An inguinal hernia is where the bowel herniates through the inguinal canal. They are more common in preterm infants and males. It is usually diagnosed within the first year of life.
Pathophysiology
The inguinal canal is a tube that runs between the deep inguinal ring (where the inguinal canal opens into the peritoneal cavity) and the superficial inguinal ring (where it opens into the scrotum). In males, the inguinal canal contains the spermatic cord.
During fetal development, the processus vaginalis is a pouch of the peritoneum that extends from the abdominal cavity through the inguinal canal and into the scrotum. The testes descend through the processus vaginalis. Normally, the deep inguinal ring closes after the testes descend through the inguinal canal, and the processus vaginalis is obliterated.
In some patients, the deep inguinal ring remains patent, and the processus vaginalis remains intact. This leaves a tract or tunnel from the abdominal contents through the inguinal canal and into the scrotum. The bowel can herniate along this tract, creating an indirect inguinal hernia.
Presentation
The main presenting feature is a soft lump in the groin or scrotum. This may be more noticeable when the infant is crying or upright. Most infants are otherwise asymptomatic unless complications occur.
The contents of the hernia should be reducible back through the inguinal canal by applying gentle pressure to the lump. Incarceration is when the hernia is not reducible, requiring urgent management.
Management
Surgical repair is required as soon as possible to reduce the risk of complications.
Complications
Complications include:
- Incarceration
- Bowel obstruction
- Strangulation (the blood supply to the herniated bowel is cut off)
- Recurrence after surgery
Last updated February 2025
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