Influence of Contents in Manual Reduction of Incarcerated Inguinal Hernia in Neonates and Infants

Abstract

Background: Incarceration of the intestine is frequently seen in inguinal hernia in infants below one year of age. Most of the cases are seen in neonates below the age of one month. Manual reduction is the first line of treatment in cases with an incarcerated inguinal hernia in neonates and infants before they are operated upon. If the reduction is successful, then surgical repair is performed after 48 hours. It was observed that in some cases of incarceration manual reduction fails. Our observation is that in the cases where manual reduction fails, the nature of contents of hernia sac play an important role. Objective: To identify the nature of the contents of incarcerated inguinal hernia sac in neonate and infants in whom manual reduction was unsuccessful. Study Design: Observational study. Duration: January 2016 to June 2018. Setting: Department of Pediatric Surgery, Allied Hospital, Faisalabad Medical University Faisalabad and Faisal Hospital, Canal Road, People`s Colony, Faisalabad. Methodology: All male & female neonates and infants presenting with an incarcerated inguinal hernia were included in this study. Cases with other anomalies having incarcerated inguinal hernia were excluded from this study i.e. anorectal malformations, spina bifida, babies with ventriculoperitoneal shunts etc., Informed consent was obtained from their parents. Results: There were 72 cases with age ranging between 36/40 weeks to one year. There were 62 males and 10 females. Manual reduction was performed in male babies only. Out of 62 male babies, 6 were premature, 40 were neonates and 16 were infants. Babies with failed manual reduction underwent immediate surgery. In the 6 preterm babies’ manual reduction was successful. Manual reduction was successful in 42 cases. In the 13 cases who had to be operated upon caecum alone or accompanied with the appendix was found on the right side. In one case Meckel's diverticulum with rim of ileum was found on right side.  On the left side caecum with appendix was seen in two and in the other 4 a loop of sigmoid colon full with semisolid stool was present. The gut was viable in all cases and was reduced manually. Conclusion: Amyand hernia found major cause of failed manual reduction along with impacted stool in sigmoid colon.