DIKKI DRAJAT K. SpB., SpBA Pediatric Surgery Dept. Hasan Sadikin Hospital/ Faculty of Medicine Padjadjaran University

Etiology: Congenital, Failure of vaginal proccess to obliterate (Indirect type ) Acquired Previous surgery (DIRECT TYPE)

Incidence 0.8 % to 4.4% of all children Male : Female ratio 5:1 Right sided hernia : Twice as common as those on the left Increase Incidence: Prematurity Cryptorhidism Ascites, VP shunt

Clinical Presentation Most Hernia are asymptomatic except for bulging with straining

History and Phiysical Examination History of intermittent lump or bulge in the groin, scrotum or labia Maneuvers: rise the head while supine Blowing up a ballon with a thumb in the mouth Standing the child upright Silk glove sign

HYDROCELE LYMPHADENOPATTHY RETRACTILE TESTIS ABSES NEOPLASIA

Test (+) for Hydrocele

Operative : HERNIORAPHY Timing of operation: A S A P ELECTIVELY - avoid of incarceration - regardless of age and weight

Reponible/Reducible Inguinal Hernia No initial management required  elective hernioraphy Incarcerated Inguinal Hernia Initial management, Conservative Tx/: Trendelenburg position NGT decompression  Edema subside  Herniorhaphy Diazepam Manual Reduction Strangulated Inguinal Hernia Initial management  Emengency surgery Herniotomy