Inguinal hernia

Case contributed by Naim Qaqish


Left inguinal swelling and evaluation of developmental dysplasia of the hip.

Patient Data

Age: 5 months
Gender: Male



Well-formed acetabular roofs.

Acetabular angle measures about 20° on the left and 22° on the right side.

Ossific nuclei of femoral head epiphyses are not visualized yet.

Shenton line is not interrupted bilaterally.

No Radiological evidence of DDH.

Cupping, fraying, and widening of the proximal and distal metaphyses of both femurs are seen suggesting metabolic bone disease.

Bowel containing gas is seen in both inguinal areas, more advanced in the left side which extends into the left hemiscrotum suggesting bilateral inguinal hernia.

Case Discussion

This is a 5 months old boy with left inguinal hernia and hypospadias. Referred from his primary pediatrician to evaluate for DDH. Blood workup shows anemia and vitamin D deficiency. Pelvis x-ray was done as requested depicted bilateral inguinal hernias more on the left side extending to left hemiscrotum indicating indirect type.

Incidental findings of widening, cupping, and fraying of proximal femur metaphyses were noted, hence the evaluation of the femoral distal ends was also requested demonstrating findings of Rickets.

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