Inguinal Swelling in a Child – Is it Always Hernia?

Excerpt

A 4-mo-old presented to emergency services with incessant crying. There was no history of fever or vomiting. Vital signs were within normal limits. On examination marfanoid habitus, micrognathia, clenched position of hands (fist-like), crumpled ears and multiple contractures of large joints were noted (Fig. 1a). Congenital contractural arachnodactyly (CCA) or Beal’s syndrome was suspected. Cardiac and ocular exam was normal. On abdominal exam there was no guarding, rigidity or abdominal distention, but a left tender and red, non-reducible, firm and oval inguinal swelling was noted (Fig. 1b). A working diagnosis of incarcerated inguinal hernia was made. However, bilateral non palpable testis led to suspicion of torsion of undescended testis. An ultrasound Doppler scan showed avascular left testis in inguinal canal. Emergency inguinal exploration was done and testicular torsion was confirmed. There was no return of blood supply on detorsion and left orchiectomy was performed (Fig. 1c).

…