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Inguinal hernia, hydrocele and umbilical hernia in children

An inguinal hernia in a child is almost always an indirect hernia through a patent processus vaginalis and does not close on its own — so it is repaired soon after diagnosis; a hydrocele and an umbilical hernia, in contrast, usually close on their own and are observed.

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Why it matters in the exam

The exam asks who is at risk (preterm infants, boys, the right side), the timing of surgery, the management of an incarcerated hernia, a girl with a hernia containing an ovary or a gonad, and the difference between communicating and non-communicating hydrocele. The incidence is especially high in preterm infants, and the risk of incarceration is highest in the first year, so one does not "wait for the child to grow". In a preterm infant still in hospital, repair is usually done before discharge or shortly after it.

Incarcerated hernia: a hard, painful groin swelling, crying, vomiting and sometimes signs of obstruction. If there are no signs of necrosis or peritonitis, manual reduction is attempted under sedation with the head down, and it succeeds in most cases; the hernia is then repaired within 24–48 hours, once the oedema settles. If reduction fails or there are signs of necrosis — emergency surgery. In a male infant, incarceration can also compromise the testicular blood supply. In a girl with an ovary in the sac that does not reduce — repair urgently because of the risk of torsion; and in a girl with a "hernia" containing a gonad that looks like a testis — think of androgen insensitivity syndrome and check the karyotype.

At surgery (high ligation of the sac, open or laparoscopic) the risks are injury to the vas and the testicular vessels, testicular atrophy, recurrence and a testis that ascends after surgery. Preterm infants are at risk of apnoea after anaesthesia, so they are monitored overnight after surgery up to a corrected age of about 60 weeks. A non-communicating hydrocele in a newborn usually disappears by one to two years of age; a hydrocele whose size changes during the day is communicating and is treated like a hernia. An umbilical hernia closes on its own in most cases by 4–5 years of age, and incarceration is rare; an epigastric hernia does not close on its own and is repaired.

Key points

• Paediatric inguinal hernia — indirect, repaired soon.
• Incarceration risk is highest in the first year and in preterm infants.
• Incarcerated — manual reduction and repair within 24–48 hours.
• Hydrocele and umbilical hernia usually close on their own.
• Preterm infants — monitoring for apnoea after anaesthesia.

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Sources

• AAP Section on Surgery: Clinical report — Assessment and management of inguinal hernia in infants, 2012 — Timing of repair and incarceration
• Holcomb and Ashcraft's Pediatric Surgery, 7th edition (2019) — Inguinal and Umbilical Hernias and Hydroceles

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.