Hernia
Differential Diagnosis for Inguinal Lump
Inguinal or femoral hernia, which may be reducible or irreducible
Lymphadenopathy: Tender and mobile, usually related to infection
Tumours: Testicular tumours in males, lipoma, or sarcoma
Hydrocoele: Fluctuant, transilluminates, painless
Ectopic or undescended testes: Non-palpable or abnormal testicular location
Ovarian herniation in females: Firm, non-tender groin lump
Umbilical and Epigastric Hernia
Midline defects presenting with a reducible lump
Often resolve spontaneously by age 4
Referral indicated if persistent beyond 2 years or if complications occur
Inguinal Hernia Management
Follow the "6-2 Rule" for surgical timing
Birth to 6 weeks: Operate within 2 days
6 weeks to 6 months: Operate within 2 weeks
After 6 months: Operate within 2 months
Urgent surgical intervention is required if there are signs of strangulation or incarceration (pain, irreducibility, erythema)
Femoral Hernia
Present as a lump below the inguinal ligament
Carry a high risk of strangulation
Require immediate referral and surgical management
Additional Considerations
Neonates and infants under 6 months are at high risk; prompt intervention prevents bowel ischaemia
Ultrasound is useful for evaluating non-palpable testes, differentiating hydrocoele, and assessing ovarian herniation
A thorough clinical examination and history are essential to distinguish hernias from other inguinal masses
Parental education on recognising signs of strangulation, such as sudden pain or irreducibility, is vital
Postoperative follow-up is important to monitor for recurrence or complications
Notes
Early surgical management in high-risk groups reduces the likelihood of bowel incarceration
Femoral hernias in females have a higher risk of strangulation than inguinal hernias
Imaging should be considered when the diagnosis is unclear
Detailed documentation of findings guides appropriate management and referral decisions
