Pediatric Inguinal Hernia

  • Etiology: patent processus vaginalis
  • Imaging: bowel within the inguinal canal and / or scrotum, in 15-20% of females the hernia sac contains ipsilateral ovary
  • Complications: incarcerated inguinal hernia is trapping of hernia contents within hernia sac, strangulated inguinal hernia is prolonged incarceration -> reduced venous flow and impairment of arterial flow -> ischemia and necrosis, may cause testicular ischemia due to compression due to decreased blood flow and venous return
  • Clinical: often presents as asymptomatic mass in inguinal canal lateral to rectus sheath and superior to pubic tubercle, may present as distal small bowel obstruction, incidence of 30% in premature infants, incarcerated hernia is a clinical diagnosis and not a radiologic diagnosis

Radiology Cases of Inguinal Hernia

AXR of small bowel obstruction due to inguinal hernia
AXR supine shows massively dilated loops of bowel filling the abdomen with a loop of bowel noted in each of the scrotal sacs.
AXR of bilateral inguinal hernias
AXR AP shows large air-filled loops of bowel within the scrotum bilaterally.
US of inguinal hernia
Sagittal US of the scrotum (below) shows a loop of bowel superior to the right testicle within the right scrotal sac. Transverse US (above) best demonstrates the presence of a reactive hydrocele around the loop of bowel. The bowel was subsequently successfully reduced into the abdomen and repaired 3 days later.
US of inguinal hernia
Sagittal US of the right scrotum shows a normal appearing right testicle (to the right of the image) that is displaced inferiorly in the scrotal sac by a large mass composed of multiple tubular structures that demonstrated peristalsis on real-time imaging.