Disorders involving a child’s inguinal (groin) and scrotal area are frequent and the most common condition treated by the pediatric surgeons at UPMC Children's Hospital of Pittsburgh. The array of inguinal and scrotal disorders includes hernia, hydrocele, undescended testis, torsion of the testis or appendix testis, and rarely testicular tumors.
While inguinal and scrotal disorders are common, each disorder has unique attributes and treatment.
Inguinal Hernia
The inguinal hernia is the most prevalent of all inguinal and scrotal disorders. In short, a hernia is a sac of tissue that protrudes through the abdominal lining. Usually, the sac closes and disappears before birth. But in about 20 percent of infants, the sac does not close and pushes through the lower abdominal muscles. This sac is typically filled with fluid or tissue.
Hernias are usually noticed first by the parents as a small bulge in the lower abdomen or sometimes an enlarged scrotum in boys.
The surgical procedure to repair an inguinal hernia is low-risk done using a general anesthetic. Using a one inch incision, the surgeon can disconnect the sac and suture the remaining tissue.
Hydrocele
Similar to a hernia, a hydrocele is simply a sac of water. Sometimes, a hydrocele is the first stage of a hernia, and can be treated the same as an inguinal hernia. There are, however, several types of hydroceles and each may require a different treatment approach.
Often a painless hydrocele may develop after a child has a virus or has experienced trauma to the testes. These should be examined and monitored, but rarely is surgery needed. They shrink and may disappear on their own.
A hydrocele that develops rapidly without explanation, (for example after a viral illness or trauma to the testes), may require an early ultrasound of the scrotum. The surgical approach is often through the scrotum, after it’s determined that no small hernia is involved. Otherwise an inguinal approach is used, especially in a patient of school-age.
Undescended Testis
An undescended testis occurs when the testicle fails to travel down into the scrotum by the time of birth. At birth, four out of every one hundred males will have an undescended testis; however by one year of age, three of these four will have descended into a satisfactory position.
Although an undescended testis is not a health risk, surgery should be performed to relocate the testis into the scrotum to allow normal development to occur. This procedure is similar to that of the hernia, with a small groin incision. Hernias often result simultaneously with undescended testes. The testis is placed into the scrotum by lengthening the tissue and blood vessels that supply the testis. Occasionally, more than one surgery is required. Rarely, the testis will not continue to develop for unknown reasons.
Torsion
Torsion means twisting of an organ and risks losing the blood supply to that organ. This can be a rather dramatic event and requires a quick and precise diagnosis and treatment.
Torsion of the testis may occur when the testis lacks its normal attachments to the scrotum. This is sometimes called the “bell clapper” deformity. When this happens the blood supply to the testis is twisted or kinked, preventing proper flow. Torsion is almost always accompanied by excruciating pain.
Surgery is almost always required to prevent loss of the testis. During surgery, the surgeon will “unkink” the blood flow and sometimes “pex” or affix the testis in place to avoid further twisting.
Testicular torsion is most common in the 4 to 11 year old age group and often occurs after moderate activity. Early surgical repair can preserve fertility. For the testis that has been twisted longer than 24 hours, removal is generally recommended.
Testicular Tumors
Tumors of the testis are rare in childhood and usually appear with slowly growing, painless masses. They are often mistaken for a hernia and accidentally found at surgery. Surgery is used to remove the mass through a groin incision. Further treatment depends on the type of tumor and its extent of spread.
