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- Lane S. Palmer, MD*
- *Departments of Urology and Pediatrics, Hofstra North Shore-LIJ School of Medicine, and Department of Pediatric Urology, Cohen Children’s Medical Center of New York, Long Island, NY.
Author Disclosure
Dr Palmer has disclosed no financial relationships relevant to this article. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.
Practice Gap
Medical management of hernias and hydroceles has changed; pediatricians need to be aware that the urgency to surgically correct these entities depends on the nature of the hernia or hydrocele and the likelihood of incarceration or spontaneous resolution.
Objectives
After completing this article, readers should be able to:
Derive the differential diagnosis of a mass in the inguinal area in an infant: hydrocele, inguinal hernia, trauma, or tumor.
Understand the history and physical examination differences between an inguinal hernia and a hydrocele.
Plan the evaluation of a patient with a mass in the inguinal area.
Appreciate the principles in the surgical management of the hernia and hydrocele in infants and children.
Hernias and hydroceles present within embryologic and clinical continuums that are commonly encountered by pediatricians. These conditions are typically discovered by pediatricians on routine physical examination or after a bulge in the groin and/or scrotum is noted by the child’s caretaker. The common nature of the inguinal hernia-hydrocele is documented by autopsy studies reporting an incidence of a patent processus vaginalis in 80% to 94% in newborn infants. The importance of identifying these conditions based on the history and physical examination findings lies in averting their complications and ensuring proper referral for further management.
Embryology of the Inguinal Canal
Inguinoscrotal abnormalities in children are best understood by reviewing the underlying embryology of testicular descent and the inguinal region development. At approximately 6 weeks of gestation, the primitive germ cells migrate from the yolk sac to the genital ridge located high on the posterior wall of the abdomen where they differentiate into a testis or an ovary during the next 2 weeks. During the next few weeks of fetal elongation, …
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