Inguinal hernia (peds)
This page is for pediatric patients. For adult patients, see: inguinal hernia
Background
- 1-2% of children have these
- 10% become incarcerated
- 70% of incarceration occurs in infants (usually <6 mo)
- 10% become incarcerated
- Male:Female ration = 6:1
- 21% of female inguinal hernias contain an ovary!
Clinical Features
- Parents usually report bulge in scrotum or groin that increases with crying
- Lack of transillumination indicates incarcerated hernia vs hydrocele (usually no change with crying)
Differential Diagnosis
0–3 Months Old
- Emergent
- Necrotizing Enterocolitis
- Volvulus
- Testicular torsion
- Inguinal hernia
- Incarcerated hernia
- Trauma
- Pyloric stenosis
- Toxic megacolon
- Hirschsprung's Disease
- Nonemergent
- Constipation
- Acute Gastroenteritis
- Colic
3 mo–3 y old
- Emergent
- Intussusception
- Testicular Torsion
- Trauma
- Volvulus
- Appendicitis
- Toxic megacolon
- Vaso-occlusive crisis
- Nonemergent
- Acute Gastroenteritis
- Constipation
- Urinary tract infection
- Henoch-Schonlein purpura
3 y old–adolescence
- Emergent
- Appendicitis
- DKA
- Vaso-occlusive crisis
- Toxic ingestion
- Testicular Torsion
- Ovarian Torsion
- Ectopic Pregnancy
- Trauma
- Toxic megacolon
- Inflammatory bowel disease
- Gastric ulcer disease
- Ovarian cyst
- Pregnancy
- Pancreatitis
- Cholecystitis
- Intussusception (to age 6)
- Nonemergent
- Constipation
- Acute Gastroenteritis
- Nonspecific viral syndrome
- Streptococcus pharyngitis
- Urinary tract infection
- Pneumonia
- Renal Stone
- Henoch-Schonlein purpura
- Inflammatory bowel disease
- Vulvovaginitis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Evaluation
- Clinical diagnosis
- Testicular ultrasound for confirmation
Management
- 95% can be reduced without surgery using gentle firm continuous pressure, Trendelenberg, & analgesics
- Surgery consult or follow up if cannot reduce. Ensure no obstruction.
See Also
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