Emergency presentation of inguinal hernia in childhood--treatment strategy. A follow-up study.
This article presents a retrospective study of 95 cases of irreducible inguinal hernia in 93 children (median age 0.5 years; range 0-13 years) admitted with this diagnosis. In 38 cases operations were performed without delay, in 51 from 12 to 48 hours after admission, and in 6 cases at a later stage. Thus, a total of 57 patients (60%) could be treated with conservative measures at the time of admission. Three instances of minor wound haematoma which did not require treatment and two instances of pneumonia caused by aspiration were recorded. Eighty-three patients could be traced, 70 of whom responded to our questionnaire. The number of infections was 2 (2.8%) and the number of recurrences was 9 (12.3%). In order to reduce the recurrence and infection rates in emergency cases of irreducible inguinal hernia in childhood, the following treatment strategy is suggested: primarily gentle taxis, combined with sedation, if necessary. If reduction is impossible, surgery should be performed without delay. If reduction is achieved, the child can be discharged after 24 hours of observation and readmitted after one week for elective out-patient herniotomy.