CAPTULO 12

HRNIA INGUINAL,
HIDROCELE E CISTO DE
CORDO ESPERMTICO
Paulo Juvncio Gomes Tubino
Elaine Maria de Oliveira Alves

Hrnia inguinal KUQLDLQJXLQDOHVWUDQJXODGDFRQWHGRLUUHGXWYHOVHPWUDQ-

Denio VLOXPLQDRDFRPSDQKDGDGHGRUYPLWRVHSDUDGDGRWUQ-
(QWUDGDGHDOJXPDSDUWHGRFRQWHGRDEGRPLQDOHPXPSUR- sito intestinal.
cesso vaginal persistente.
Tratamento
Incidncia ,QGLFDRRSHUDWULDORJRDSVRGLDJQVWLFR
&HUFDGHDGDVFULDQDVWPKUQLDLQJXLQDO(PSUHPD- SURSHUDWULR URWLQD SURSHUDWULD PQLPD DXVFXOWD FDU-
WXURVDLQFLGQFLDYDULDGHD$WGRVFDVRVRFRUUHP GLRSXOPRQDU H[DPH GD SHOH KHPRJUDPD H FRDJXORJUDPD
em crianas com menos de 6 meses de idade. FRPSOHWRV
RSHUDRKHUQLRUUDDLQJXLQDOOLJDGXUDDOWDGRSURFHVVRYD-
Sexo
$UHODRVH[RPDVFXOLQRVH[RIHPLQLQRGHFHUFDGH
Lateralidade
(PGRVFDVRVRFRUUHGLUHLWDHPHVTXHUGDHHP
ELODWHUDOPHQWH
Diagnstico
$EDXODPHQWR LQWHUPLWHQWH QD UHJLR LQJXLQDO QR HVFURWR RX
QRVJUDQGHVOELRVQRWDGRQDVRFDVLHVGHDXPHQWRGDSUHV-
VRLQWUDDEGRPLQDO$SDOSDRGRFRUGRHVSHUPWLFRFRQ-
WUDRSELVPRVWUDVHXHVSHVVDPHQWRHPYLUWXGHGRSURFHVVR
vaginal persistente. Na menina, principalmente na lactente,
JLQDO
SVRSHUDWULR DOWD KRVSLWDODU H UHDOLPHQWDR TXDQGR D
FULDQDHVWLYHUEHPDFRUGDGDQRKUHWLUDGDGHSRQWRVFLUU-
JLFRVYLVWRTXHDVXWXUDLQWUDGUPLFDFRPRDEVRUYYHO2
FXUDWLYRIHLWRFRPFROGLRHOVWLFRQRVHQGRQHFHVVULRWUR-
c-lo.
'LYHUVRVWUDEDOKRVPRVWUDUDPTXHQDVKUQLDVLQJXLQDLVXQL-
ODWHUDLVDOJXPWHPSRDSVDRSHUDRKRXYHRDSDUHFLPHQWR
GHKUQLDFRQWUDODWHUDOJHUDQGRDGYLGDVHVHULDPHOKRUH[-
SORUDU R RXWUR ODGR QR SULPHLUR DWR FLUUJLFR D P GH HYLWDU
nova anestesia.1 Nesses casos, a conduta recomendada
DWXDOPHQWHFRPDFULDQDDQHVWHVLDGDH[DPLQDVHGHWL-
SRGH KDYHU KUQLD SRU GHVOL]DPHQWR FRQWHQGR D WURPSD H GDPHQWHVHPSUHGRLVFLUXUJLHVRODGRRSRVWRDRGDKU-
principalmente, o ovrio. QLDDVHURSHUDGDVHKRXYHUTXDOTXHUVXVSHLWDGHSHUVLVWQ-
(PJHUDOQRUHGXWYHOPDVUDUDPHQWHKFRPSURPH- cia do processo vaginal contralateral, indicada a
timento vascular nesses casos. H[SORUDR FLUUJLFD GR RXWUR ODGR DSV R WUPLQR GD KHU-
QLRUUDDXQLODWHUDOSURSRVWDLQLFLDOPHQWH2,3&RPHVVDFRQ-
Diagnstico diferencial duta cuidadosa, que informada aos pais da criana e auto-
+LGURFHOHWUDQVLOXPLQDRHLUUHGXWLELOLGDGH UL]DGD SRU HOHV SUHYLDPHQWH VR REWLGRV H[FHOHQWHV
KLGURFHOHFRPXQLFDQWHFRQWHGRWUDQVLOXPLQYHOHYDULDHV UHVXOWDGRV(VVDFRQGXWDGLWDGDSHODKLVWULDQDWXUDOGD
OHQWDVGHYROXPH HYROXR GR SURFHVVR YDJLQDO D SHUVLVWQFLD GR SURFHVVR
RUTXLWHVLQDLVHVLQWRPDVGHLQIHFR YDJLQDOGLPLQXLFRPDLGDGH(PFULDQDVRSHUDGDVFRP
WHVWFXORUHWUWLOEROVDWHVWLFXODUYD]LDLQWHUPLWHQWHPHQWH PHVHVRXPHQRVGHLGDGHDWD[DGHSHUPHDELOLGDGHIRLGH
DQRPDOLDV GH SRVLR GR WHVWFXOR FULSWRUTXLD HFWRSLD DX- HPDOJXQVWUDEDOKRVHDRVDQRVFDLXSDUD(P
VQFLDSHUPDQHQWHGRWHVWFXORQRHVFURWR HVWXGRVDQDWPLFRVHGHQHFURSVLDVHPDGXOWRVTXHIDOHFH-
2108 TRATADO DE PEDIATRIA SEO 25 CIRURGIA PEDITRICA
UDP VHP QXQFD WHU WLGR KUQLD FOQLFD D WD[D  GH DSUR[L-
PDGDPHQWH4
Hrnia inguinal encarcerada
e/ou estrangulada
Denio
(PJHUDODKUQLDLQJXLQDOWHQGHDVHUHGX]LUHVSRQWDQHDPHQ-
WHHPERUDSRVVDSHUPDQHFHUH[WHULRUL]DGDGXUDQWHPLQXWRV
RXKRUDV4XDQGRDUHGXRHVSRQWQHDQRRFRUUHWUDWDVH
GHKUQLDHQFDUFHUDGD
0DLV GD PHWDGH GRV FDVRV RFRUUH QR SULPHLUR DQR GH
YLGDVREUHWXGRQRVSULPHLURVPHVHV6HRHQFDUFHUDPHQ-
WR HVWLYHU SUHVHQWH SRU YULDV KRUDV SRGH KDYHU YPLWRV
GRUHPFOLFDGLVWHQVRDEGRPLQDOHSDUDGDQDHOLPLQDR
GHIH]HVHJDVHV6HDKUQLDQRIRUUHGX]LGDKFRPSUR-
PHWLPHQWR GD YDVFXODUL]DR FDUDFWHUL]DQGR KUQLD HV-
WUDQJXODGD TXH  UDUD HPERUD R HQFDUFHUDPHQWR VHMD UD-
zoavelmente frequente em lactentes.
Diagnstico diferencial
+LGURFHOH WRUR GR WHVWFXOR RUTXLWH H WXPRU GR WHVWFXOR
Incidncia
+LGURFHOHVVRFRPXQVHPPHQLQRVSHTXHQRV&RPRDVKU-
nias, so mais frequentes direita que esquerda, mas podem
VHUELODWHUDLV
Diagnstico
7UDQVLOXPLQDRSRVLWLYDFRQVLVWQFLDFVWLFDHYDULDHVGH
YROXPHQDKLGURFHOHFRPXQLFDQWH
Diagnstico diferencial
+UQLDLQJXLQDOFRQWHGRQRWUDQVLOXPLQYHO
KUQLDLQJXLQDOHVWUDQJXODGDGRUYPLWRVSDUDGDGRWUQVL-
WRLQWHVWLQDO
WXPRUGRWHVWFXORWHVWFXORGHFRQVLVWQFLDUPHQRWUDQ-
VLOXPLQYHOFRPYROXPHDXPHQWDGRHPGRVFDVRVGH
WXPRUHVWHVWLFXODUHVKKLGURFHOHDVVRFLDGD
Tratamento
1. ,QGLFDR RSHUDWULD QDV KLGURFHOHV GD YDJLQD H GR FRUGR
DSV RV  PHVHV GH LGDGH VH QR KRXYHU UHJUHVVR HVSRQW-
QHDHQDVKLGURFHOHVFRPXQLFDQWHVDSVRGLDJQVWLFRQR
SULQFLSDOPHQWHSHODKLVWULDFOQLFD KULVFRGHHQFDUFHUDPHQWRPDVQRKFXUDHVSRQWQHD
2. 3URSHUDWULR URWLQD SURSHUDWULD PQLPD DXVFXOWD FDU-
Tratamento GLRSXOPRQDU H[DPH GD SHOH KHPRJUDPD H FRDJXORJUDPD
1. ,QGLFDRRSHUDWULDYHULFDURWHPSRGHHQFDUFHUDPHQWRH completos).
HPDWKRUDVWHQWDUDUHGXRPDQXDO$UHGXRGHYHVHU 3. 2SHUDRUHVVHFRSDUFLDOGDWQLFDYDJLQDOHPWRGRVRVFD-
WHQWDGD FRP VHGDR SRVLR GH 7UHQGHOHPEXUJ EROVD GH VRVHOLJDGXUDDOWDGRSURFHVVRYDJLQDOQDVKLGURFHOHVFRPXQL-
JHORVREUHDKUQLDHPDQREUDVGHOLFDGDVDSVFHUFDGHPL- cantes.
QXWRVGHHVSHUD6HDKUQLDIRUUHGX]LGDDRSHUDRGHYHVHU 4. 3VRSHUDWULR DOWD KRVSLWDODU H UHDOLPHQWDR TXDQGR D
IHLWDDSVKRUDV6HHVVDWHQWDWLYDQRIRUEHPVXFHGLGDD FULDQD HVWLYHU EHP DFRUGDGD 1R K UHWLUDGD GH SRQWRV FL-
H[SORUDRFLUUJLFDLPHGLDWDHVWLQGLFDGD UUJLFRVYLVWRTXHDVXWXUDLQWUDGUPLFDFRPRDEVRUYYHO
2. 3VRSHUDWULR 2FXUDWLYRIHLWRFRPFROGLRHOVWLFRQRVHQGRQHFHVVULR
FRPUHVVHFRLQWHVWLQDOGLHWDRUDO]HURVRQGDJHPJVWULFD troc-lo.
KLGUDWDRYHQRVDHUHDOLPHQWDRTXDQGRKRXYHUSHULVWDO-
WLVPRIUDQFRUXGRVSHULVWOWLFRVDXGYHLVHHOLPLQDRGH Ao nal da leitura deste captulo, o pediatra deve estar apto a:
JDVHV Indicar a operao, o mais precocemente possvel aps
VHPUHVVHFRLQWHVWLQDODOLPHQWDRRUDOTXDQGRKRXYHU o diagnstico, das hrnias inguinais, principalmente at
SHULVWDOWLVPRIUDQFRDOWDKRVSLWDODUDSVGHQLRGRTXD- os 6 meses de idade em vista da probabilidade maior
GURFOQLFR de encarceramentos nesta faixa etria. Muitas vezes, a
famlia quer adiar por algum motivo (festas,
&RPRDVXWXUDLQWUDGUPLFDFRPRDEVRUYYHOHRFXUDWLYR aniversrios, viagens) e o pediatra no deve concordar.
IHLWRFRPFROGLRHOVWLFRQRKQHFHVVLGDGHGHUHWLUDUSRQ- Orientar que as hidroceles, bastante comuns em recm-
tos ou trocar curativos. -nascidos e lactentes, no oferecem risco algum e que a
conduta observar sua involuo espontnea, o que
Hidrocele acontece quase sempre, sem necessidade de indicao
Denio cirrgica.
+LGURFHOHYDJLQDOFROHRGHOTXLGRFLUFXQVFULWDWQLFDYD- Fazer o diagnstico diferencial das hidroceles por meio
JLQDOSUSULDGRWHVWFXORFRPREOLWHUDRGDSRURSUR[LPDO da transiluminao com uma pequena lanterna comum.
GRSURFHVVRYDJLQDODPDLVFRPXP Orientar que nas operaes para correo de hrnias e
KLGURFHOH GR FRUGR FROHR GH OTXLGR QR SURFHVVR YDJLQDO hidroceles no h necessidade de antibioticoterapia
FRPREOLWHUDRQDVSRUHVSUR[LPDOHGLVWDOUDUD preventiva ou proltica. So operaes, se feitas por
KLGURFHOH FRPXQLFDQWH REOLWHUDR SDUFLDO GR SURFHVVR YDJL- cirurgies pediatras, que no entram na cavidade
QDOSHUPLWLQGRDSDVVDJHPOHQWDGHOTXLGRGDFDYLGDGHSHUL- peritoneal, so rpidas, atraumticas e com isso a
toneal. contaminao praticamente no existe.