WISEMD Pediatric Hernia

Question 1

What are the four ways a processus vaginalis can close improperly?

Answer 1

1) PV closes distally but not proximally (hernia)
2) PV remains open (scrotal hernia)
3) PV closes proximally but not distally (hydrocele [noncommunicating] - cord structures are palpated in the inguinal ring)
4) PV almost closes, but leaves small channel opened (communicating hydrocele, no hernia)

Question 2

At what age is the highest incidence of incarceration for an inguinal hernia?

Question 3

What treatment is required for strangulation?

Answer 3

Emergency surgery. Therefore, surgeries in children should be scheduled for elective repair ASAP

Question 4

When are labs indicated for a routine hernia repair in a pediatric patient?

Answer 4

1) Underlying illness
2) Very young
3) Ex-premature baby

Question 5

What can be ordered to check for infectious cause if the mass is not a hernia or hydrocele?

Answer 5

Urinalysis

Question 6

What test may be indicated in a pediatric patient if both testes are truly absent?

Answer 6

B-hCG

Question 7

What labs should be drawn in emergency situations for an inguinal mass in a pediatric patient?

Answer 7

CBC, electrolytes, and type and screen

Question 8

Is imaging required for pediatric hernia or hydrocele?

Answer 8

No

Question 9

What inguinal masses in pediatric patients can undergo imaging for further testing?

Answer 9

1) Suspicion of testicular mass
2) Lymphadenopathy
3) Undescended testis

Question 10

If a testicular torsion is suspected, what imaging can be done promptly?

Answer 10

Color doppler ultrasound to visualize blood flow to the testis

Question 11

If an incarcerated hernia presents with evidence of bowel obstruction, what is the next step?

Answer 11

Emergent surgery without imaging

Question 12

What are exceptions to quickly schedule a hernia repair in an infant?

Answer 12

1) Large defect in little danger of incarceration

2) High anesthesia risk (newborn, ex-premies in first 2 months of life)