Bimanual technique to reduce pediatric inguinal hernia 

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A 7-week-old male infant named Johnny presents to the Emergency Department with a bulge in his right scrotum that the parents noticed today, worse when he is crying and upset. On exam you notice an inguinal hernia and try to reduce it but are unsuccessful. What technique could you try next?

Incarcerated hernias can often be reduced using a bimanual (two-hand) technique and lots of patience.  Place the fingers of your non-dominant hand over the inguinal canal on the same side as the hernia.  This hand applies constant counter-pressure while your gently and patiently decompress the hernia with your dominant hand and then guide it toward the external inguinal ring.  The counter-pressure is helpful to prevent the hernia from getting stuck in the canal between the internal and external rings. Constant gentle pressure for up to 3 to 5 minutes may be needed to decompress the hernia.

Adjuncts to the bimanual reduction technique include analgesia since this is painful and crying increases intra-abdominal pressure which works against the reduction.  Use caution with sedation if the infant has been vomiting from the obstruction and is hypovolemia.  Trendelenburg positioning of the stretcher may also help.

This post was copyedited by Daniel Ting and Evan Formosa.

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Garth Meckler

Garth Meckler

Garth is an Associate Professor of Pediatrics and Emergency Medicine at the University of British Columbia and head of pediatric emergency medicine at BC Children’s Hospital. His research interests include pediatric headache, pediatric prehospital care, and out-of-hospital cardiac arrest in children. He has no conflicts of interest.
Garth Meckler

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