Inguinal hernia

Abstract

Inguinal hernias are the commonest type of groin hernia and are present in 2% of live born babies (4% of male babies), the incidence rising in premature and lowbirth-weight babies. The development of inguinal hernia is commonest in the first 3 months of life and is caused by failure of the processus vaginalis to close. The neck of the hernia is at the internal inguinal ring, lateral to the inferior epigastric vessels, and such hernias are indirect by definition. All indirect hernias arise as a consequence of the failure of the processus vaginalis to close. Direct inguinal hernias (defect and neck of the hernial sac medial to the inferior epigastric vessels) virtually never occur in infants. The ratio of males to females affected is 9: LA female infant developing an inguinal hernia may have the testicular feminization syndrome and chromosome studies should be performed to exclude this. At all ages inguinal hernias are commoner on the right than the left (5:4). Appoximately 60% of children with an inguinal hernia present with incarceration but this rarely progresses to strangulation, 95% resolving with sedation and elevation in gallows traction.