Effectiveness of Sonography in Detecting Clinically Occult Femoral Hernias

Comparison of Doppler Ultrasound and Clinical Features of Patients With and Without Femoral Hernia in Lower Extremity Venous Insufficiency Patients

ABSTRACT

In this study, we aim to evaluate Doppler ultrasound (US) and clinical features of patients with and without femoral hernia (FH) in lower extremity chronic venous insufficiency (CVI) patients.We retrospectively analyzed prospectively collected data of 1364 limbs with the CVI suspected. Femoral hernia was detected in 32 of the limbs, and the control group was formed with 32 limbs without FH. All limbs were evaluated with Valsalva maneuver and augmentation method to detect venous reflux in FH group. Venous reflux rates in the Doppler US, venous clinical severity scores (VCSSs), and clinical classes of Clinical-Etiology-Anatomy-Pathophysiology classification were compared statistically in both groups.The mean VCSS was 3.87 ± 0.74 in the FH group and 2.68 ± 0.65 in the control group, which was statistically significant ( P = 0.04). In the more severe clinical classes of Clinical-Etiology-Anatomy-Pathophysiology (C4-6), the number of limbs in the FH group was higher than in the control group (8 and 4, respectively). Doppler US examinations showed venous reflux in 22 of 32 limbs in the FH group and 19 of 32 patients in the control group, and there was a statistically significant difference ( P = 0.029). In the FH group, reflux could be shown only by augmentation method in the vast majority of limbs (16 of 22, 73%).In conclusion, VCSS and reflux rates are higher in limbs with CVI accompanied by FH. In addition, FH may cause false negative results in the evaluation of CVI. The use of augmentation method in limbs with FH can help avoid false negatives.

Sonographic "speech bubble/speech box sign" in clinically occult femoral hernias: ultrasound findings and anatomical basis

Femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal lying deep and inferior to the inguinal ligament. The hernia sac usually contains preperitoneal fat, omentum, bowel, or fluid. Ultrasound is recommended as the first-line investigation for diagnosing clinically occult femoral hernias in nonemergency settings, whereas CT is the imaging of choice in emergency settings. High accuracy of the ultrasound in clinically occult femoral hernia is further validated with further CT and MRI. In this article, we propose sonographic detection of the physiological peritoneal fluid herniating through capacious femoral ring manifesting as a "speech bubble/speech box appearance." This is a potentially invaluable sonographic sign for clinically occult femoral hernias, differentiating them from inguinal hernias and cysts of the canal of Nuck in females and preventing inadvertent attempts to aspirate.

Pediatric femoral hernia in the laparoscopic era

INTRODUCTION

Femoral hernia is a rare and often misdiagnosed condition in childhood. The aim of our study was to demonstrate that the laparoscopic approach improves diagnostic accuracy and offers a safe and effective treatment.

METHODS

A retrospective study of 687 pediatric patients who underwent laparoscopic inguinal hernia repair from January 2000 to December 2015 was performed.

RESULTS

Femoral hernias were identified in 16 patients (2.3%). The right side was affected in 10 cases (62.5%), the left side in 5 (31.2%), and 1 case was bilateral (6.2%). The mean age of patients was 8.00 ± 3.81 years, and there was a male predominance. Preoperative diagnosis was femoral hernia in eight cases (50%) and indirect inguinal hernia in the remaining eight (50%). Seven children (43.8%) presented with hernia recurrence after having undergone an open ipsilateral indirect hernia repair. A modified laparoscopic McVay technique was performed in 12 cases (70.6%). An epigastric artery injury by trocar occurred in one patient. All operations were completed laparoscopically. The mean surgical time was 45.6 ± 22.9 min for unilateral cases and 110 ± 10.0 min for bilateral cases. No immediate postoperative complications were noted. The mean postoperative hospital stay was 0.6 ± 0.4 days. No recurrence was observed after a median follow-up of 11 years (range, 4-16 years).

CONCLUSION

Femoral hernia is a rare pathology in pediatric patients that is often difficult to diagnose. The laparoscopic approach is effective in the diagnosing and treating these hernias, and it allows for the simultaneous repair of multiple groin defects.