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Question 14#

The high incidence of inguinal hernias in preterm babies is most often due to:

A. Failure of the peritoneum to close
B. Familial history
C. Female gender
D. Developmental dysplasia of the hip

Correct Answer is A

Comment:

Inguinal hernias may be congenital or acquired. Most adult inguinal hernias are considered acquired defects in the abdominal wall although collagen studies have demonstrated a heritable predisposition. A number of studies have attempted to delineate the precise causes of inguinal hernia formation; however, the best-characterized risk factor is weakness in the abdominal wall musculature (Table below). Congenital hernias, which make up the majority of pediatric hernias, can be considered an impedance of normal development, rather than an acquired weakness. During the normal course of development, the testes descend from the intra-abdominal space into the scrotum in the third trimester. Their descent is preceded by the gubernaculum and a diverticulum of peritoneum, which protrudes through the inguinal canal and becomes the processus vaginalis. Between 36 and 40 weeks of gestation, the processus vaginalis closes and eliminates the peritoneal opening at the internal inguinal ring. Failure of the peritoneum to close results in a patent processus vaginalis (PPV), hence the high incidence of indirect inguinal hernias in preterm babies. Children with congenital indirect inguinal hernias will present with a PPV; however, a patent processus does not necessarily indicate an inguinal hernia (Fig. below). In a study of nearly 600 adults undergoing general laparoscopy, bilateral inspection revealed that 12% had PPV. None of these patients had clinically significant symptoms of a groin hernia. In a group of 300 patients undergoing unilateral laparoscopic inguinal hernia repair, 12% were found to have a contralateral PPV, which was associated with a fourfold 5-year incidence of inguinal hernia.

Presumed causes of groin herniation:

Varying degrees of closure of the processus vaginal is (PV). A. Closed PV. B. Minimally patent PV. C. Moderately patent PV. D. Scrotal hernia.