Bilateral congenital perineal hernias: Spontaneous resolution

A congenital perineal hernia develops through a defect in the pelvic floor muscles and presents as a reducible buttock swelling. These hernias are exceptionally rare with only six cases previously documented in the English literature. We report an extremely premature infant who developed bilateral posterior perineal hernias at 2 weeks of age. The diagnosis was confirmed by ultrasound scan. She remained asymptomatic. By a corrected age of 10 weeks post term, the hernias had resolved clinically and on imaging. A congenital perineal hernia should be considered in the differential diagnosis of a reducible buttock swelling. The diagnosis can be confirmed by imaging and elective surgical repair is indicated for symptomatic or persistent hernias. This case demonstrates that an asymptomatic perineal hernia in a very premature infant should initially be managed conservatively as it may resolve spontaneously.