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Key Features

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  • Most often indirect

  • Occur more frequently in boys than in girls (9:1)

  • May present at any age

  • Incidence in preterm male infants is close to 5% and is reported in 30% of male infants weighing 1000 g or less

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Clinical Findings

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  • Painless inguinal swelling

  • Parents may be the only one to see the mass, since it may retract when the infant is active, cold, frightened, or agitated

  • Clinical clues

    • History of inguinal fullness associated with coughing or long periods of standing

    • Presence of a firm, globular, and tender swelling, sometimes associated with vomiting and abdominal distention

  • Herniated loop of intestine may become partially obstructed leading to severe pain

  • Rarely, bowel becomes trapped in the hernia sac, and complete intestinal obstruction occurs

  • Gangrene of the hernia contents or testis may occur

  • In girls, the ovary may prolapse into the hernia sac presenting as a mass below the inguinal ligament

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Diagnosis

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  • A suggestive history often is the only criterion for diagnosis, along with the "silk glove" feel of the rubbing together of the two walls of the empty hernia sac

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Treatment

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  • Manual reduction of incarcerated inguinal hernias can be attempted after the sedated infant is placed in the Trendelenburg position with an ice bag on the affected side

  • Manual reduction is contraindicated if incarceration has been present for more than 12 hours or if bloody stools are noted

  • Surgery is indicated if a hernia has ever incarcerated

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