Pediatric Hernias Workup

  • Author: Andre Hebra, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Feb 25, 2010
 

Laboratory Studies

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

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

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, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey J DuBois, MD  Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville 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, and California Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York 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: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, 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.

References

  1. Brandt ML. Pediatric hernias. Surg Clin North Am. Feb 2008;88(1):27-43, vii-viii. [Medline].

  2. Skinner MA, Grosfeld JL. Inguinal and umbilical hernia repair in infants and children. Surg Clin North Am. Jun 1993;73(3):439-49. [Medline].

  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].

  4. [Guideline] Al-Ansari K, Sulowski C, Ratnapalan S. Analgesia and sedation practices for incarcerated inguinal hernias in children. Clin Pediatr (Phila). Oct 2008;47(8):766-9. [Medline].

  5. Miltenburg DM, Nuchtern JG, Jaksic T, et al. Laparoscopic evaluation of the pediatric inguinal hernia--a meta-analysis. J Pediatr Surg. Jun 1998;33(6):874-9. [Medline].

  6. Dutta S, Albanese C. Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up. Surg Endosc. Jan 2009;23(1):103-7. [Medline].

  7. 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].

  8. Gonzalez Santacruz M. Low prevalence of complications of delayed herniotomy in the extremely premature infant. Acta Paediatr. 2004;93:94-98. [Medline].

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

  10. 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].

  11. Myers JB, Lovell MA, Lee RS, et al. Torsion of an indirect hernia sac causing acute scrotum. J Pediatr Surg. Jan 2004;39(1):122-3. [Medline].

  12. Othersen HB Jr. The pediatric inguinal hernia. Surg Clin North Am. Aug 1993;73(4):853-9. [Medline].

  13. Rescorla FJ, West KW, Engum SA, et al. The "other side" of pediatric hernias: the role of laparoscopy. Am Surg. Aug 1997;63(8):690-3. [Medline].

  14. Scherer LR 3d, Grosfeld JL. Inguinal hernia and umbilical anomalies. Pediatr Clin North Am. Dec 1993;40(6):1121-31. [Medline].

  15. Stoppa R. About biomaterials and how they work in groin hernia repairs. Hernia: The Journal of Hernias and Abdominal Wall Surgery. 2003;7:57-60. [Medline].

  16. Tesselaar CD, Postema RR, van Dooren MF, et al. Congenital diaphragmatic hernia and situs inversus totalis. Pediatrics. Mar 2004;113(3 Pt 1):e256-8. [Medline].

 
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Typical appearance of an infant with a large right indirect inguinal hernia. The right scrotal sac is enlarged and contains palpable loops of bowel and fluid.
A premature baby boy with bilateral giant inguinoscrotal hernias. Because of the large size of the hernias, operative repair typically requires repair of the inguinal floor in addition to the high ligation of the indirect hernia sac.
Illustration of the technique for intraoperative diagnostic laparoscopy to evaluate for the presence of an asymptomatic contralateral inguinal hernia at the time of elective repair of an indirect inguinal hernia.
Laparoscopic view of a left indirect inguinal hernia at the time of surgery for laparoscopic needle-assisted repair.
Laparoscopic needle-assisted repair of a left indirect inguinal hernia. Note the passage of a Prolene suture through a small 22G spinal needle; this is used for creation of the purse-string suture that closes the open inguinal ring.
Laparoscopic view of the repaired left indirect inguinal hernia with the closed Prolene purse-string suture around the internal inguinal ring.
 
 
 
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