Question 139

Question:

A 5-year-old boy is brought in by his mother because she is concerned that he might have a mass in his lower abdomen. She says it is usually noticeable, but sometimes completely goes away. On exam, the boy’s intestines are palpated protruding through the internal inguinal ring. The protrusion increases with maneuvers that increase intra-abdominal pressure, but is reducible. In surgery, which of the following findings would confirm the likely diagnosis?

Correct Answer: C.  Hernia sac lateral to the inferior epigastric artery

This boy has an indirect inguinal hernia. It is caused by the failure of closure of the processus vaginalis (i.e. a ‘patent’ processus vaginalis), which allows intra-abdominal contents to enter the inguinal canal. Direct inguinal hernias occur in older patients, and are characterized by a bulge medial to the inferior epigastric artery.