This is an urgent surgical condition. The younger the child, the increased risk of irreducibility.

See resources for referral form, parent information and more.

Assessment and when to refer

Physical examination:

• Appears as a tender lump in the inguinal region (or extending into the scrotum in boys) that the examining hand cannot get above.
  • IMMEDIATE REFERRAL if within easy reach of the hospital. Keep fasted and give paracetamol prior to transfer - spontaneous reduction is more likely in a relaxed child.
  • Please provide history and any investigations undertaken.

Potential complications of irreducible hernias include: testicular (or ovarian) ischaemia, bowel obstruction and bowel ischaemia.  

• If there is anticipated delay - reduction should be attempted provided the period of irreducibility is no longer than 24 hours and there is no redness over the lump.
  • TIP: principles of reduction are using one hand to apply firm continuous pressure to the mass and the other hand to direct the hernial contents through the deep ring. This hand should be placed just lateral to the midpoint of the inguinal ligament and pushing posteriorly.
  • Please provide history and any investigations undertaken.

Contact information

For clinical advice call RCH Switchboard tel (03) 9345 5522 and ask for:

• General surgery registrar or fellow on-call
• Department of General Surgery - clinical advice
• Emergency Department - for clinical advice after hours

For outpatient bookings

• Fax to 03 9345 5034 (number also on referral form)
• For urgent appointments please also call 03 9345 6180
• For private referrals see Paediatrician Listing for private surgeon contact details.

Admission enquiries call RCH Switchboard tel (03) 9345 5522 and ask for:

• General admission enquiries (or direct dial 03 9345 6172)
• ED admission enquiries: (or direct dial 03 9345 6477)

• RCH OPD referral form (word)
• Generic parent handout (about RCH pre-referral guidelines)
• Kids Health Info - parent information website
• Kids Connect (Primary Care Liaison) www.rch.org.au/kidsconnect
  OPD resources for GPs page contains all referral forms, clinic information, referral process information, other pre-referral guidelines, MBS Enhanced Primary Care Items and parent information.
• Paediatric Pharmacopoeia

References

Urgent paediatric surgical conditions - management guidelines by Tom Clarnette MBBS, MD, FRACS (Paeds). Consultant Paediatric Surgeon, RCH, Melbourne, Australia.

Feedback

Please give feedback on this guideline - kids.connect@rch.org.au / telephone: (03) 9345 4645 / fax (03) 9345 4650

Thanks to Consultant Paediatric Surgeon Tom Clarnette for permission to adapt existing guidelines.  Many thanks to the GPs involved in the review.  First published Dec 2007. Reviewed August 2009. Please read Copyright and Disclaimer.