How is a physical exam performed on a child with an abdominal inguinal hernia?

Updated: Jul 01, 2021
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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For examining a child, invagination of the scrotum is counterproductive because a hyperactive cremasteric muscle contraction reduces hernial contents into the peritoneum. In the subtle hernia of a child, palpation of the cord structures facilitates recognition of a thickened cord, particularly during straining, which can be easily prompted by tickling the child. A sensation of rubbing two layers of silk together (the so-called silk sign) may be felt.

If the hernia is not demonstrable in the supine position, the child should be examined in the upright position with intermittent manual pressure applied to the abdomen. If the examiner looks down at an angle from the infant’s chest level toward the groin, a combination of gravity and increased intra-abdominal pressure will inflate the open sac and thus confirm the hernia or hydrocele. The inguinal rings may be of normal size, even in children with very large hernias.

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