A 3-month-old boy is brought to the office by his mother due to a "bulge in his groin." The mother states that the bulge appears when the infant passes stool, but then it disappears without intervention. The bulge does not appear to cause him any discomfort. The infant is exclusively breastfed and nurses every 2 hours. He rarely spits up and is voiding and stooling adequately. The patient was born at 35 weeks gestation due to preterm premature rupture of membranes. Pregnancy and delivery were otherwise uncomplicated. Length and weight are at the 75th percentile. Vital signs are normal. The child is alert and smiling. The abdomen is soft, nontender, and without hepatosplenomegaly. The testes are descended bilaterally. A 4-cm (1.6-in), nontender bulge appears in the right groin and extends toward the scrotum when the infant cries. The mass has no discoloration or tenderness and is able to be gently pushed back into the groin. The area appears normal once the child is consoled by his mother. This patient's condition is associated with which of the following complications?

Question

A 3-month-old boy is brought to the office by his mother due to a "bulge in his groin."  The mother states that the bulge appears when the infant passes stool, but then it disappears without intervention.  The bulge does not appear to cause him any discomfort.  The infant is exclusively breastfed and nurses every 2 hours.  He rarely spits up and is voiding and stooling adequately.  The patient was born at 35 weeks gestation due to preterm premature rupture of membranes.  Pregnancy and delivery were otherwise uncomplicated.  Length and weight are at the 75th percentile.  Vital signs are normal.  The child is alert and smiling.  The abdomen is soft, nontender, and without hepatosplenomegaly.  The testes are descended bilaterally.  A 4-cm (1.6-in), nontender bulge appears in the right groin and extends toward the scrotum when the infant cries.  The mass has no discoloration or tenderness and is able to be gently pushed back into the groin.  The area appears normal once the child is consoled by his mother.  This patient's condition is associated with which of the following complications?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf3b_55ea_8f63_33d4e5209c20_MD0005_00 This infant has a groin mass that increases with abdominal pressure, consistent with an indirect inguinal hernia resulting from the failed obliteration of the processus vaginalis. Risk factors include prematurity, conditions that cause increased intraabdominal pressure (eg, prune belly syndrome), and concomitant genitourinary abnormalities (eg, cryptorchidism, hypospadias). processus vaginalis Most children are asymptomatic and present with a nontender, reducible mass (ie, reducible inguinal hernia). However, up to 13% of patients subsequently develop an incarcerated hernia, in which the mass is entrapped in the scrotum. The irreducible hernia can compromise blood supply to the entrapped intestines (bowel ischemia) and testis (impaired fertility, testicular atrophy). Signs of incarceration include vomiting, abdominal distension, and scrotal pain. Therefore, prompt surgical correction within 1-2 weeks is required for a reducible inguinal hernia, as a treatment delay of >2 weeks after diagnosis doubles the risk of incarceration. An incarcerated hernia is a surgical emergency requiring immediate repair. (Choice B) Chronic epididymitis can result from recurrent infection, inflammation, or urinary tract anomalies. This patient is afebrile and has no tenderness on examination, making infection unlikely. (Choice D) Testicular rupture typically occurs due to scrotal trauma. Patients present with severe scrotal pain and swelling following significant injury rather than a nontender, reducible scrotal mass. (Choices C and E) Malignant transformation and testicular torsion are sequelae of untreated cryptorchidism, which presents with an empty, poorly rugated scrotum due to an undescended testicle. Cryptorchidism is unlikely in this patient with palpable bilateral descended testes. Educational objective: Inguinal hernias in children typically present with a nontender, reducible groin mass. Without prompt surgical correction, the mass can become incarcerated and lead to complications such as bowel ischemia or testicular atrophy. References: Hernias and hydroceles. (http://www.ncbi.nlm.nih.gov/pubmed/24085793) Pediatric inguinal hernia, hydroceles, and undescended testicles. (http://www.ncbi.nlm.nih.gov/pubmed/22595705) Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery. (http://www.ncbi.nlm.nih.gov/pubmed/18981440)

A 3-Month-Old Boy Is Brought to the Office by His