Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • A hernia is a benign process unless the contents within the hernia sac become incarcerated.• Incarceration is the inability of the hernia’s contents to be reduced.• The risk of incarceration is highest during infancy with a 28–31% incarceration rate before 3 months of age and 15–24% by 6 months of age.• Although the risk of incarceration gradually decreases with age, the severity of its consequences mandates immediate manual reduction when possible, followed by prompt operative repair. +++ Absolute + • Reduction should not be attempted if there has been bowel compromise or when the patient appears toxic.• Concern for toxicity should arise when the patient has any of the following:• Severe tachycardia.• Increased leukocyte count.• Bloody stool or positive result on modified guaiac test.• Severe pain with palpation.• Erythema of the hernia sac. +++ Relative + • Some surgeons do not advocate manual reduction if the patient has any signs or symptoms of intestinal obstruction. + • Gloves. +++ Risks + • There are few risks with manual reduction.• However, parents should be informed that once a hernia has been incarcerated, it has a high probability of recurring.• A hernia will not resolve on its own and operative management will be required in the near future.• If sedation is used during the reduction, a parent is required to sign a consent form and be made aware of the risks and benefits that accompany sedation.• In addition, a parent should be instructed not to feed the child should the hernia become strangulated or is not reducible and the patient requires emergent operative intervention. + • The most common differential diagnosis for a bulge in the groin consists of the following:• Hernia.• Hydrocele.• Lymphadenopathy.• Abscess.• Undescended testis.• A testicle in the groin may resemble a hernia; thus, it is imperative to confirm the presence of the testis in the scrotum during initial evaluation.• A hydrocele is usually present at birth and can also be bilateral in nature. It is generally described by the parents as a rapid swelling of the scrotum that may cause the child discomfort if tense.• With a communicating hydrocele, the swelling is most prominent at the end of the day and reduces over night.• On examination, a hydrocele is a soft, bluish, cystic swelling within the scrotal sac that cannot be reduced.• With a hydrocele, the spermatic cord should be able to be felt at its upper limits unlike a hernia, whose upper margin is not clearly defined and continues into the internal ring.• Transillumination may help differentiate a hernia from a hydrocele.• Hernias do not transilluminate as brightly as hydroceles.• However, hernias can transilluminate if they are filled with an air-filled loop.• Simple hydroceles generally resolve by the age of ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth