Groin And Scrotum Inguinal hernia and hydrocele

Inguinal hernia (Fig. 23.5) and hydrocele are common groin and scrotal conditions in infancy and childhood. Repair of inguinal hernia represents one of the most frequently performed operations in childhood. Inguinal hernia and hydrocele in childhood are different from the same conditions in adulthood both in their aetiology and treatment.

Figure 23.5. Bilateral inguinal hernia in a preterm infant.

Childhood inguinal hernia and hydrocele are congenital anomalies resulting from a persistence of processus vaginalis. As the testis descends from its retroperitoneal position to beyond the internal ring, it carries with it an anteromedial diverticulum of peritoneum (the processus vaginalis). The process of obliteration of the processus vaginalis begins at 32 weeks gestation and may continue for the first 2 years of life. A widely patent processus vaginalis which allows the passage of visceral contents results in an indirect inguinal hernia. A narrowly patent processus vaginalis which allows the passage of peritoneal fluid results in a communicating hydrocoele. An inguinal hernia does not regress whereas most infantile hydroceles will resolve spontaneously upon completion of the process of obliteration of the processus vaginalis. Occasionally, the fluid collection may persist after closure of the processus vaginalis resulting in a hydrocele of cord (hydrocele of canal of Nuck in females) or a non-communicating hydrocele.

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