Acute Scrotal Pain or Swelling

An inguinal hernia is a peritoneal pouch that extends through the inguinal canal, sometimes as far as the scrotum. The bowel can also pass into it. 

An inguinal hernia usually presents as an inguinal swelling that is often intermittent. Therefore, it may not be noticed until the baby cries or strains. 

All inguinal hernias require prompt surgical referral once diagnosed because the small bowel can easily become trapped in the hernia compromising the bowel's blood supply and causing bowel obstruction (strangulation). Inguinal hernias are more common in premature babies and recent evidence advises that uncomplicated hernia can be managed with non-urgent surgery.¹

Hydrocele is common. It is a painless fluid filled sack around the testis present from birth. It may not be possible to feel the testes separate from the hydrocele, if the hydrocele is tense.

The following link is a guide to assessment, management and treatment of acute scrotal pain or swelling for health professionals.  Whilst the focus of the guideline is on infants and paediatric patients, in this context the sections relevant to neonates and infants, Irreducible hernia and Hydrocele are of most importance.

^{1. HIP Trial Investigators. Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants: A Randomized Clinical Trial. JAMA. 2024;331(12):1035-1044. doi:10.1001/jama.2024.2302}

Safer Care Victoria endorses the Paediatric Improvement Collaborative Clinical Practice Guideline.

Acute Scrotal Pain or Swelling >