1/4. 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.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Herniography in patients with clinically suggested recurrence of inguinal hernia.In order to assess the diagnostic effectiveness of herniography in patients with pain in the groin, 49 patients who had been operated upon earlier for inguinal or related hernias in the groin were examined. The patients' history suggested the presence of recurrent hernia but physical examination was inconclusive. In 17 patients herniography revealed one or two hernias on the side of the symptoms: 2 indirect hernias, 9 direct hernias, 1 with both direct and indirect hernias, 1 with a combined hernia, and 4 femoral hernias. An incisional hernia was detected in 2 patients. Eleven of the 17 patients were operated upon. The results indicate that herniography is valuable in the follow-up of patients with possible recurrent inguinal hernia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Obturator hernia: current diagnosis and treatment.BACKGROUND. Obturator hernia is a rare pelvic hernia for which both diagnosis and therapy are difficult. Because symptoms are nonspecific and specific physical findings are often obscure, diagnosis of obturator hernia is often delayed until laparotomy for bowel obstruction. Strangulation is frequent, and mortality remains high (25%). Primary closure of the hernia defect is difficult because adjacent tissues are not easily mobilized. Although a variety of techniques have been described, surgical repair has not been standardized. methods. We report a case of bilateral obturator hernia with incarceration in association with bilateral femoral hernia in which these problems were satisfactorily addressed. RESULTS. The hernias were diagnosed by computed tomography (CT) scan and repaired with synthetic mesh placed in the preperioneal space. This technique is well suited to unilateral and bilateral combinations of obturator, inguinal, and femoral hernias. CT scan in the work-up of severe gastrointestinal symptoms with weight loss may lead to a diagnosis of occult hernia, thereby allowing elective repair and, hopefully, a reduction in mortality risk. CONCLUSIONS. We recommend CT scan for suspected obturator hernia and preperitoneal mesh repair of noninfected cases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Richter's femoral hernia: a clinical pitfall.A.G. Richter described in 1777 a hernia in which the antimesenteric part of the small intestine was incarcerated. We demonstrate in the article the diagnostic pitfalls of the Richter's femoral hernia. The physical signs consist of vague abdominal complaints, swelling in the groin but usually no symptoms of intestinal obstruction. The Richter's femoral hernia can be complicated by a stenosis in the initially incarcerated distal ileum.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |