Types/Clinical Presentation 5 (Inguinal Hernia)

Operative findings in a 10-day-old newborn with an incarcerated inguinal hernia of the left side. On the swab lie the left testis, epididymis and spermatic cord; they are discolored black to dark red. At the top an intestinal loop is recognizable. On the right a hernia sac is being grasped with a forceps, containing in its proximal part a loop of the intestine. The final diagnosis is bilateral inguinal hernia (the right side without a clinical manifestation so far). Due to the incarceration of the left side there is a severe impairment of blood supply of the corresponding testicle and epididymis. It should not be removed in case of doubt concerning the irreversibility of damage, but clinical long term follow-ups are necessary. The right side was revised prophylactically due to the left-sided injury of the testis. In a large group of children with operated inguinal hernias, incarceration is observed in 10 %. In boys with incarceration 25 % have an irreversible injury of the testis (atrophy or hypotrophy in the late follow-up) and 10 % a total loss of the testis. On the other hand, although the testis is dark blue during emergency surgery, in 70 % no loss of volume is recognizable later; therefore, the testis should be removed initially only as an exception (Högger C. Z Kinderchir 23:293-302,1978).