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Question: Surgical

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A 3 week old female infant presents with a palpable inguinal mass of 2 hours duration. The dad states he noticed it while changing her diaper. He has seen it before while bathing her, but by the end of the bath it had disappeared. She is otherwise well, feeding and growing well, not vomiting, and is afebrile. She appears comfortable. The mass is nontender, and there is no overlying redness or discoloration. 

What is the most appropriate next step?

pemsou5_wp • October 4, 2022

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  1. Kelly October 9, 2022 - 9:15 pm Reply

    B) Gentle attempt at manual reduction, but do not continue efforts if unsuccessful
    The vignette describes an infant with inguinal hernia, a not uncommon finding in infants, particularly those born prematurely. It is 3-4 times more common in males than females. In females, there is the significant possibility that the ovary and/or fallopian tube is herniated. Therefore, in a female infant, if an initial gentle attempt at reduction is unsuccessful, ultrasound should be performed to ascertain the contents of the hernia before more forceful attempts. Additional attempts to reduce herniated bowel may be facilitated by Trendelenburg positioning, ice packs to reduce swelling, procedural sedation, and more firm persistent pressure. If a hernia is not reducible, it is incarcerated. Incarcerated hernias may become strangulated, which refers to vascular compromise that can lead to necrosis. These may present with redness or discoloration, tenderness, discomfort and irritability, and vomiting.

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