Inguinal Hernia and Hydroceles Reference Pediatric Surgery 7th ed (2012) Ashcraft's Pediatric Surgery (2010)

Embryology and Pathogenesis Indirect inguinal hernias are fundamentally the result of failure of closure of the processus vaginalis (patent processus vaginalis, PPA). Note Patent a. e.g. patent ductus arteries (PDA) patent foramen ovale opp. obliterative adj. obliteration n.

Clinical Features 1. Inguinal hernias are generally found by parents at bath time or during well-child examinations by their pediatricians 2. There is typically a history of intermittent bulge in the groin, labia, or scrotum. 3. It is most often apparent when there is increased intra-abdominal pressure such as during episodes of crying or straining

Notes history n. e.g. present history of ~ bulge n. His eyes seemed to bulge like those of a frog increased/decreased a. (commonly used in medical writings)

Physical Examination(PE) An infant may be allowed to strain or cry to provoke an inguinal bulge to appear If a mass is still not present, the spermatic cord can be palpated to determine thickening Note 1. Palpate v. e.g. palpate the abdominal mass 2. present v. e.g. present a history with…. n. / a. e.g. the presence of a tumor

Radiologic Investigations In most cases the diagnosis of an inguinal hernia can be made by history and physical examination alone. Note. make the diagnosis of ~ e.g. Diagnosis of malignant tumors could only be made by pathological examinations.

Surgery The fundamental principle guiding pediatric inguinal hernia repair is high ligation of the hernia sac One major advantage of laparoscopic repair is contralateral exploration. (Surgically-related terms)

Complications Recurrence Injury to the Vas deference Scrotal swelling Testicular atrophy Iatrogenic undescended testicle (e.g. iatrogenic injury)

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