I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

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Friday, 8 May 2015

Paediatric Hernias

Often present within 1st year of life.

Indirect - most hernias are indirect and extend through the internal and external rings. Often on the right hand side. 

Signs & Symptoms
- Asymptomatic bulge in the groin or scrotum - above the testicle
- May resolve when calm and supine
- Analgesia needed before reduction
- Gentle traction on the scrotum to help align the hernia sac with the external ring.
- While keeping gentle traction, squeeze distal to proximal 
- Apply pressure laterally with the index and thumb along each side of the hernia neck and inguinal canal.
- Imagine you are trying to stretch open the rings.
- Gently add more pressure distally and help reduce the hernia.
- This can take up to 40minutes

Incarceration or Strangulation
- Happens in 7 - 30% 
- Severe pain, bilious emesis, blood in stool, signs of peritonitis, redness and oedema on affected side of scrotum
- Don't attempt to manually reduce



  1. Not all torsions are torsions! It’s hard for paed surgeons to refuse!
    - Inguinal hernia – lump above the testicle. Protruded peritoneum.
    - Complete inguinal hernia- testicle joined to peritoneal cavity. Can’t get above it.
    - Hydrocele of cord – grape like lump.
    - Communicating hydrocele – can get above it. Transilluminates. Not tender. Testicle not discrete.
    - Strangulated Hernias – in females could be an ovary. If the lump is hard think about how long the history is for. Bowel doesn’t die in 3 hours so it could be a trapped ovary, which doesn’t respond well to being squished.
    When reducing hernias, squeeze the oedema out first, then feed up in to bowel – don’t push down! If reduced, go to paediatricians for observation and stabilisation, then they can refer to surgeons for semi-elective repair in 24 – 28hours.

  2. http://stemlynsblog.org/i-think-my-child-has-a-hernia-st-emlyns/

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