Pediatric Inguinal Hernia

  • Etiology: Patent processus vaginalis
  • Imaging AXR: Bowel gas below pubis
  • Imaging US:
    — Abdominal contents of fat and or bowel extending through inguinal canal and possibly into scrotum
    — Look for gut signature and peristalsis to confirm diagnosis
  • Note: Amyrand hernia is when inguinal hernia contains appendix which is rare
  • DDX:
  • Complications:
    — Distal small bowel obstruction
    — Incarcerated inguinal hernia is trapping of hernia contents within hernia sac
    — Incarcerated inguinal hernia may cause testicular ischemia due to compression due to decreased blood flow and venous return
    — Strangulated inguinal hernia is prolonged incarceration of hernia leading to reduced venous flow and impairment of arterial flow which leads to ischemia and necrosis
  • Treatment: Surgical
  • Clinical:
    — Often presents as asymptomatic mass in inguinal canal lateral to rectus sheath and superior to pubic tubercle
    — May present as distal small bowel obstruction
    — Incidence of 30% in premature infants
  • Note: Incarcerated hernia is a clinical diagnosis and not a radiologic diagnosis

Radiology Cases of Inguinal Hernia

AXR of small bowel obstruction due to inguinal hernia
AXR supine shows massively dilated loops of bowel filling the abdomen with a loop of bowel noted in each of the scrotal sacs.
AXR of bilateral inguinal hernias
AXR AP shows large air-filled loops of bowel within the scrotum bilaterally.
US of inguinal hernia
Sagittal US of the scrotum (below) shows a loop of bowel superior to the right testicle within the right scrotal sac. Transverse US (above) best demonstrates the presence of a reactive hydrocele around the loop of bowel. The bowel was subsequently successfully reduced into the abdomen and repaired 3 days later.
US of inguinal hernia
Sagittal US of the right scrotum shows a normal appearing right testicle (to the right of the image) that is displaced inferiorly in the scrotal sac by a large mass composed of multiple tubular structures that demonstrated peristalsis on real-time imaging.