Inguinal and Scrotal Disorders

Abstract

Inguinal and scrotal pathology compose a large percentage of a general pediatric surgeon’s practice. This article reviews these conditions and their associated pathology, diagnosis, and treatment. Current controversy in management is highlighted. For brevity, an in-depth knowledge of embryology and pathophysiology is assumed and is beyond the scope of this monograph. Inguinal hernia and hydrocele Congenital inguinal hernia and hydrocele in children are a result of the failure of the processus vaginalis to obliterate. The end result is the same, with the provision for the extra-abdominal passage of peritoneal fluid (resulting in a hydrocele) or a viscus (resulting in a hernia). The processus vaginalis may obliterate at any point between the internal inguinal ring and the scrotum, or it may do so incompletely. These variations account for the diverse classification of hernias and hydroceles, including complete or scrotal hernias, communicating or noncommunicating hydroceles, hydroceles of the spermatic cord in males, and the canal of Nuck in girls. Although the exact process is unclear, it is generally agreed that obliteration of the processus vaginalis occurs only after the seventh month of gestation [1], thus accounting for the higher incidence of inguinal hernias in the premature infant [2]. Also not clearly defined is a known heredity factor, with hernias occurring more frequently in twin gestations and in infants who have a family history of hernia [3]. The incidence of congenital inguinal hernia has been variously reported to be between 0.8% and 4% of live births [4]. Boys are 10 to 12 times more affected than girls. The risk of incarceration has been reported to be as high as 60% in the first 6 months of life, leading to the generally accepted recommendation for surgical repair of hernia at the earliest elective date