I.

General Data
 P.A
 10 months old
 Female
 Filipino
 Roman Catholic
 born on September 18, 2018
 currently residing at Bohol
 II. Chief Complaint

Bulging Mass on Inguinal Area,

Bilateral
 III. History of Present Illness
6 months PTA
- Mother noticed a bulging mass on the inguinal area, Left
- Spontaneously reduced
- no consult was done

3 months PTA
- the bulging mass was noted to increase in size
- mass on the right inguinal area was noted, nonreducible
- patient also had cough and sought consult at Gallares
Hospital
 III. History of Present Illness

1 month PTA
- persistence of mass increasing in size on both inguinal
area, nonreducible, aggravated by coughing
- no consult was done

1 week PTA
- sought consult at VSMMC OPD
- CT Scan and Ultrasound were ordered
- revealed Indirect Inguinal Hernia , Bilateral
 IV. Personal History
A. Prenatal History:
 Patient’s mother was 35 years old during pregnancy,
with OB score of G4P3 (2-1-0-3)
 Prenatal Check up: AOG at 3 months , regular ,
attended by a midwife at a local health center
 Maternal Illnesses: none
 Medications: Calcium , Iron
 IV. Personal History
B. Natal History:

- delivered at 7 months old via a normal

spontaneous vaginal delivery at a lying in clinic
attended by a midwife with a birth weight of 1,300 g.

- September 18, 2018

 IV. Personal History
C. Postnatal History:
Feeding: Milk Formula
Medical Problem: at 10 days old, admitted at
Gallares due to Neonatal Sepsis
 IV. Personal History
E. Developmental History
 at 10 months old
- poor head control
- not able to sit without support
- cannot crawl
- cannot imitate any hand movement/facial
expressions
 V. Past Medical History

September 2019 : Neonatal Sepsis at

Gallares Hospital
May 2019: Pneumonia at Gallares
Hospital
 VI. Immunization History
 None since birth
 VII. Family History
 No Signficant Family History
 VIII. Personal and Social History
 youngest among 4 siblings
 patient's parents is married for 16 years
 patient usually sleeps from 5pm - 4am
XI. PHYSICAL
EXAMINATION
 General Survey & Vital Signs
General survey: Patient was seen lying on bed,
alert, awake, not in distress.

Vital Signs:
 Temperature: 37.1°C
 Heart rate: 110 bpm
 Respiratory rate: 35 cpm
 SPO2: 98%
 Anthropometric data
 Weight: 5 kg
 Length: 62 cm
 Head Circumference: 36 cm
 Chest Circumference: 31 cm
 Abdominal circumference: 38 cm
 MUAC: 17 cm
 Skin: Normal skin color, no rash, eruptions,
hemorrhages, bruises, burns, scars, edema, or
jaundice, Nails are normal and pinkish, No nail
clubbing, warm with good skin turgor

 HEENT: Hair is black, thin, smooth, and

distributed evenly. Scalp is clean and dry. Face
is symmetric. both Fontanels are closed. No
bulging of fontanels noted. No lesions or
masses palpated. Anicteric Sclerae, Pink
Conjunctuvae
 Chest/Lungs: Equal chest Expansion, crackles
noted on both lung fields
 CVS: Distinct Heart sounds
 Abdomen: Globular, not distended, normoactive bowel
sounds
 GUT: (+) Bulging mass on inguinal area, Bilateral
 Left: soft , slightly reducible
 Right: Solid mass, fixed, nonreducible, 3 x 5 cm

 Extremities: Strong pulses , CRT < 2secs

 CNS: GCS 15
 O. Nervous System
Cranial Nerves:
 I - not tested
 II- Fixes eye on examiner
 III,IV,VI- Spontaneous eye movements in all directions
 V- Facial grimace
 VII- Face is symmetric at rest and with movement.
 VIII- acoustic blink reflex present.
 IX, X, XII- Well-coordinated suckling and swallowing.
 XI –Shoulders symmetric; passive rotation of head
 O. Nervous System
 Motor System: Symmetric tone and strength.
Normal spontaneous movement of all extremities.
Muscle bulk is normal. No atrophy, tremors, or tics
noted.
 Primary Impression

Indirect Inguinal Hernia,

Bilateral, Incarcerated
- Bulging mass on Both inguinal area, non
reducible
(+) Bulging mass on inguinal area, Bilateral
 Left: soft , slightly reducible
 Right: Solid mass, fixed, nonreducible, 3 x 5 cm
Differential Diagnosis
Sliding Hernia
 Female
 bulging mass, solid mass
 UTZ
Femoral Hernia
At the ER
 IVF of D5LR 1L at 30cc/hour
 OGT, FBC
 Labs: CBC, UA , serum electrolytes, Prothrombin
time, blood typing
 Chest Xray APL, Abdomen Flat plate and Upright
 Meds: Cefuroxime 85 mg IVTT q 8 hours (50mkd)
 Metronidazole 50mg /IVTT q 8 hours (50mkd)
 Ranitidine 10 mg/ IVTT q 8 hours

SURGICAL REPAIR of HERNIA

 Complete Blood
Result Reference Value
Count
WBC 14.43 4.5-11.0
Hemoglobin 115 140-175
Hematocrit 37.20 41- 50%

Platelet 541 150-450

RBC Count 4.72 4.2-5.9
Differential Count
Neutrophil 31.41 55-65%

Lymphocyte 51.40 25-35%

Monocyte 9.40 3-11%
Eosinophil 7.30 2-4%
Basophil 0.50 0-1%
Sodium 126 135-145

Potassium 3.94 3.50 - 5.50

Chloride 92.30 98-108

ionized Calcium 1.14 1.10-1.40

Presumed Causes of Groin
Herniation
 Coughing
 BW: <1,500g
 COPD
 Straining
 pregnacy
DIAGNOSIS
• History and physical examination
• Imaging:
Ultrasound – Sensitivity 86%, Specificity
77%
CT Scan - Sensitivity 80%, Specificity 65%
MRI- Sensitivity 95%, Specificity 96%
MANAGEMENT
 Herniorraphy
 Mesh repair
 Laparoscopic
 Open method