Brian S., 2

Brian Shikanda is a cheerful 2-year-old boy currently under the care of his aunt and well-wishers. His mother left the country in search of employment and has not been in contact since her departure. The aunt, who is currently unemployed, has been looking after Brian ever since, and the family does not know the mother's whereabouts. Brian was healthy from birth until around eight months of age, when he had already begun walking. At that time, his guardian noticed a swelling in his left scrotum, which appeared intermittently—sometimes reducing and then recurring. Initially, it did not raise concern. However, about three months ago, the condition worsened, and Brian began experiencing difficulty urinating, increased swelling, and scrotal pain. He also had a fever and loss of appetite as per the time he was bein admitted. He was diagnosed with severe malaria, severe anaemia, inguinal hernia and phimosis.

Brian was admitted with inguinal hernia and phimosis but also had a very high fever when he presented to the hospital. On examination, he was febrile, pale, and lethargic, with laboratory results showing Hb 5.2 and platelets 108. He was diagnosed with severe malaria and anemia and admitted for medical management, including oral antimalarials and blood transfusion. Once stabilized and fit for anesthesia, he underwent herniotomy and circumcision, with hemostasis achieved successfully. At a follow-up review five days after discharge, Brian was found to be recovering well.

If phimosis and a left inguinoscrotal hernia are not treated in a 2-year-old boy, the child may face complications. Pathological phimosis can lead to recurrent infections, difficulty urinating, urinary tract infections, and hygiene issues, while the inguinoscrotal hernia poses a more urgent risk, potentially resulting in bowel incarceration, strangulation, and testicular damage if left untreated. While mild phimosis may be monitored, inguinal hernias in children typically require timely surgical intervention to prevent life-threatening complications.