Pediatric inguinal hernia (indirect inguinal ) is mostly caused by the failure to occlude the peritoneal sphincter during the descent of the testis during the embryonic period, and it can develop in the neonatal period. The failure of the peritoneal sphincter (Nuck’s canal) to attain degeneration is the pathological basis of pediatric inguinal hernia. The testis originates from the middle kidney in the 5th week of embryonic life, and is located next to the 2nd to 3rd lumbar vertebrae behind the peritoneum. The testis descends with the pulling of the lead band and the transfer of pressure in the abdominal cavity, passing through the inguinal canal’s inner and outer annulus to the scrotum; at the inner annulus, the peritoneum protrudes outward with the descent of the testis to form a diverticulum-like tubular protrusion called the sheath, and under normal circumstances the distal end of the sheath wraps around the testis to form the intrinsic sheath of the testis; after the testis exits the outer annulus, the sheath is also pulled into the scrotum, and when the testis descends In girls, the inguinal canal contains a round ligament from the uterus to the labia majora; in males, there is also a peritoneal sphincter, called Nuck’s canal, which descends through the inguinal canal into the labia majora along the round ligament and closes in the same way as in boys. The thickness of the sphincter varies according to the age, and is extremely thin in newborns. 2. Increased intra-abdominal pressure and weakness of the abdominal wall muscles are the contributing factors to inguinal hernia Some people report that 80% to 90% of neonates are born with the peritoneal sphincter not yet closed, and the time and mechanism of its closure are not clear, but the incidence of neonatal hiatal hernia after birth is not high; therefore, it is believed that the presence of the sphincter is only the basis for the occurrence of inguinal hernia, and there are still other predisposing factors such as increased intra-abdominal pressure, ascites Sometimes, after peritoneal dialysis or lateral ventricular abdominal drainage, inguinal hernias or syringomyelia can develop in children who were previously asymptomatic. The inguinal hernia hernial sac starts from the inguinal canal, is located lateral to the inferior abdominal wall artery, travels along the inguinal canal, penetrates the abdominal wall, is in front of the inner spermatic cord and is in close proximity to the spermatic cord, the spermatic vessels are lateral to the vas deferens, and the spermatic vessels are often separated from the vas deferens. In adults, the inguinal hernia is formed after the occlusion of the peritoneal sphincter and the peritoneal protrusion and the hernia sac is formed, so the hernia sac is relatively loose from the spermatic cord. In children, the inguinal canal is very short, especially in neonates and infants, and is about 1 cm in length. In newborns and infants, the large omentum is very short and rarely protrudes into the hernia sac, and the most common hernia contents are small intestine. In a few children, the cecum or bladder forms part of the wall of the hernia sac, forming a sliding hernia. In a few children, the cecum or bladder forms part of the wall of the hernia sac, forming a sliding hernia. In primary hernias or small infantile hernias with a small neck or narrow outer ring, a sudden increase in intra-abdominal pressure during violent crying and coughing can push more organs to expand the hernia ring and enter the hernia sac, and when the intra-abdominal pressure temporarily decreases, the hernia ring retracts elastically and the contents of the hernia cannot be retracted and become embedded. The intestinal canal strangulation and necrosis are less common because of local pain and intestinal canal colic, the child cries more and more, and the intra-abdominal pressure continues to increase, and the local pain can reflexively cause spasm of the abdominal wall muscles, which aggravates the intussusception and makes it difficult to be returned. obstruction of return flow, bruising. The development of edema to intestinal necrosis is relatively slow. The blood circulation of the embedded intestine is obstructed, and the intestinal canal may become congested with edema, lamellar bleeding, cyanosis of the intestinal canal, and there is much exudate in the hernia sac. In females, the hernia contents may include the uterus, ovaries, and fallopian tubes, with a high incidence of ovarian impaction and necrosis. The broad ligament or the vascular tip of the ovary may enter the hernia sac and become part of the sliding hernia sac. In testicular hernia, the entire peritoneal sheath is not occluded and the hernia sac consists of the intrinsic testicular sheath cavity and the spermatic cord sheath, and the testis can be seen wrapped in the sheath inside the hernia sac. The testis is not visible inside the hernia sac.