🔑 Key Learning

  • Groin swellings in children include inguinal hernias and cryptorchidism (undescended testes).
  • Inguinal hernias in children are at risk of incarceration and require early surgical intervention.
  • Most undescended testes descend spontaneously, but orchidopexy is recommended if not descended by 6–12 months.

🧬 Inguinal Hernias

📚 Background

  • Almost always indirect hernias (via patent processus vaginalis).
  • Most common in boys, especially on the right side.
  • 15% are bilateral.

👀 Clinical Features

  • Often asymptomatic.
  • Intermittent groin swelling, especially with straining or crying.
  • May resolve when supine.

🩺 Examination

  • Soft, reducible swelling in the groin.
  • Cannot get above the swelling.
  • Cough impulse may be present.
  • May hear bowel sounds if herniated bowel.

💊 Management

  • Elective herniotomy is advised — especially early in infants due to high risk of incarceration.
    • Any child with a suspected inguinal hernia
    • An infant under 3 months of age should be referred urgently
    • Any child with an irreducible hernia should be referred as an emergency

💥 Incarcerated Hernia

👀 Clinical Features

  • Irreducible, painful groin swelling.
  • No cough impulse.
  • May have absent bowel sounds.
  • May lead to intestinal obstruction and testicular infarction (compression of spermatic vessels).

💊 Management

  • Taxis: Attempt gentle, sustained manual reduction if no signs of strangulation.
  • Surgical exploration if taxis fails or signs of ischaemia/strangulation are present.

🍼 Umbilical Hernia

📚 Background

  • Failure of closure of the umbilical ring after birth.
  • Affects 10–30% of infants, more common in African descent.

👀 Clinical Features

  • Painless, reducible swelling at the umbilicus.
  • More prominent with crying/straining.

⚠️ Red Flags

  • Painful, irreducible lump.
  • Overlying skin discolouration.
  • Vomiting or constipation → suspect strangulation.

💊 Management

  • Reassure parents: most close by age 4–5.
  • Refer to paediatric surgery if:
    • Still present after age 4
    • Hernia is >2 cm or symptomatic
    • Evidence of incarceration → urgent referral
  • Surgery: day-case open repair with low recurrence and complication rates.

🧬 Cryptorchidism

📚 Background

  • Failure of testicular descent into the scrotum.
  • Affects 3% of full-term male infants (higher in preterms).
  • Most cases spontaneously descend by 3–6 months.

🩺 Classification

1. Palpable Undescended Testes (80%)

  • Most commonly at the external inguinal ring.
  • 👨‍⚕️ Management: Refer for orchidopexy if not resolved by to be seenby urology by 6 months of age.
    • Usually performed between 6–12 months.

2. Impalpable Testes (20%)

  • Testes may be intra-abdominal, inside the inguinal canal, or absent.
  • Risk of malignancy in intra-abdominal testes.
  • 🧪 Investigation: Laparoscopy (gold standard).
  • ⚒️ Management: Orchidopexy if viable. If torsion/atrophy occurred, excision may be necessary.

📝 Exam Clues & Clinchers

  • Groin lump that is reducible, increases with crying, can't get above it = indirect inguinal hernia.
    • Refer any child with a suspected inguinal hernia for elective herniotomy - high risk of incarceration
  • Boy >6 months with undescended testis = refer for orchidopexy.
  • Empty hemiscrotum, testis not palpable = impalpable testis → consider laparoscopy.