Case 4: Two Children with Presumed Inguinal Hernias

1. Jennifer Adair Williams, MD* 2. Gordon Bruce, MD† 3. Nishit Patel, MD† 4. Jo-Ann Nesiama, MD, MS† 1. *Department of Pediatrics, Children’s Health, Dallas, TX 2. †Department of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX We present 2 patients, A and B, with a similar condition. Patient A is a 7-year-old girl with no medical history who is referred to the emergency department by her pediatrician due to concern for incarcerated inguinal hernia. She has a 3-day history of genital area redness, pain, swelling, and dysuria. She has had similar, although less severe, episodes of inguinal area swelling without redness twice in the past year, which resolved spontaneously. She denies fevers, vomiting, or dyspnea. Her vital signs are normal. She does not have any breast development or pubic hair, with a sexual maturity rating (SMR) of 1. Her physical examination reveals bilateral labial redness, tenderness with swelling extending to the suprapubic and bilateral inguinal area, and an enlarged clitoris with no vaginal opening (Fig 1). Findings from a complete blood cell count, comprehensive metabolic panel, and urinalysis are unremarkable. Pelvic ultrasonography shows cellulitis of the labia minora without discrete fluid collection or abscess, testicles in the bilateral inguinal canals, and no definite uterus or ovaries. Figure 1. Physical examination …