Femoral hernia in children: diagnostic and therapeutic challenge. Case report.

INTRODUCCIÓN: Las hernias femorales son raras en la infancia. El defecto está abajo del ligamento inguinal. La frecuencia de un diagnóstico erróneo es de hasta el 75%. Pueden ser resueltas mediante cirugía abierta o laparoscópica. OBJETIVO: Comunicar el caso de un niño con hernia femoral resuelto mediante laparoscopía. CASO CLÍNICO: Varón de 5 años, con antecedente de criptorquidia bilateral resuelta a los 2 años de edad. Padecimiento actual con 1 mes de evolución, con aumento de volumen en el tercio externo de la ingle. El ultrasonido reportó un defecto aponeurótico junto a los vasos femorales derechos. Abordaje laparoscópico, con hallazgos de defecto por abajo del ligamento inguinal. Sin recidiva a los 12 meses de seguimiento. DISCUSIÓN: Las hernias femorales son raras en los niños y su diagnóstico es difícil. La exploración laparoscópica permitió identificarla al encontrar un defecto por abajo del ligamento inguinal y junto a los vasos femorales independiente del anillo inguinal profundo y de la fascia transversal. INTRODUCTION: Femoral hernias are rare in children. The defect is below the inguinal ligament. The frequency of a misdiagnosis is up to 75%. They can be resolved by open or laparoscopic surgery. OBJECTIVE: To report the case of a child with femoral hernia, resolved by laparoscopy. CASE REPORT: Male, 5 years old, with a history of bilateral cryptorchidism resolved at 2 years of age. Current condition with a month of evolution with an increase in volume in the outer third of the groin. Ultrasound reported aponeurotic defect along with the right femoral vessels. Laparoscopic approach, with defect findings below the inguinal ligament. No recurrence at 12 months follow-up. DISCUSSION: Femoral hernias are rare in children, their diagnosis is difficult. Laparoscopic examination allowed its identification, finding a defect below the inguinal ligament and adjacent to the femoral vessels independent of the deep inguinal ring and the transversalis fascia.

Laparoscopic Approach of the Obstruction of the Lower Third of the Esophagus in Children.

Objective: To review the diagnostic methodology in pediatric patients with obstruction of the lower third of the esophagus as well as minimally invasive therapeutic options. Materials and Methods: Retrospective study carried out reviewing records of children with esophageal obstruction diagnostic, from 2000 to 2018. They were divided into Group I stenosis secondary to reflux; Group II achalasia; and Group III embryonic remnants. Results: Thirty-three patients. Group I: 7; esophageal barium swallow irregular stenosis of the distal third and endoscopy irregular stenosis in 7. Treated with laparoscopic fundoplication 2, Collis Nissen 5. Group II: 22 patients, age X = 11.55 years. All with dysphagia and symmetrical stenosis of esophagogastric junction. Fifteen underwent manometry and all underwent intraoperative endoscopy. All had laparoscopic myotomy, with 2 perforations and no conversions, 2 patients had subsequent dysphagia to solids, and they did not need esophageal dilatation. Group III: 4 patients, stenosis was above esophagogastric junction. On endoscopy, inflammation was present in all 3 with irregular esophagogastric junction and difficulty passing endoscope. Three patients underwent laparoscopic resection and anastomosis. One patient leaked and developed a fistula. One patient has not been operated upon as yet. Conclusions: In those patients, the best surgical option depends upon the diagnosis. Esophageal barium studies and endoscopy allow discerning among them.