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Inguinal hernia (peds)
From WikEM
Contents
Background
- 1-2% of children have these
- 10% become incarcerated
- 70% of incarceration occurs infants (usually <6 mo)
- 10% become incarcerated
- Male:Female ration = 6:1
- 21% of females with inguinal hernia 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
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Testicular Diagnoses
- Testicular torsion
- Epididymitis
- Orchitis
- Torsion of testicular appendage
- Scrotal abscess
- Fournier gangrene
- Hydrocele
- Indirect inguinal hernia
- Hematocele
- Spermatocele
- Testicular trauma
- Testicular rupture
- Varicocele
- Inguinal lymph node (Lymphadenitis)
- Testicular tumor
- Cellulitis
- Tinea cruris
Evaluation
- Clinical diagnosis
- Ultrasound for confirmation
Management
- 95% can be reduced with out surgery using gentle FIRM CONTINUOUS pressure, trendelenberg, & analgesics
- Surgery consult or follow up if cannot reduce. Ensure no obstruction
