Types/Clinical Presentation 3 (Inguinal Hernia)

Operative findings in a 2.5-week-old newborn with an abdominal emergency due to an incarcerated inguinal hernia. After the opening of the hernia sac and expansion of the inner groin (inguinal) ring (hernia orifice) the cecum with the appendix becomes visible on the left, and in the center and on the right in the picture the dilated terminal ileum is presented by a swab. The diagnosis is an obstructive ileus due to right incarcerated inguinal hernia. The intestinal segment situated below the swab was lying within the hernia sac; in addition, it was injured by the trial of closed reduction (notice laceration of the serosa). The furrow of the intestinal segment at the bottom marks the site of incarceration at the inner groin (inguinal) ring, and the intestinal part running to the left the prestenotic intestinal segment. During surgery, some air has already entered the intestine in the direction of the ileocecum. In case of a suspected obstructive ileus a plain up-right abdomen x-ray should be performed, and if the obstructive ileus is confirmed by multiple air-fluid levels, a closed reduction should be avoided. Although an intestinal resection seems not necessary in the presented case, the injured intestinal segment (serosa laceration, furrow, reversible ischemia) may cause a delayed recovery of the intestinal motility and later an obstructive ileus due to adhesions.