Small bowel intussusception in children.
Diagnosis & Tests
Diagnosis is made on observation and physical exam by a doctor. A bulge or swelling will be present in the scrotum or groin, particularly when there is increased abdominal pressure (when the child is crying or straining). The swelling may be progressive throughout the day and get smaller during naps or overnight (this indicates communication of the hydrocele or inguinal hernia). Hydroceles may appear bluish; there may be presence of a “silk glove sign” when the layers of the hernia sac are palpated sliding over each other. The doctor will apply gentle pressure to assess if the swelling is reducible. Imaging studies are generally not needed, except in rare circumstances when there is concern for incarcerated hernia, or other acute scrotum pathology.
Treatment & Care
There is no medical management for inguinal hernia or hydrocele, only surgical treatment.
· Noncommunicating hydrocele can be observed until the child is close to 1 year old, as there is a chance of spontaneous resolution (meaning he outgrows it).
· Communicating hydrocele/inguinal hernia should be repaired surgically when diagnosed to decrease the risk of constriction. A small incision is made in the groin to gain access to the hernia sac. The sac is then tied off. The success rate for this procedure is very high, and risk of damage to the surrounding structures (the spermatic cord) is low, about 1%. In infants and children less than 2 years old, exploration of the other side for a hernia is sometimes performed.
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