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Updated: Nov 19, 2025
Cecal Ligation Puncture Procedure
Published on: May 7, 2011
Emergency high ligation in a suspected COVID-19 pediatric patient with incarcerated inguinal hernia: A case report
Gunadi1, Munawir Makkadafi2,3,4, Aditya Rifqi Fauzi1
1Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Insights
This case report details an 11-month-old with an incarcerated inguinal hernia and suspected COVID-19. Emergency surgery was required due to failed manual reduction, highlighting the need for surgical preparedness during the pandemic.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- COVID-19 Research
Background:
- SARS-CoV-2 affects children, including those requiring pediatric surgery for acute abdominal conditions.
- This report focuses on a pediatric surgery case involving an incarcerated inguinal hernia and suspected COVID-19.
Observation:
- An 11-month-old male presented with symptoms of intestinal obstruction and a suspected SARS-CoV-2 infection.
- Manual reduction of the incarcerated inguinal hernia failed, necessitating emergency surgical intervention.
- The patient underwent high ligation surgery with full personal protective equipment (PPE) due to suspected COVID-19.
Findings:
- Intraoperative findings confirmed a small intestine loop incarcerated within the inguinal canal.
- The patient was managed postoperatively as a COVID-19 case pending RT-PCR results.
Implications:
- Highlights the importance of considering COVID-19 in pediatric surgical emergencies.
- Emphasizes the need for stringent safety protocols, including appropriate PPE, to minimize cross-transmission risks during surgical procedures in the pandemic era.
- Underscores the necessity of prompt surgical intervention when manual reduction of incarcerated hernias fails, even amidst a pandemic.
Background:
SARS-Cov-2 infects not only adults, but also children, including pediatric surgery patients with acute abdomen. Here, we report a pediatric surgery case with incarcerated inguinal hernia and suspected COVID-19.
Case Presentation:
A 11-month-old male was brought to our emergency department with the main complaint of recurrent yellowish-green vomiting that was experienced from one day before admission. High fever and shortness of breath were also reported. This patient was also suffering from moderate dehydration. Neither history of contact with a confirmed case of COVID-19 nor traveling from any local transmission area were found. However, a SARS-CoV-2 rapid antibody test revealed a positive result. A lump in the left scrotum that persisted during admission was found. Fluid resuscitation and nasogastric tube placement for decompression was performed. Manual reduction was attempted but failed to reduce the lump. Accordingly, we decided to perform an emergency high ligation using tertiary protection regulations, i.e., full personal protective equipment (PPE) for COVID-19. Intraoperatively, we found a small intestine loop trapped in the scrotum and stuck in the inguinal canal. Postoperatively, the baby was continued to be managed as a patient with COVID-19 while waiting for the real-time reverse transcription polymerase chain reaction (RT-PCR) results.
Discussion:
Manual reduction is standard treatment for incarcerated inguinal hernia in children. The successful rate of manual reduction is about 70%, therefore, if the manual reduction fails, an emergency surgery is mandatory.During the COVID-19 pandemic, all medical procedures require clarity of the patient's status including whether infected with COVID-19. Along with proper precautions, great care must be taken during surgery to minimize the risk of cross infection to health workers.
Conclusions:
During the COVID-19 pandemic, surgeons should always be aware of the possibility of cross-transmission from the patient, since children are also susceptible to SARS-CoV-2 infection. When and wherever possible, surgeons should perform the procedure in the quickest and most effective manner to shorten exposure time with patient and anesthetic aerosols as well as using appropriate PPE.
