Pediatric Hernias and Hydroceles

Abstract

Pediatric inguinal hernias and hydroceles represent the clinical manifestations of a patent processus vaginalis, whereby incomplete fusion and obliteration permit access of intraperitoneal contents to the groin and/or scrotum. Hernias represent the protrusion of bowel, omentum, and other intraperitoneal contents (fallopian tube, ovaries, etc.) down the patent processus vaginalis which present as intermittently palpable groin and/or scrotal masses. The term incarcerated hernia is used to describe a situation where the hernia sac contents fail to spontaneously reduce from the groin and scrotum requiring prompt medical attention. A strangulated hernia represents a situation where entrapped viscera undergo ischemic necrosis representing a true surgical emergency. Hydroceles reflect the presence of intraperitoneal fluid, rather than visceral organs within the processus vaginalis. Non-communicating hydroceles represent retained fluid within the groin or scrotum which does not freely communicate with the intraperitoneal cavity thus posing little risk for the sequelae of incarceration or strangulation. Communicating hydroceles, however, reflect a persisting connection with the intraperitoneal cavity which poses a distinct risk for future incarceration and strangulation.