A 55-day-old infant born prematurely at 27 weeks of gestation is shown below. The swelling is not tender, firm, hot, or red, and it does not transilluminate. It seems to resolve with pressure, but returns when the infant cries or strains. Which of the following is the most appropriate course of action at this point?
(a) Source: (Hay et al, pp 606-607. Kliegman et al, pp 1362-1368. McMillan et al, pp 1925-1927. Rudolph et al, pp 1429-1432.) A congenital indirect inguinal hernia is the result of incomplete closure of the processus vaginalis. This is in contrast to the less commonly acquired direct inguinal hernia, caused by weakness in the musculature of the inguinal canal. Inguinal hernias are commonly seen in premature infants (16%-25%). Incarceration is common; elective repair is often considered prior to hospital discharge. Transillumination, while frequently mentioned as a method to distinguish hydrocele from hernia, can be misleading. The diagnosis is so common that diagnostic tests are performed infrequently, but when there is diagnostic uncertainty, a scrotal ultrasound may be performed.
Obtain a surgical consultation.
Perform a needle aspiration.
Order a barium enema.
Order a KUB (plain radiographs of kidney, ureter, and bladder).
Gastro Intestinal System