Hernia, Inguinal

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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