INGUINO-SCROTAL swelling is common in children and the usual causes are inguinal hernias and hydroceles.
Hernias and hydroceles do not cause any pain unless complications develop.
Such conditions are generally detected by parents or caretakers during bath time or by a doctor during a routine check-up.
In inguinal hernias, there is intermittent bulging in the groyne, scrotum or labia which is more apparent when the child is crying or straining. The swelling can disappear when the child is lying down.
The reported incidence of inguinal hernias ranges from one to five per cent, with the highest incidence in premature infants (up to 25 per cent). It presents most commonly during the first year of life, and males are more likely to have inguinal hernias.
Acute hydroceles, which presents later during childhood can be caused by either infection to the testis/epididymis, trauma, a tumour or following an upper respiratory tract infection or diarrhoea.
In hydroceles, the swelling is persistent but the size can vary. Older children may complain of pain or discomfort during exercise.
The diagnosis for inguinal hernias and hydroceles is made mainly from a history and clinical examination of the patient. If swelling is present, attempts will be made to reduce it.
An inguinal hernia will not resolve spontaneously, so surgery is often required. It is advisable to do it as soon as a diagnosis has been confirmed to avoid complications, particularly in infants.
If left untreated, it will lead to gangrene and bowel perforation. The testis can also be damaged.
Most congenital hydroceles can resolve spontaneously, however, so surgery can wait until the child is two years of age, except in cases of communicating hydroceles and very large, tense hydroceles which cause discomfort. Hydroceles that arise in older children and congenital hydroceles that persist beyond two years of age require surgery.
Surgeries for inguinal hernias and hydroceles will be done under general anaesthesia and can be performed as day care procedures in a healthy child.
*The writer is a paediatric surgeon at KPJ Puteri Specialist Hospital.