RT Book, Section
A1 Shah, Ashish
A1 Sobolewski, Brad
A1 Mittiga, Matthew R.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181044681
T1 Inguinal Hernia
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181044681
RD 2024/04/24
AB Inguinal  hernias  are  common  in  childhood  with  an  incidence  as  high  as  5%.  Premature  infants  have  an  even  higher  incidence,  and  boys  are  approximately  10  times  more  likely  than  girls  to  develop  an  inguinal  hernia.  There  are  two  types  of  inguinal  hernias:  indirect  (common)  and  direct  (rare).  Indirect  inguinal  hernias  result  from  failure  of  the  processus  vaginalis  to  obliterate  toward  the  end  of  fetal  development.  With  a  patent  processus  vaginalis,  the  intra-abdominal  viscera  can  protrude  through  the  internal  inguinal  ring.  Indirect  inguinal  hernias  are  more  common  on  the  right  and  present  as  a  bulge  in  the  groin  by  parental  history  or  on  physical  examination.  Maneuvers  that  increase  intra-abdominal  pressure,  such  as  crying  in  an  infant  or  blowing  bubbles  in  an  older  child,  may  make  the  hernia  easier  to  visualize.  Associated  symptoms  such  as  vomiting,  abdominal  distention,  constipation,  blood  in  the  stool,  lethargy,  or  irritability  suggest  incarceration  or  strangulation  of  the  hernia.  Incarceration  is  most  common  in  the  1st  year  of  life.  The  differential  diagnosis  includes  hydrocele,  inguinal  lymphadenopathy,  testicular  torsion,  torsion  of  the  appendix  testis/epididymis,  epididymitis/orchitis,  and  a  retractile  testicle.