This child has an inguinal hernia. This condition is less common in females but does occur. Inguinal hernias are almost always indirect in children under the age of 11y.

The hernia can usually be reduced if the child presents acutely. After making sure that the child has adequate analgesia and is comfortable the hernia can usually be reduced by the action of gentle traction rather than compression. In cases where the child is systemically unwell, has signs suggestive of peritonism, or has an irreducible hernia urgent surgical referral is required. If the hernia is easily reduced the child may be discharged after a period of observation and a referral made to the surgeon on an out-patient basis with instructions to the child's parents to return if the lump recurs.

In female patients the inguinal hernia may sometimes contain the ovary. Some surgeons advocate bilateral exploration in females as these patients have a higher risk of hernia on the contra-lateral side and there is little risk to the patient from having this procedure. Most surgeons would not apply this to male patients due to the small but definite risk of damage to the testicle.

In children of this age the operation required is a herniotomy with excision of hernia sac and closure of the peritoneum. There is no need for a mesh repair in this patient group.

Inguinal hernia (male)

Submitted by Craig Ferguson
Research Fellow
Manchester Royal Infirmary

Submitted by Craig Ferguson
Research Fellow
Manchester Royal Infirmary