Inguinal Hernia and the Acute Scrotum in Infants and Children
Don K. Nakayama MD1
Marc I. Rowe MD2
1 Assistant Professor of Pediatric Surgery, Dept of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh
2 Benjamin R. Fisher Professor of Pediatric Surgery, Dept of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh
INGUINAL HERNIA AND OTHER INGUINAL SCROTAL PROBLEMS
Inguinal Hernia
Inguinal hernia and hydrocele develop because the processus vaginalis remains open after birth. When fluid passes distal to the internal ring, a hydrocele forms. An intraabdominal structure entering the processus produces a hernia. The processus, first seen during the third month of gestation at a time when the developing testis lies within the abdomen, extends into the scrotum by the seventh month. As the testis completes its descent, the processus begins to obliterate, a process that continues after birth. Data from autopsy studies reveal that most infants have an open processus for several months after birth. The incidence in the newborn period is 80% to 94% and decreases to 57% in the 4- to 12-month age group. A patent processus persists in 20% of adults without clinically apparent hernias. These rates far exceed the incidence of hernia or hydrocele; therefore, a patent processus may persist undetected throughout life. Excess fluid within the peritoneal cavity, typically from ventriculoperitoneal shunts and peritoneal dialysis, tends to maintain patency of the processus.
Inguinal hernia is one of the most common surgical conditions in infancy, with an incidence of 0.8% to 4.4% that varies with gestational age and birth weight.
