Inguinal hernia
Disclaimer
These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
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Refer to the Emergency Department immediately if the child is unwell, the hernia is irreducible, strangulated or concerns of testicular or ovarian torsion.
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Introduction
Inguinal hernias present as a bulge in the inguinal area and may extend to the scrotum in boys. It is more common in boys, but can occur in girls.
This usually painless swelling will either spontaneously reduce as the child relaxes or can be reduced with gentle pressure.
There will often be a change in size when crying or coughing.
An irreducible or strangulated hernia will present as a tender firm swelling that is unable to be reduced. There may be erythema, inflammation or thickening of the tissue along with irritability in an infant.
Do not attempt to reduce if there are any symptoms of bowel obstruction, bowel compromise or testicular/ovary strangulation.
Pre-referral investigations
- Physical examination.
- Imaging is not indicated.
Pre-referral management
Symptoms of bowel obstruction may indicate an incarcerated hernia and requires immediate referral to the Emergency Department.
Attempt to gently reduce only if competent in the procedure and there are no indications of bowel compromise, obstruction, or testicular/ovary strangulation.
When to refer
All children with inguinal hernia should be referred to the general surgery team at Perth Children’s Hospital.
Immediately refer to the Emergency Department if the child is unwell, the hernia is irreducible, there are indications of bowel compromise or concerns of ovarian or testis torsion.
- For stable infants under 1 month of age (corrected) –Contact on call General Surgical Registrar and send referral directly to PCH Referrals office.
- For stable children over 1 month of age (corrected) refer to General Surgery via the Central Referrals Service.
How to refer
- Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
- Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office.
Essential information to include in your referral
- Patient demographics including next of kin and contact details.
- Gestational age at birth if under 12 months of age.
- Physical examination report.
- Medical and surgical history.
Useful resources
References
- PCH Emergency Department Guidelines - Inguinal hernia
| Reviewer/Team: |
Dr Parshotam Gera
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Last reviewed: |
Apr 2021 |
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Review date: |
Apr 2024 |
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