A 3-month-old, 3.5 kg male infant, born full term following a normal spontaneous vaginal delivery and diagnosed with Trisomy 21 and congenital heart disease at birth, is booked for an urgent inguinal hernia repair. He is scheduled forsurgical repair of his atrioventricular septal defect the following week, but unfortunately presented to the ER with a poorly reducible right-sided inguinal hernia.
Similarly to any patient presenting with an inguinal hernia, this patient needs to be evaluated for NPO status,presence of bowel sounds/obstruction or emesis. In terms of his cardiac status, it is important to review the history,existing imaging studies, current medications and assess the patient for signs and symptoms of congestive heart failure(Failure to thrive, poor feeding, cold sweating with feeding,tachypnea, history of recurrent respiratory infections, etc.) or pulmonary hypertension (hepatomegaly, tachypnea,cyanosis).