POCUS and Laparoscopic Repair for Incarcerated Pediatric Direct Inguinal Hernia

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Frontiers in Medicine Published May 1, 2026 Medically reviewed May 1, 2026 Study authors: Guanghua Zhang, Ming Sun, Jun Shu, Hongqiang Bian, Qin Guo, Jun Yang DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider POCUS for rapid diagnosis and laparoscopic repair with ligament reinforcement for incarcerated pediatric direct inguinal hernia, but evidence is limited to a single case.

A case report details the management of a 15-month-old male infant presenting to the emergency department with an incarcerated pediatric direct inguinal hernia. Point-of-care ultrasound (POCUS) accurately diagnosed the condition within 2 hours of admission, leading to emergency laparoscopic surgery completed within 6 hours. The procedure involved laparoscopic closure of the fascial defect combined with medial umbilical ligament reinforcement without synthetic mesh implantation. Operation duration was 15 minutes with an estimated blood loss of 1 mL. The patient was discharged on postoperative day 1 with uneventful recovery. At follow-up visits at 1, 2, 3, and 6 months, no hernia recurrence was observed and abdominal wall development was normal. Safety was reported as safe and feasible, though adverse events were not reported. Key limitations include the single-case design, making findings hypothesis-generating and requiring validation in larger studies with longer follow-up. Clinicians should recognize this as a potential diagnostic and therapeutic pathway but await further evidence before routine adoption.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

Pediatric direct inguinal hernia (DIH) is an extremely rare congenital abdominal wall defect, accounting for less than 4% of all pediatric inguinal hernias. Its clinical manifestations overlap highly with indirect inguinal hernia (IIH), leading to frequent diagnostic dilemmas in emergency settings, especially for incarcerated cases. This single-case report aims to describe a case of incarcerated pediatric DIH and elaborate on the emergency diagnostic and therapeutic approach, to provide a detailed reference for managing similar cases. A 15-month-old male infant with left incarcerated DIH was admitted to the emergency department. Point-of-care ultrasound (POCUS) was performed to confirm the diagnosis by identifying the herniation pathway through Hesselbach’s triangle. Laparoscopic closure of the fascial defect combined with medial umbilical ligament reinforcement was implemented without synthetic mesh implantation, in line with the physiological characteristics of pediatric abdominal wall development. The infant was accurately diagnosed via POCUS within 2 h of admission, and emergency laparoscopic surgery was completed within 6 h (including time for diagnosis, preoperative optimization, and mandatory fasting). The operation duration was 15 min with an estimated blood loss of 1 mL. Postoperative recovery was uneventful, and the infant was discharged on postoperative day 1. Follow-up at 1, 2, 3 and 6 months showed no hernia recurrence, with normal abdominal wall development. In this case, POCUS was instrumental in the emergency differential diagnosis. Laparoscopic defect closure combined with medial umbilical ligament reinforcement, which avoids synthetic mesh, appeared to be safe and feasible with good short-term outcomes. This report highlights a diagnostic and therapeutic pathway for a rare condition. As a single-case report, these findings are hypothesis-generating and require validation in larger studies. Future prospective studies with longer follow-up are needed to confirm the efficacy and generalizability of this approach.