The Accuracy of Silk Glove Sign Compared with Ultrasonography in the Diagnosis of Inguinal Hernia in Children
Puntharee Taisab MD**, Mongkol Laohapensang MD, FRCST*
Affiliation : * Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Saraburi Hospital, Saraburi, Thailand
Background : History taking and physical examination regarding the “Silk Glove Sign”, are useful tasks to diagnose indirect
inguinal hernia in children. The accuracy of silk glove sign however, varies among physician’s experience. Recent studies
demonstrated ultrasonography to play a role in the diagnosis of inguinal hernia.
Objective : To compare the accuracy between silk glove sign and ultrasonography.
Material and Method: 36 patients (22 unilateral, 14 bilateral) with clinically diagnosed indirect inguinal hernia were
included into a double-blinded trial. There were 25 boys and 11 girls enrolled, which median age was 12 months old (range
1 to 72 months). Silk glove sign was performed at both groins by the authors blinded to the clinical diagnosis followed
by bedside ultrasonography. Correspondingly, herniotomy was performed in the diagnosed groin only. The results of
ultrasonography were compared to silk glove sign. The gold standard was groin exploration.
Results : Of the 36 patients, there were 50 groins diagnosed as indirect inguinal hernia, which underwent herniotomy. Forty-
eight hernial sacs were identified. The median size of the hernial sac was 3 mm (range 0.7 to 20 mm). The two negative
findings; one had positive silk glove sign whereas the other negative in both silk glove sign and ultrasonography. The
sensitivity of Silk Glove Sign was 89.6% and specificity was 50%. The sensitivity of ultrasonography was 95.8% and
specificity was 100%. Total accuracy of silk glove sign was 88% and ultrasonography 96%. The important sign that
suggested a hernial sac from ultrasound technique was the demonstration of a sac located above the inferior epigastric
vessels at the level of internal inguinal ring, which became wider when we applied positive pressure to the abdomen.
Conclusion : Ultrasonography of the groin is a useful non-invasive technique in the diagnosis of inguinal hernia in children.
It provides more accuracy than Silk Glove Sign and can be used for detection of metachronous lesion in unilateral inguinal
hernias.
Keywords : Inguinal hernia, Metachronous inguinal hernia, Silk Glove Sign, Ultrasonography
