- a twisted or infected testicle - which can be an urgent &
serious matter itself. This requires prompt medical attention. While it is possible
for girls also to have both congenital and acquired hernias (but not hydroceles), it is
much more common in boys.
A hydrocele is a sac of
fluid around the testicle, while a hernia is an outpouching of abdominal contents. When
congenital, both are remnants of abdominal lining pulled down into the scrotum in mid
pregnancy by the testicle as it was making it's trip from where it formed higher up near
the kidney. The tube of abdominal lining so pulled down is supposed to disintegrate once
the testicle reaches it's destination, but this doesn't always happen completely. If the
result is a sac that is still connected to the abdominal cavity, it's hernia. If it's not
connected, it's a hydrocele. Most hydroceles go away (finish disintegrating) on their own
by the time a baby is one year old with no intervention. Hernia's never go away by
themselves, and will always need to be repaired surgically, although unless they
incarcerate there is no urgency to doing this.
It can be hard to tell the
difference between a hydrocele and a hernia on examination, even for an experienced
pediatrician - it we think it's a hernia on exam we are almost always right, but when we
think it's just a hydrocele it may turn out to be a hernia anyway.
In any case, correct
management is to WAIT until EITHER:
1.) It becomes obvious that
it's really a hernia on exam, or
2.) The child is approaching his first birthday and it isn't going away.
If you get to one of these
points, a surgical consultation (either with a urologist or a pediatric surgeon) is
indicated. If there is any chance that it's a hernia they will operate. A fairly high
percentage of hydroceles that aren't going away by one year actually do turn out to be
hernias at surgery. It's a simple and safe operation at any age - even just a few weeks of
life - at a good Children's Hospital.
On the other hand, if the
surgeon is very sure it's really just a hydrocele, they may try draining it with a needle
- this sometimes needs to be done several times but often works and avoids surgery.
Finally, while observing or
waiting for surgery, the one and only danger is "incarceration". This is when,
with a hernia (which all suspected hydroceles MIGHT be), the abdominal contents get
"stuck" in the hernia sac, can't get back into the abdomen, and start to suffer
an impaired blood supply. While a "normal", non-incarcerated hernia is soft and
varies in size - bigger when crying or having a BM, smaller when calm and relaxed - an
incarcerated hernia is firm, bigger, and fixed in size. Likewise, a "normal"
hernia is not painful or tender, while an incarcerated hernia is very tender to touch. A
"normal" hernia may have be normal skin color or have a faint blue tinge - but
an incerated hernia may be red or deep purple like a bruise. While few hernias actually
incarcerate, when they do it is a
and requires surgery within a matter