Femoral hernia in children: an infrequent problem revisited.

Femoral hernias are of very rare occurrence at any age, but are exceedingly rare in the pediatric population. A 10-year survey, 1979-1989, of our experience with pediatric hernias produced a total of 1,134 inguinal hernias and 6 femoral hernias, supporting an incidence of 0.5% for femoral hernias in our population. The correct diagnosis was made in only two cases preoperatively. These two patients had undergone inguinal herniorrhaphies less than 6 months prior to presenting with recurrent groin masses. Femoral hernias were most frequently misdiagnosed as inguinal hernias. Inclusion of this entity in the differential diagnosis of groin masses, an accurate preoperative physical exam, and a careful surgical exploration will allow one to make the correct diagnosis and prevent unnecessary reoperations. In addition, early recurrence of a groin mass after inguinal exploration and herniorrhaphy should make one suspicious of a femoral hernia. At surgery, our recommendations include a simple infra-inguinal exploration medial to the femoral vessels when an inguinal hernia is unexpectedly not found at groin exploration and a Cooper's ligament repair when a femoral hernia is encountered. All six cases in our review were repaired with Cooper's ligament repair without complication.