eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Pediatric Hernias: Differential Diagnoses & Workup

Author: Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Oct 21, 2009

Differential Diagnoses

Hydrocele and Hernia in Children
Varicocele in Adolescents

Other Problems to Be Considered

Inguinal adenitis
Femoral adenitis
Psoas abscess
Saphenous varix
Hydrocele
Retractile testis
Varicocele
Testicular tumor
Undescended testis

Workup

Laboratory Studies

  • No laboratory studies are needed in the assessment of a patient with a suspected inguinal hernia and/or hydrocele.

Imaging Studies

Imaging studies are generally not indicated to assess for inguinal hernia. However, ultrasonography can be helpful in the assessment of selected patients.

  • Ultrasonography: Some advocate the use of ultrasonography to differentiate between a hydrocele and an inguinal hernia. Ultrasonography is capable of finding a fluid-filled sac in the scrotum, which would be compatible with a diagnosis of hydrocele. However, if the patient has an incarcerated inguinal hernia, ultrasonography may not be sensitive enough to differentiate between the two conditions. Thus, this study is rarely helpful in the treatment of a pediatric patient with a suspected inguinal hernia. When presentation and examination suggest a diagnosis other than hernia or hydrocele, appropriate imaging, including ultrasonography, may be necessary. An enlarged inguinal lymph node can mimic an incarcerated inguinal hernia, and surgical exploration may occasionally be necessary to confirm the diagnosis.
  • Peritoneography: Injection of contrast in the peritoneal cavity has been used to determine the presence of a patent processus vaginalis. Although this test is very sensitive, its use is limited. Because of possible complications, including bowel perforation and sepsis, injection of contrast is rarely performed today.

Procedures

  • Laparoscopy: Diagnostic laparoscopy is a very effective method for determining the presence of an inguinal hernia but is used only selectively because it requires anesthesia and surgery. Laparoscopy can be useful to assess the contralateral side (see Treatment) or to evaluate for presence of a recurrent inguinal hernia in patients with a history of operative repair.

Histologic Findings

  • Hernia sacs are composed of fibrous and connective tissue. Embryonal müllerian remnants are recognized in 1-6% of surgical specimens; therefore, the finding of vas or epididymis on the surgical pathology specimen of a hernia sac does not necessarily imply injury.
  • Specific histologic features of the remnant include a smaller diameter and failure to show a prominent muscular wall with Masson trichrome staining.

More on Pediatric Hernias

Overview: Pediatric Hernias
Differential Diagnoses & Workup: Pediatric Hernias
Treatment & Medication: Pediatric Hernias
Follow-up: Pediatric Hernias
Multimedia: Pediatric Hernias
References
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References

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  3. Deeba S, Purkayastha S, Paraskevas P, et al. Laparoscopic approach to incarcerated and strangulated inguinal hernias. JSLS. Jul-Sep 2009;13(3):327-31. [Medline].

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  6. Given JP, Rubin SZ. Occurrence of contralateral inguinal hernia following unilateral repair in a pediatric hospital. J Pediatr Surg. Oct 1989;24(10):963-5. [Medline].

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  8. Han BK. Uncommon causes of scrotal and inguinal swelling in children: sonographic appearance. J Clin Ultrasound. Jul-Aug 1986;14(6):421-7. [Medline].

  9. Matsuda T, Muguruma K, Horii Y, et al. Serum antisperm antibodies in men with vas deferens obstruction caused by childhood inguinal herniorrhaphy. Fertil Steril. May 1993;59(5):1095-7. [Medline].

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Further Reading

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Keywords

pediatric hernias, inguinal hernia, indirect inguinal hernia, groin hernia, umbilical hernia, femoral hernias, incarcerated hernia, strangulated hernia, hydrocele, prematurity, gonadal dysfunction, intestinal necrosis, intestinal perforation, intestinal obstruction, treatment, diagnosis

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Contributor Information and Disclosures

Author

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey J DuBois, MD, Consulting Staff, Division of Pediatric Surgery, Kaiser Permanente, North Sacramento Medical Center
Jeffrey J DuBois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, California Medical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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