DIAGNOSIS AND TREATMENT OF INGUINAL HERNIA

¹ Children's Memorial Hospital, Chicago, Illinois

INGUINAL HERNIA has always been of concern to the pediatrician as the commonest surgical condition to confront him in practice and one always carrying the hazards of incarceration. It has been estimated that a problem associated with inguinal hernia will arise at sometime or other in 20 out of every 1,000 of the population. In the more precise studies done in England, the Newcastle statistics indicate that about 10 out of every 1,000 children up to the age of 12 years have an inguinal hernia. It is my impression that this lesion is more hazardous to life than is appendicitis, for during the past 10 years I have seen two deaths in infants with incarcerated hernia and intestinal obstruction but observed no deaths from appendicitis. The diagnosis of inguinal hernia presents few difficulties. Usually, the mother notes in the infant a swelling, characteristically intermittent, in the groin or the scrotum. In older children a swelling present at the end of the day but obscure in the morning constitutes prime evidence for a hernia; swelling which disappears on pressure or when the patient is recumbent is pathognomonic. Examination for such a swelling should be performed each time the pediatrician examines a child. Although a hernia may not be apparent, if by rolling the cord structures over the pubic spine the examiner finds a thickened cord, this, in addition to a reliable history, is sufficient to establish the diagnosis and to warrant embarking on surgical treatment of the lesion. The vast majority of groin hernias are indirect inguinal hernias, in which the hernial sac traverses the internal ring, with the deep epigastric vessels lying inferior and medial to the sac.

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