Most hernias are painless, but at times the initial presentation may be an incarcerated loop of bowel. Hydroceles may be differentiated from incarcerated hernias by the absence of pain and symptoms of bowel obstruction. Increased fat in the pubic area may make the diagnosis difficult. A hernia not felt on careful examination is unlikely to incarcerate. Must differentiate from retractable testes that may appear as an inguinal bulge.
Most hydroceles disappear during the first year of life.
There is no place for conservative management in either infancy or childhood. An incarcerated hernia is a medical emergency. The high risk of incarceration in the pediatric age group make the presence of an inguinal hernia an indication for surgical repair. Pediatric Hernias and Hydroceles. Pediatric Clinics of North America.