Melomed Articles


18 May 2020 - Dr. Babalwa Nondela

What Is Inguinal Hernia In Children?


Inguinal hernia happens when an opening is present in the abdominal wall in the groin (inguinal) area through which a sac protrudes from the abdomen (belly). 

In children it is generally a developmental abnormality they are born with. When a baby boy grows in the womb, the testicles first grow in his belly. As he develops, his testicles move down a tunnel into the scrotum. (This tunnel also exists in girls). Occasionally, the tunnel does not close, leaving an opening from the belly into the groin where a piece of intestine, fluid or an ovary can pass through. 

About 1- 4% of healthy, full-term babies are born with an inguinal hernia. Incidence increases to nearly 30% in preterm infants. 

If an inguinal hernia is not treated, it can cause serious problems. 

How do I suspect inguinal hernia?
Children commonly present with a painless soft bulge in the groin or scrotum that typically come and go. It might only be noticed when the child is crying, coughing, or straining during a bowel movement, or it might appear to be larger during these times. 

NEVER IGNORE: pain or distress or bulge in an infant or child. Call your doctor for professional opinion or go to the emergency room.

What is an irreducible hernia?
If the defect in the belly is small to moderate in size, a piece of intestine might get trapped, or irreducible (cannot push the bulge back into the belly). This can cause problems such as firm bulge, pain, nausea, vomiting, or absence of bowel movements. Larger abdominal wall defects allow the intestine to move freely in and out of the groin tunnel and do not tend to be as painful.

What is a strangulated hernia?
If the intestine becomes irreducible, blood flow to the trapped organ might become blocked, referred to as a strangulated hernia. The child might have a firm and very painful bulge, redness or bruising around the bulge, no appetite, and sometimes fever and bloody stools. This condition requires prompt surgery, as delay might cause death and loss of the trapped piece of intestine or ovary.

This hernia is frequently confused with a less serious condition, a hydrocoele.

A hydrocele is a painless fluid filled sac in the groin or scrotum. A hydrocele does not require immediate surgery unless it causes pain.  

What is the role of imaging?
Thorough clinical assessment can confirm suspicion of inguinal hernia or make a differentiation from other similar conditions. If in doubt, an ultrasound can be done to help make a proper diagnosis. 

What is the treatment?
Surgery is mandatory to repair an inguinal hernia to prevent intestinal damage and further complications. Once a hernia is noticed, the child needs to be referred to a Paediatric Surgeon. The timing of the surgery depends on the age, severity of the symptoms and the type of hernia. An irreducible or strangulated hernia needs to be taken care of immediately. For a reducible hernia, surgery can be scheduled for the next days or weeks.

Before the surgery
The child should not eat for 6 hours before the surgery to reduce the risk of vomiting and aspiration (inhaling fluids) while under anaesthesia.

During the surgery
During a hernia operation, the child will be asleep under general anaesthesia. The child will not feel pain during the surgery.

What are the surgical options?
Specific treatment will be based on the following:
  • childs age, overall health
  • the type of hernia
  • childs tolerance for specific medications or procedures

  • For an open hernia repair approach: Small incision is made near the bulge and the contents of the hernia are pushed back into the abdomen. (If intestine is strangulated viability will need to be ensured before reducing it). The inguinal tunnel where the organs are exiting from the abdomen is closed. The muscles are then stitched together. 

    For laparoscopic (scope) approach: Small cuts are made on the abdomen allowing the scope and instruments to be inserted to see and repair the hernia.

    If the child is younger than 1 year old, the chance that a hernia will develop on the other side of the groin is very high. Exploration and or repair of both inguinal areas is, therefore, recommended. 

    After the surgery
    Most children will be able to go home a few hours after surgery. However, premature infants and children with certain medical conditions might need to spend a night in the hospital for observation.

    Melomag

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