A 10 year old male comes in with c/o sudden onset of pain in inguinal region. No history of trauma. No complaints of vomiting, diarrhea/constipation. No complaints of dysuria or hematuria. No complaints of fever. No past medical history and was a full term child without any complications. Patient is up to date on immunizations and has no surgical history.
Initial vital signs were within normal range for age but child writhing in pain. Examination reveals a well-developed child complaining of pain. Abdominal exam is benign with a soft, non-tender abdomen with no rebounding, guarding or rigidity. Normal bowel sounds are heard and no organomegaly noted. Genitourinary examination reveals masses in both inguinal regions which extending into scrotum.
Differential diagnosis in this case included, but not limited, abscess, incarcerated hernia and torsion testis. Ultrasound was in this instance to evaluate mass.
Ultrasound shows loop of bowel with increased motility with surrounding edema indicating strangulated hernia.
In this instance the patient was placed in Trendelenberg position and sedated with ketamine and pain control with morphine. Constant steady pressure was applied and the hernia was able to be partially reduced. Given the difficulty and that it was bilateral; this patient was transferred for pediatric urology to reduce the swelling.
Dr. Kanak Naidu
Acute and Emergency Care Centre, Khoo Teck Puat Hospital. Singapore.