Atypical hernia defects in childhood

Objectives: to present our experience with atypical hernia defects in pediatric patients and review of the literature.

Material and methods: a retrospective analysis of patients diagnosed with hernia between 2002 and 2012 in our Center. Patients with inguinal, umbilical and epigastric hernia were excluded.

Results: we treated six patients: four femoral hernias, a Spigelian hernia and a lumbar hernia. The diagnosis was made by physical examination of a reductible mass in different anatomical locations. Ultrasound was used in the Spigelian hernia because it is associated to undescended testis, and in two cases of femoral hernia for suspected incarceration. Two patients with femoral hernia presented with an associated inguinal hernia and one patient with femoral hernia presented same side cord cyst. Primary open closure was performed in all cases except in the Spigelian hernia where a laparoscopy was performed in order to descend the testicle. Two cases of femoral hernia recurrence needed a polypropylene mesh placement into the defect and in one case of femoral hernia, another femoral hernia was found on the other side.

Conclusions: different types of hernias are diagnosed by the anatomical location of a reductible mass seen in the physical examination. Surgery is the treatment of choice right after diagnosis due to a higher risk of complications compared with adults. Pediatric surgical consultation is thereby mandatory.