Inguinoscrotal hernia in infants: Three case reports in ultrasound diagnosis

Abstract

An inguinal hernia occurs when an intestinal loop or part of the omentum or genital organs passes into the scrotal cavity or labia through an incompletely obliterated processus vaginalis. Inguinal hernias are most common in preterm neonates, especially at 32-weeks gestation. Content of hernia is mostly bowel and ovary/testicles. Presence of uterus in herniated sac is rare, and only few cases are reported in literature. Hernia is more frequently located on the right side because the right processus vaginalis closes later than the left. Physical examination is sufficient to enable diagnosis in most cases. Ultrasound examination is indicated in patients with inconclusive physical findings, in patients with acute scrotum, and to investigate contralateral involvement in patients in whom only a unilateral hernia is clinically evident. Routinely, color or power Doppler imaging is used in inguinal-scrotal hernia to investigate intestinal and testicular/ovarian perfusion. Urgent surgery is indicated in patients with an akinetic dilated bowel loop (a sign of strangulation) or impaired testicular/ovarian perfusion.

Persistence of the processus vaginalis and its related disorders

“…In both sexes, right‐sided hernia are more common, possibly due to the typically later closure of the right processus vaginalis . Premature infants have an increased risk with up to 30% born with an inguinal hernia . Whilst 90% of indirect inguinal hernias in adults are due to a persistent processus vaginalis, in the paediatric population this is almost always the cause …”

“…4,5 Premature infants have an increased risk with up to 30% born with an inguinal hernia. 34 Whilst 90% of indirect inguinal hernias in adults are due to a persistent processus vaginalis, in the paediatric population this is almost always the cause. 2,5,35,36 Failure of closure of the processus vaginalis at the deep inguinal ring leaves an opening between the peritoneum and the inguinal canal, greatly increasing the likelihood of an indirect inguinal hernia in both paediatric and adult populations.…”

Accuracy of Ultrasound in the Evaluation of Pediatric Abdominal Surgical Emergency: A Comparison with Intra-Operative Findings

“…The diagnosis of obstructed hernia is always clinical. Ultrasound examination may be required if physical findings are inconclusive or in cases of acute scrotum [18]. Ultrasound can also be used in assessing peristalsis, wall thickness and vascularity of the bowel in the hernia sac [19].…”

Definition of giant inguinoscrotal hernias in infants and evaluation of reliable surgical approach in a single-center study

“…Narrowing of the inner ring using primary sutures that is another procedure we recommend for giant hernias, forms a supporting tissue at the base of the inguinal canal. It prevents subcutaneous palpation of the hernia sac stump and evaluation of swelling in the inguinal region as recurrence by mistake during the effort movements especially in children with less weight [10]. Yokomori et al have narrowed the internal inguinal canal by a modified Marcy repair and reported in their series that this method was effective to prevent recurrence [11].…”