: laparoscopic sutureless inguinal hernia repair in girls. J Laparoendosc Adv Surg Tech A 2017; 27 (04) 430-433
  • 55 Lloyd DA, Rintala R. Inguinal hernia and hydrocele. In: O'Neill J, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran A. , eds. Pediatric Surgery, Vol II Chap 69. 5th ed. St Louis: Mosby; 1998: 1071-1086
  • 56 Ben-Ari J, Merlob P, Mimouni F, Rosen O, Reisner SH. The prevalence of high insertion of scrotum, hydrocele and mobile testis in the newborn infant (36-42 weeks gestation). Eur J Pediatr 1989; 148 (06) 563-564
  • 57 Grosfeld JL. Hernias in children. In: Spitz L, Coran AG. , eds. Rob and Smith Operative Surgery. 5th ed. UK: Chapman and Hall; 1995: 222-238
  • 58 Wang Z, Xu L, Chen Z, Yao C, Su Z. Modified single-port minilaparoscopic extraperitoneal repair for pediatric hydrocele: a single-center experience with 279 surgeries. World J Urol 2014; 32 (06) 1613-1618
  • 59 Koutsoumis G, Patoulias I, Kaselas C. Primary new-onset hydroceles presenting in late childhood and pre-adolescent patients resemble the adult type hydrocele pathology. J Pediatr Surg 2014; 49 (11) 1656-1658
  • 60 Huang SS, Wu DL, Gui YP, Zhao X, Xie H. [Diagnosis and treatment of yolk sac tumor of the testis with hydrocele in children: report of 7 cases]. Zhonghua Nan Ke Xue 2013; 19 (11) 1007-1010
  • 61 Aydin GB, Ciftçi AO, Yalçin B. , et al. Paratesticular metastasis from Wilms tumor associated with a hydrocele. Pediatr Blood Cancer 2006; 47 (01) 97-99
  • 62 Esposito C, Valla JS, Najmaldin A. , et al. Incidence and management of hydrocele following varicocele surgery in children. J Urol 2004; 171 (03) 1271-1273
  • 63 Méndez-Gallart R, Bautista Casasnovas A, Estévez Martínez E. , et al. Reactive hydrocele after laparoscopic Palomo varicocele ligation in pediatrics. Arch Esp Urol 2010; 63 (07) 532-536
  • 64 Ein SH, Nasr A, Wales P, Gerstle T. The very large recurrent postoperative scrotal hydrocele after pediatric inguinal hernia repair: a rare problem. Pediatr Surg Int 2009; 25 (03) 239-241
  • 65 Mohammadi A, Hedayatiasl A, Ghasemi-Rad M. Scrotal migration of a ventriculoperitoneal shunt: a case report and review of literature. Med Ultrason 2012; 14 (02) 158-160
  • 66 Hsu CC, Chen YW, Chuang YW, Huang YF. Ascites with a communicating hydrocele detected by peritoneal scintigraphy. Clin Nucl Med 2004; 29 (05) 326
  • 67 Patil SN, Bielamowicz K. Female hydrocele of canal of nuck. J Ark Med Soc 2010; 107 (02) 38-39
  • 68 Naji H, Ingolfsson I, Isacson D, Svensson JF. Decision making in the management of hydroceles in infants and children. Eur J Pediatr 2012; 171 (05) 807-810
  • 69 Alp BF, Irkilata HC, Kibar Y. , et al. Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children. Kaohsiung J Med Sci 2014; 30 (04) 200-205
  • 70 Wilson JM, Aaronson DS, Schrader R, Baskin LS. Hydrocele in the pediatric patient: inguinal or scrotal approach?. J Urol 2008; 180 (4, Suppl): 1724-1727 , discussion 1727–1728
  • 71 Saka R, Okuyama H, Sasaki T, Nose S, Yoneyama C, Tsukada R. Laparoscopic treatment of pediatric hydrocele and the evaluation of the internal inguinal ring. J Laparoendosc Adv Surg Tech A 2014; 24 (09) 664-668
  • 72 Liu W, Wu R, Du G. Single-port laparoscopic extraperitoneal repair of pediatric inguinal hernias and hydroceles by using modified Kirschner pin: a novel technique. Hernia 2014; 18 (03) 345-349
  • 73 Peng Y, Li C, Lin W, Xu L. Application of a laparoscopic, single-port, double-needle technique for pediatric hydroceles with multiple peritoneal folds: a trial from a single-center 5-year experience. Urology 2015; 85 (06) 1466-1470
  • 74 Lym L, Ross JH, Alexander F, Kay R. Risk of contralateral hydrocele or hernia after unilateral hydrocele repair in children. J Urol 1999; 162 (3 Pt 2): 1169-1170
  • 75 Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Perrakis E, Perrakis A. Incarcerated recurrent inguinal hernia containing an acute appendicitis (Amyand hernia): an extremely rare surgical situation. Arch Med Sci 2017; 13 (03) 702-704
  • 76 Smith-Singares E, Boachie JA, Iglesias IM. A rare case of appendicitis incarcerated in an inguinal hernia. J Surg Case Rep 2016; 2016 (06) 2016
  • 77 Coleman K, Aurora T, Suri P, Hoffman RJ. Clinical confounder: an incarcerated appendix masquerading as epididymitis. J Emerg Med 2012; 42 (02) e35-e37
  • 78 Sandhu A, Liaqat N, Nayyar SI, Faryal R, Shafique S. Amyand's hernia with perforated appendix in a neonate. APSP J Case Rep 2014; 5 (03) 34
  • 79 Al-Mayoof AF, Al-Ani BH. Left-sided amyand hernia: report of two cases with review of literature. European J Pediatr Surg Rep 2014; 2 (01) 63-66
  • 80 Li B, Zhang JY, Wang YB. , et al. Laparoscope-assisted diagnosis and treatment for Amyand's hernia in children-report of six cases. Pediatr Surg Int 2013; 29 (05) 525-528
  • 81 Çığşar EB, Karadağ ÇA, Sever N, Dokucu AI. [Should appendectomy be performed in Amyand's hernia? two case reports]. Ulus Travma Acil Cerrahi Derg 2013; 19 (05) 488-490
  • 82 Okur MH, Karaçay S, Uygun I, Topçu K, Öztürk H. Amyand's hernias in childhood (a report on 21 patients): a single-centre experience. Pediatr Surg Int 2013; 29 (06) 571-574
  • 83 Ebisawa K, Yamazaki S, Kimura Y. , et al. Acute appendicitis in an incarcerated femoral hernia: a case of De Garengeot hernia. Case Rep Gastroenterol 2009; 3 (03) 313-317
  • 84 Elbanna KY, Alzahrani HA, Azzumeea F, Alzamel HA. Neuroendocrine tumor of the appendix inside an incarcerated Amyand's hernia. Int J Surg Case Rep 2015; 14: 152-155
  • 85 Akin M, Kurukahvecioglu O, Tezcaner T, Anadol AZ, Onur K. Acute hemiscrotum due to inguinoscrotal Littre hernia: a case report. Am J Emerg Med 2008; 26 (08) 973.e3-973.e4
  • 86 Pampal A, Aksakal ED. Littre hernia in childhood: a case report with a brief review of the literature. Afr J Paediatr Surg 2011; 8 (02) 221-224
  • 87 Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P. Richter hernia: surgical anatomy and technique of repair. Am Surg 2006; 72 (02) 180-184
  • 88 Hartin Jr CW, Caty MG, Bass KD. Laparoscopy for perforated Richter hernia with incarcerated foreign body. J Pediatr Surg 2011; 46 (07) 1449-1451
  • 89 Weledji EP, Mokake M, Ngowe MN. A rare presentation of Maydl's hernia. Case Rep Surg 2014; 2014: 184873
  • 90 Ganesaratnam M. Maydl's hernia: report of a series of seven cases and review of the literature. Br J Surg 1985; 72 (09) 737-738
  • 91 Roberts PA. W-strangulation of bowel; the so-called Maydl's hernia, or retrograde strangulation of intestine due to double loop incarceration. Guys Hosp Rep 1954; 103 (03) 265-268
  • 92 Kapisiz A, Karabulut R, Turkyilmaz Z, Sonmez K, Basaklar AC. Omental incarceration may cause hydrocele and this hydrocele confused simple or scrotal hydrocele. Hernia 2011; 15 (01) 43-45
  • 93 Patel RV, Dawrant M, Scott V, Fisher R. Omental infarct in a hernia: an unusual cause of paediatric acute scrotum. BMJ Case Rep 2014; 2014: 2014
  • 94 Liaqat N, Nayyer S, Yousaf AR, Iqbal N, Ahmed E, Dar SH. Duplication cyst presenting as hydrocoele in a child. J Coll Physicians Surg Pak 2015; 25 (10) 776-777
  • 95 Teoh CW, Haydar R, Gillick J. , et al. Migration of Tenckhoff catheter into an occult inguinal hernia. Perit Dial Int 2015; 35 (01) 113-114
  • 96 Demirel F, Kara O, Esen I. Inguinal ovary as a rare diagnostic sign of Mayer-Rokitansky-Küster-Hauser syndrome. J Pediatr Endocrinol Metab 2012; 25 (3-4): 383-386
  • 97 Sookpotarom P, Ariyawatkul K, Paramagul P, Sakulisariyaporn C, Stimanont T, Vejchapipat P. Stone ingestion causing obstructed inguinal hernia with perforation. Afr J Paediatr Surg 2014; 11 (02) 191-193
  • 98 Jategaonkar PA, Yadav SP. Ruptured hemorrhagic ovarian cyst presenting as an incarcerated inguinal hernia in an adult female: a rare clinical scenario of a common surgical emergency. Case Rep Emerg Med 2013; 2013: 925694
  • 99 Pensabene M, Girgenti V, Cimador M, Li Voti G, Rodolico V, Siracusa F. An uncommon case of adolescent ovarian teratoma incarcerated in inguinal hernia. Case Rep Pediatr 2016; 2016: 4534053
  • 100 Lazarus J, Pillay K. Abdominal tuberculosis presenting as an inguinal hernia in a child. Urology 2011; 77 (06) 1470-1471
  • 101 Partrick DA, Bensard DD, Karrer FM, Ruyle SZ. Is routine pathological evaluation of pediatric hernia sacs justified?. J Pediatr Surg 1998; 33 (07) 1090-1092 , discussion 1093–1094
  • 102 Al Nemer AM, Al-Buainain H. The necessity of routine histologic examination of hernia sac, revisited. Hernia 2015; 19 (06) 915-918
  • 103 Steigman CK, Sotelo-Avila C, Weber TR. The incidence of spermatic cord structures in inguinal hernia sacs from male children. Am J Surg Pathol 1999; 23 (08) 880-885
  • 104 Kim B, Leonard MP, Bass J, Ruzhynsky V, de Nanassy J, Guerra L. Analysis of the clinical significance and cost associated with the routine pathological analysis of pediatric inguinal hernia sacs. J Urol 2011; 186 (4, Suppl): 1620-1624
  • 105 Ibrahim H, Khaled M, Gates T, Trice H, Sangster G. Irreducible indirect inguinal hernia in premature infant with ectopic uterus and bilateral adnexa. J La State Med Soc 2016; 168 (06) 194-195
  • 106 Celik A, Ergün O, Ozbek SS, Dökümcü Z, Balik E. Sliding appendiceal inguinal hernia: preoperative sonographic diagnosis. J Clin Ultrasound 2003; 31 (03) 156-158
  • 107 Ishii T, Yonekura T, Yamauchi K. , et al. Laparoscopic repair of sliding inguinal hernia in female children. Pediatr Surg Int 2016; 32 (09) 895-899
  • 108 Richardson WS, Jones DG, Winters JC, McQueen MA. The treatment of inguinal pain. Ochsner J 2009; 9 (01) 11-13
  • 109 Kemp S, Batt ME. The ‘sports hernia’: a common cause of groin pain. Phys Sportsmed 1998; 26 (01) 36-44
  • 110 Garvey JF, Hazard H. Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia 2014; 18 (06) 815-823
  • 111 Nam A, Brody F. Management and therapy for sports hernia. J Am Coll Surg 2008; 206 (01) 154-164
  • 112 Broadley P, Offiah AC. Hip and groin pain in the child athlete. Semin Musculoskelet Radiol 2014; 18 (05) 478-488
  • 113 Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A. , et al. Athletic pubalgia: definition and surgical treatment. Ann Plast Surg 2005; 55 (04) 393-396
  • 114 Santilli OL, Nardelli N, Santilli HA, Tripoloni DE. Sports hernias: experience in a sports medicine center. Hernia 2016; 20 (01) 77-84
  • 115 Minnich JM, Hanks JB, Muschaweck U, Brunt LM, Diduch DR. Sports hernia: diagnosis and treatment highlighting a minimal repair surgical technique. Am J Sports Med 2011; 39 (06) 1341-1349