A 3 month old male born full term with no complications presents for a right groin mass. His mother first noticed it two days ago when he cried. Otherwise, he has been acting normally, drinking formula regularly, and having several bowel movements daily. Vital signs and weight are within normal limits for age. Exam shows a happy appearing infant that cries when taken away from his mother. When he cries, a 3 cm soft, non-tender mass is appreciated in the right inguinal region that is easily reducible. There is no overlying erythema or skin changes. Genital exam reveals palpable bilateral testes with no additional masses in the scrotum. Which of the following is the most appropriate management of this condition?
A: admit for observation
B: discharge with expedited surgical follow up
C: discharge with reassurance that it will likely spontaneously resolve
D: emergent surgical consultation
Answer: discharge with expedited surgical follow up
This infant is presenting with a reducible inguinal hernia that increases in size with increased intra-abdominal pressure such as with crying or straining. It is most common in premature males in the first year of life. Unlike in adults, children require surgical referral for interval repair of simple reducible inguinal hernias due to the higher risk of incarceration. Thus, reassurance that it will likely spontaneously resolve without surgical follow up is incorrect. If the hernia was incarcerated, emergent surgical consultation with admission for prompt surgical repair would be appropriate management.
References:
Fleischman R.J., & Meckler G (2020). Acute abdominal pain in infants and children. Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill.
