Laboratory Studies
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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. [3]
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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.
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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
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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
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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.
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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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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.
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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.
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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.
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Laparoscopic view of a left indirect inguinal hernia at the time of surgery for laparoscopic needle-assisted repair.
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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.
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Laparoscopic view of the repaired left indirect inguinal hernia with the closed Prolene purse-string suture around the internal inguinal ring.
