Overview of inguinal hernia in children
- Chris Ramsook, MD
Chris Ramsook, MD
- Attending Physician
- Phoenix Children's Hospital
- Erin E Endom, MD
Erin E Endom, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Primary inguinal hernia occurs in 1 to 5 percent of all newborns and 9 to 11 percent of those born prematurely . Inguinal hernia repair is the most commonly performed surgical procedure in children . Most children with an inguinal hernia have minimal symptoms. The diagnosis is usually made easily and the repair generally is uncomplicated. Strangulation can be avoided when incarceration is promptly recognized and treated.
The epidemiology, clinical presentation, and management of inguinal hernia in children will be reviewed here.
The evaluation of inguinal swelling and the causes and evaluation of scrotal pain and swelling in children and adolescents are discussed separately. (See "Evaluation of inguinal swelling in children" and "Causes of painless scrotal swelling in children and adolescents" and "Causes of scrotal pain in children and adolescents" and "Evaluation of scrotal pain or swelling in children and adolescents".)
Hydrocele — A hydrocele is a fluid-filled collection that can occur anywhere along the path of descent of the testis or ovary. (See 'Embryology' below.)
Hernia — A hernia is the protrusion of a portion of an organ or tissue through an abnormal opening in the wall that normally contains it.
- Grosfeld JL. Current concepts in inguinal hernia in infants and children. World J Surg 1989; 13:506.
- Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am 1998; 45:773.
- Wang KS, Committee on Fetus and Newborn, American Academy of Pediatrics, Section on Surgery, American Academy of Pediatrics. Assessment and management of inguinal hernia in infants. Pediatrics 2012; 130:768.
- Rowe MI, Copelson LW, Clatworthy HW. The patent processus vaginalis and the inguinal hernia. J Pediatr Surg 1969; 4:102.
- Aiken JJ. Inguinal hernias. In: Nelson Textbook of Pediatrics, 17th, Behman RE, Kliegman RM, Jenson HB. (Eds), Saunders, Philadelphia 2004. p.1293.
- Tanyel FC, Müftüoglu S, Dagdeviren A, et al. Myofibroblasts defined by electron microscopy suggest the dedifferentiation of smooth muscle within the sac walls associated with congenital inguinal hernia. BJU Int 2001; 87:251.
- Iason, A. Hernia in infancy and childhood. Am J Surg 1945; 68:287.
- Misra D, Hewitt G, Potts SR, et al. Inguinal herniotomy in young infants, with emphasis on premature neonates. J Pediatr Surg 1994; 29:1496.
- George EK, Oudesluys-Murphy AM, Madern GC, et al. Inguinal hernias containing the uterus, fallopian tube, and ovary in premature female infants. J Pediatr 2000; 136:696.
- Bijnens E, Broeckx J, Hoffbauer R, Borreman JP. Sonographic diagnosis of an incarcerated inguinal hernia containing uterus and left adnex A. J Ultrasound Med 1992; 11:249.
- Ando H, Kaneko K, Ito F, et al. Anatomy of the round ligament in female infants and children with an inguinal hernia. Br J Surg 1997; 84:404.
- Bronsther B, Abrams MW, Elboim C. Inguinal hernias in children--a study of 1,000 cases and a review of the literature. J Am Med Womens Assoc 1972; 27:522.
- FOSBURG RG, MAHIN HP. FEMORAL HERNIA IN CHILDREN. Am J Surg 1965; 109:470.
- Immordino PA. Femoral hernia in infancy and childhood. J Pediatr Surg 1972; 7:40.
- Peevy KJ, Speed FA, Hoff CJ. Epidemiology of inguinal hernia in preterm neonates. Pediatrics 1986; 77:246.
- Harper RG, Garcia A, Sia C. Inguinal hernia: a common problem of premature infants weighing 1,000 grams or less at birth. Pediatrics 1975; 56:112.
- Skoog SJ, Conlin MJ. Pediatric hernias and hydroceles. The urologist's perspective. Urol Clin North Am 1995; 22:119.
- Pan ML, Chang WP, Lee HC, et al. A longitudinal cohort study of incidence rates of inguinal hernia repair in 0- to 6-year-old children. J Pediatr Surg 2013; 48:2327.
- Aboagye J, Goldstein SD, Salazar JH, et al. Age at presentation of common pediatric surgical conditions: Reexamining dogma. J Pediatr Surg 2014; 49:995.
- Rescorla FJ, Grosfeld JL. Inguinal hernia repair in the perinatal period and early infancy: clinical considerations. J Pediatr Surg 1984; 19:832.
- Rowe MI, Clatworthy HW Jr. The other side of the pediatric inguinal hernia. Surg Clin North Am 1971; 51:1371.
- Puri P, Guiney EJ, O'Donnell B. Inguinal hernia in infants: the fate of the testis following incarceration. J Pediatr Surg 1984; 19:44.
- CLATWORTHY WH Jr, THOMPSON AG. Incarcerated and strangulated inguinal hernia in infants: a preventable risk. J Am Med Assoc 1954; 154:123.
- Stylianos S, Jacir NN, Harris BH. Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg 1993; 28:582.
- Rowe MI, Clatworthy HW. Incarcerated and strangulated hernias in children. A statistical study of high-risk factors. Arch Surg 1970; 101:136.
- Chen YC, Wu JC, Liu L, et al. Correlation between ventriculoperitoneal shunts and inguinal hernias in children: an 8-year follow-up. Pediatrics 2011; 128:e121.
- German J, Simpson JL, Morillo-Cucci G, et al. Testicular feminisation and inguinal hernia. Lancet 1973; 1:891.
- Sarpel U, Palmer SK, Dolgin SE. The incidence of complete androgen insensitivity in girls with inguinal hernias and assessment of screening by vaginal length measurement. J Pediatr Surg 2005; 40:133.
- Viner RM, Teoh Y, Williams DM, et al. Androgen insensitivity syndrome: a survey of diagnostic procedures and management in the UK. Arch Dis Child 1997; 77:305.
- Katz DA. Evaluation and management of inguinal and umbilical hernias. Pediatr Ann 2001; 30:729.
- Erez I, Schneider N, Glaser E, Kovalivker M. Prompt diagnosis of 'acute groin' conditions in infants. Eur J Radiol 1992; 15:185.
- Stephens BJ, Rice WT, Koucky CJ, Gruenberg JC. Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome. World J Surg 1992; 16:952.
- Zamakhshary M, To T, Guan J, Langer JC. Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery. CMAJ 2008; 179:1001.
- Osifo OD, Ovueni ME. Inguinal hernia in Nigerian female children: beware of ovary and fallopian tube as contents. Hernia 2009; 13:149.
- Jedrzejewski G, Stankiewicz A, Wieczorek AP. Uterus and ovary hernia of the canal of Nuck. Pediatr Radiol 2008; 38:1257.
- Merriman TE, Auldist AW. Ovarian torsion in inguinal hernias. Pediatr Surg Int 2000; 16:383.
- Stringer MD, Higgins M, Capps SN, Holmes SJ. Irreducible inguinal hernia. Br J Surg 1991; 78:504.
- Gahukamble DB, Khamage AS. Early versus delayed repair of reduced incarcerated inguinal hernias in the pediatric population. J Pediatr Surg 1996; 31:1218.
- Moss RL, Hatch EI Jr. Inguinal hernia repair in early infancy. Am J Surg 1991; 161:596.
- Davies N, Najmaldin A, Burge DM. Irreducible inguinal hernia in children below two years of age. Br J Surg 1990; 77:1291.
- Rowe MI, Marchildon MB. Inguinal hernia and hydrocele in infants and children. Surg Clin North Am 1981; 61:1137.
- Clark M. Hernia reduction. In: Textbook of Pediatric Emergency Procedures, 1st, Henretig FM, King C. (Eds), Williams & Wilkins, Baltimore 1997. p.927.
- Kaya M, Hückstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg 2006; 41:567.
- Paidas C, Kayton ML. Inguinal hernia. In: Oski's Pediatrics: Principles and Practice, 4th, McMillan JA, DeAngelis CD, Feigin RD, et al. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1925.
- Othersen HB Jr. The pediatric inguinal hernia. Surg Clin North Am 1993; 73:853.
- Spurbeck WW, Prasad R, Lobe TE. Two-year experience with minimally invasive herniorrhaphy in children. Surg Endosc 2005; 19:551.
- Schier F. Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg 2006; 41:1081.
- Schier F, Montupet P, Esposito C. Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. J Pediatr Surg 2002; 37:395.
- Takehara H, Yakabe S, Kameoka K. Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J Pediatr Surg 2006; 41:1999.
- Steinau G, Treutner KH, Feeken G, Schumpelick V. Recurrent inguinal hernias in infants and children. World J Surg 1995; 19:303.
- Wiener ES, Touloukian RJ, Rodgers BM, et al. Hernia survey of the Section on Surgery of the American Academy of Pediatrics. J Pediatr Surg 1996; 31:1166.
- Antonoff MB, Kreykes NS, Saltzman DA, Acton RD. American Academy of Pediatrics Section on Surgery hernia survey revisited. J Pediatr Surg 2005; 40:1009.
- Tackett LD, Breuer CK, Luks FI, et al. Incidence of contralateral inguinal hernia: a prospective analysis. J Pediatr Surg 1999; 34:684.
- Kemmotsu H, Oshima Y, Joe K, Mouri T. The features of contralateral manifestations after the repair of unilateral inguinal hernia. J Pediatr Surg 1998; 33:1099.
- Miltenburg DM, Nuchtern JG, Jaksic T, et al. Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 1997; 174:741.
- Manoharan S, Samarakkody U, Kulkarni M, et al. Evidence-based change of practice in the management of unilateral inguinal hernia. J Pediatr Surg 2005; 40:1163.
- Maillet OP, Garnier S, Dadure C, et al. Inguinal hernia in premature boys: should we systematically explore the contralateral side? J Pediatr Surg 2014; 49:1419.
- Klin B, Efrati Y, Abu-Kishk I, et al. The contribution of intraoperative transinguinal laparoscopic examination of the contralateral side to the repair of inguinal hernias in children. World J Pediatr 2010; 6:119.
- Sözübir S, Ekingen G, Senel U, et al. A continuous debate on contralateral processus vaginalis: evaluation technique and approach to patency. Hernia 2006; 10:74.
- Miltenburg DM, Nuchtern JG, Jaksic T, et al. Laparoscopic evaluation of the pediatric inguinal hernia--a meta-analysis. J Pediatr Surg 1998; 33:874.
- Mollen KP, Kane TD. Inguinal hernia: what we have learned from laparoscopic evaluation of the contralateral side. Curr Opin Pediatr 2007; 19:344.
- Walc L, Bass J, Rubin S, Walton M. Testicular fate after incarcerated hernia repair and/or orchiopexy performed in patients under 6 months of age. J Pediatr Surg 1995; 30:1195.
- Matsuda T, Muguruma K, Horii Y, et al. Serum antisperm antibodies in men with vas deferens obstruction caused by childhood inguinal herniorrhaphy. Fertil Steril 1993; 59:1095.
- Matsuda T, Muguruma K, Hiura Y, et al. Seminal tract obstruction caused by childhood inguinal herniorrhaphy: results of microsurgical reanastomosis. J Urol 1998; 159:837.
- Boley SJ, Cahn D, Lauer T, et al. The irreducible ovary: a true emergency. J Pediatr Surg 1991; 26:1035.
- Alzahem A. Laparoscopic versus open inguinal herniotomy in infants and children: a meta-analysis. Pediatr Surg Int 2011; 27:605.
- Shalaby R, Ismail M, Dorgham A, et al. Laparoscopic hernia repair in infancy and childhood: evaluation of 2 different techniques. J Pediatr Surg 2010; 45:2210.
- Associated conditions
- CLINICAL FEATURES
- No mass
- Reducible mass
- Incarcerated mass
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- No mass, reducible mass
- Inguinal mass in a female
- Incarcerated inguinal hernia
- - Manual reduction
- - Surgical reduction
- Surgical repair
- - Timing of repair
- - Contralateral exploration
- POSTOPERATIVE CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS