Overview

• Protrusion of internal contents through the wall of the cavity that normally contains it.
• Indirect Inguinal Hernia ⇒
  • Hernia through inguinal canal superior and medial to the pubic tubercle. Common in male babies. Due to failure of process vagialis to close.
  • Children presenting in the first few months of life are at the highest risk of strangulation and the hernia should be repaired urgently.
  • Mx → surgical repair. (DUE TO HIGH RISK OF STRANGULATION).
    • If Reducible → manual reduction is preferred, with elective surgery being scheduled for repair.
    • If Incarcerated (not reducible) → emergency manual reduction of hernia contents is attempted under sedation (IV morphine).
    • Surgical Correction → <6w: within 2 days, <6m: within 2 weeks, <6yo: within 2 months.
• Umbilical Hernia ⇒
  • Under the umbilicus. Common in newborns and often resolve by 12m.
  • Risk Factors → afro-carribean, down’s syndrome, mucopolysaccharide storage diseases.
  • Mx:

    • <1yo → watch and wait.

    • Small (<1.5cm) / Asymptomatic → observation until 4-5 years old.

    • Large (>1.5cm) / Symptomatic → elective repair at 2-3 years old.

      <aside> 💡 2,3,4,5 → large/symptomatic: repair at 2-3yo, small/asymptomatic: observe until/repair at 4-5yo.

      </aside>

    • Incarceration → manual reduction and surgical repair within 24 hours.

• Umbilical Granuloma → wet, moist and leaks fluid. Salt treatment. Common in first few weeks of life.
• Strangulated Hernias → compromised blood supply to tissues due to hernia.
  • Signs of Strangulation → severe abdominal pain, vomiting, signs of bowel obstruction.
  • Mx → emergency herniotomy.
• Hydrocele (main differential for indirect inguinal hernia)
  • Tunica vaginalis is affected.
  • Sx → transilluminates, able to get above swelling on palpation (CAN’T GET ABOVE SWELLING = HERNIA > HYDROCELE).
  • Mx → review at 1 year of age with consideration of surgical repair (usually resolve within first few months of life).

Making Diagnosis

Clinical Features

Investigations

Management Plan

Complications →

Prognosis →