Inguinal hernia in children

When a portion of the intestine pushes through a weak spot in the abdominal muscles, it can cause an inguinal hernia in children, which manifests as a noticeable bulge in the groin area. Although both boys and girls can be affected by this condition, boys are more likely to experience it, particularly in newborns or premature babies.

When a child cries, coughs, or strains, the abdominal pressure can rise, and parents may notice the bulge. Usually, the bulge disappears when the child is at ease or resting. Despite its seemingly benign appearance, an inguinal hernia requires medical attention because complications may arise in certain cases.

It’s critical to recognize the symptoms of an inguinal hernia and to seek treatment as soon as possible. Surgery is usually needed to resolve the issue and reduce future health risks. This article will define an inguinal hernia, discuss its symptoms, causes, and available treatments for kids.

Topic	Description
What is an inguinal hernia?	An inguinal hernia occurs when a part of the intestine pushes through a weak spot in the lower belly, creating a visible bulge in the groin area.
Causes	Inguinal hernias can be caused by a weakness in the abdominal muscles, often present from birth.
Symptoms	Common signs include a bulge in the groin, discomfort, or pain, especially when a child cries or strains.
Treatment	Surgery is usually needed to fix the hernia and prevent complications like strangulation, where blood flow is cut off.
When to see a doctor	If the bulge becomes painful, changes color, or doesn’t go away when the child is relaxed, see a doctor immediately.

What is it

The condition known as "children’s hernia in the groin" occurs when the peritoneum’s vaginal process extends through the inguinal canal. A hernial sac is what tries to escape through the inguinal canal. It contains sections of internal organs like the intestines and bladder. The inguinal canal is a tiny opening between ligaments and muscle tissue in the groin region. The uterine round ligament lies inside the gap in female children, and the spermatic cord passes through it in male children.

Hernial formations in the groin are most frequently observed in boys, according to statistics. Several estimates place their chance of developing this illness at 25–30%, compared to only 3% for girls. Pediatricians say that for every girl diagnosed with this kind of issue, there are six boys with the same issue.

Compared to babies born on schedule, premature babies have a much higher chance of experiencing an inguinal hernia. For the former, the development risk is at least 25%, whereas for timely-born children, it is only 5%.

Causes of occurrence

Groin hernias are thought to be congenital; adults and the elderly are more likely to have acquired forms. The conditions for the development of a groin lump in both boys and girls are always set when they are inside their mothers’ bellies.

The testicles in future boys form in the abdomen during the embryonic stage. Only in the fifth or sixth month of pregnancy do they start to descend to the inguinal canal. They also "pull" the peritoneum in a way at the same moment. In the ninth month of pregnancy, the testicles finally descend toward the time of childbirth. The vaginal process is that same pulled pocket of peritoneum that developed as a result of prolapse.

Usually by the time the boy is born, it has tightened all the way. In the unlikely event that this does not occur, there is still an open passage between the inguinal canal and the abdominal cavity. Due to this, it is possible for the intestine or another internal organ to follow the route taken by the testicle. This is what will develop into a groin hernia.

While the mechanisms behind the appearance of hernias in boys are generally well understood, there are typically more unanswered questions when it comes to girls. The female embryo’s anatomical characteristics hold the answers. In females, the uterus is also misaligned from the start. Initially, this crucial reproductive organ is developed and placed far higher than it ought to be. Subsequently, the uterus starts to descend around the fourth or fifth month of pregnancy, dragging a portion of the peritoneum with it in the process.

It still has a similar vaginal process at its core. Furthermore, the hernial sac’s exit is not ruled out if, at the time of birth, the communication with the abdominal cavity has not closed. It is now evident why inguinal hernias occur in premature babies five times more frequently than in full-term babies.

However, the likelihood of an event and the actual hernia are not the same. There’s no hernia, but there might be a risk.

The following are the most frequent causes of the hernial sac’s continued protrusion outward:

• genetic predisposition to weakness of the peritoneum;
• cystic neoplasms of the spermatic cord;
• hydrocele (dropsy of the testicle);
• hip dysplasia;
• herniated formations of the spinal cord, problems with the spine.

Hernias that develop later (after 9–10 years) in the groin are extremely uncommon, and their underlying causes might differ from those that affect newborns and infants. Due to the aforementioned congenital predisposition, children who are extremely obese, have an inactive lifestyle, move little, do not participate in sports, experience severe constipation on a regular basis, or have respiratory conditions that are linked to a persistently strong cough may develop inguinal hernias.

Classification

A hernia is categorized as either right- or left-sided based on which side it manifested. Males are more likely than girls to have right-sided hernias; this type of hernial sac localization is uncommon in young princesses. In one-third of cases, hernial formations are observed in the groin area on the left.

The vast majority of cases of simultaneous hernias on both sides occur in girls. About 12 percent of male children have bilateral hernias.

The two types of inguinal hernias are oblique and direct, just like many other hernial formations. Oblique hernias pass through the inguinal ring and enter the inguinal canal, exactly replicating the path taken by the testicles during their perinatal years. Rarely do children develop direct hernias, in which the hernia sac emerges through the peritoneum.

A distinct kind of illness known as scrotal or inguinal-scrotal hernia occurs in boys.

A distinction is made between the following based on the sac’s mobility or immobility:

• strangulated hernia;
• elastically strangulated hernia;
• hernia with fecal strangulation:
• hernia with Richter strangulation (parietal strangulation of an intestinal loop);
• hernia with retrograde strangulation (when two or more organs are strangulated);
• unincarcerated.

Reduction is limited to non-incarcerated inguinal hernias. Surgical procedures are used as a form of treatment for all types of imprisonment.

Dangers and complications

The primary risk factor for an inguinal hernia is the possibility of it becoming imprisoned. Nobody is able to foresee what will happen. When there is a fecal type of pathology, the intestinal loop overflows and enters the sac with fecal matter, incarcerating the patient retrogradely. This compresses both the intestinal mesentery inside the sac and the intestinal mesentery outside the abdominal cavity.

Without fail, if a child has been strangled, they require immediate, critical surgical care. Any form of incarceration is linked to an inadequate blood supply to the compressed organ, which can cause necrosis and tissue death very rapidly—sometimes in a matter of hours. Even in this advanced era of surgical medicine, 10% of cases of pinched organ gangrene are reported to doctors. The mortality rate is roughly 3.9%, but it can range from 20 to 35% in cases of gangrene.

There is always acute incarceration. The patient experiences excruciating pain in the groin area, nausea, and occasionally frequent vomiting. The hernia becomes irreducible, and the patient’s condition rapidly deteriorates. Self-medication attempts and delays are risky. The small patient needs to be taken to a surgical hospital immediately.

To be fair, it should be mentioned that incarceration does not usually exacerbate inguinal hernias in children. However, the parents of a child with a diagnosis of this kind of hernia who are unsure about surgery ought to be ready for such a development. The likelihood of a child being strangled increases with age.

A common condition in children is an inguinal hernia, which occurs when abdominal tissue or a portion of the intestine pushes through a weak spot in the groin area. It usually manifests as a conspicuous protrusion and may be uncomfortable, particularly if the child is wailing or exerting excessive effort. Even though it might not hurt all the time, getting medical help is necessary to avoid complications. Hernia repairs frequently require surgery, and prompt medical attention can help to ensure a speedy and secure recovery.

Symptoms and signs

Diagnosing an acute condition linked to strangulation is not difficult. Finding an inguinal hernia before strangulation complicates it is far more difficult. The truth is that the groin hernia’s formation is the only sign of the condition. It has a somewhat projecting appearance and resembles a rounded or asymmetric seal.

In infants, the pathology is most easily noticeable. For instance, in infants younger than a year old, a one-year-old child whose parents frequently bathe and change clothes will exhibit signs of a hernia when they cry uncontrollably or scream or cough. The baby’s hernia won’t be apparent when they are calm, not straining their abdominal wall, or sleeping.

Boys who have a scrotal hernia will have a deformed sac because it is located inside the scrotum. One labia is significantly larger than the other in girls because the hernia typically chooses to descend into the labia. If a condition affects both lips, they will both be abnormally large.

Finding a hernia in children older than five or six years old may be more challenging because parents are no longer ethically permitted to access every part of their child’s body. But these kids can express their frustrations verbally. It is important to pay attention to complaints of excruciating lower abdominal pain, as well as pain and distension in the scrotum and groin following a strenuous walk or run.

A hernia that is not imprisoned shouldn’t cause the child any concern.

The following symptoms ought to compel parents to take their child to the hospital right away:

• bloating, no gas discharge;
• increasing pain in the groin area – from tingling and pulling sensations to acute pain;
• the hernial sac becomes hard, tense and motionless, touching it causes severe pain in the child.

Diagnostics

An inguinal hernia is typically discovered in the early months of a child’s life. Frequently, the parents discover it on their own; occasionally, a pediatric surgeon finds it while doing a standard clinic examination. A child from birth to one year old should typically be examined in a horizontal position.

Two-year-olds can undergo examinations while standing, and it is required to evaluate the hernia when the child leans forward. For four-year-olds, the surgeon will assign another "task": coughing. This is because the cough reflex allows the surgeon to examine the hernia more closely and determine its size.

The physician will then make a referral for an ultrasound examination after comparing the size and shape of a girl’s labia and the symmetry of a boy’s testicles. Girls have an ultrasound of the abdominal cavity and pelvic organs, while boys have an ultrasound of the inguinal canal. In addition, boys are prescribed a scrotal diaphanoscopy. This is a straightforward and painless process that involves determining how well the organ can allow light to pass through it. Using this technique, you can confirm or deny hydrocele as a potential underlying reason for a groin hernia.

A cystography, which involves injecting a special substance into the bladder so that it is clearly visible on an X-ray and allows you to examine the condition of the pinched organ in detail, will be recommended if an ultrasound reveals that part of the bladder has descended into the hernia sac. If the results of the ultrasound show that there is an intestinal loop within the contents of the sac, an irrigoscopy is recommended. An enema is used to inject a contrast solution into the child’s rectum, and an X-ray is then taken to evaluate the features of the pinched organ.

Treatment

Doctors are typically fairly categorical when it comes to inguinal hernias and recommend surgically removing the hernia sac as a course of treatment. It is true that there is a chance of complications, and maintaining the hernia is essentially useless.

Unlike a baby’s umbilical hernia, an inguinal hernia does not go away on its own.

Comparing the vaginal process to the umbilical ring, it will not grow over or tighten. Physicians should take further action if this did not occur at the time of birth. You need to have an operation; sealing with a plaster and relying on a special bandage won’t help. A "herniorrhaphy" is the only procedure that can be used to address the issue. Nonetheless, data indicates that following such an operation, genitofemoral pain syndrome affects roughly 10% of patients. Children with small unconfined hernias are therefore granted a "deferral," opting for the cautious waiting approach.

The procedure itself is not thought to be the most difficult; even a novice surgeon can complete it (this is actually frequently the case; during hernia repair, yesterday’s medical university graduates experience their first "baptism of fire"). Thus, before executing a planned operation, parents who are naturally concerned about the outcomes of surgical intervention should find out about the specialist’s credentials. Children are put under general anesthesia during surgery. Initially, medical professionals make an incision to enter the inguinal canal, after which they locate and remove the hernial sac. The inguinal canal is then rebuilt if it is destroyed and sutured back to its normal, natural size.

A hernia can be closed with a mesh if it was possible to reduce it during surgery and do without removal. Surgeries are most often performed using a non-cavity method. For this, laparoscopy is used. Laparotomy (incision of the abdominal wall) is performed only when part of the intestine is non-viable due to strangulation of the hernia and it needs to be removed. After laparoscopic surgery, children quickly come to their senses, get up in a few hours, the recovery period is short. The probability of relapse is about 1-3%. Uncomplicated small groin hernias are removed in children on a planned basis, the child can be discharged home if he/she feels normal in 3-4 hours.

The prognosis is considered conditionally favorable by doctors. The patient can permanently forget about the inguinal hernia if the procedure went well and they follow all the instructions afterward.

Rehabilitation recommendations

In roughly a month following the procedure, the child is introduced to therapeutic exercise. It is available for use in the local clinic’s therapeutic exercise room. Ball, stick, and gymnastic wall exercises are meant to assist the child in getting back to their regular life as quickly as possible. Furthermore, this kind of physical education enhances homeostasis, fortifies abdominal wall muscles, and quickens the process of tissue regeneration in the surgical intervention area.

It is necessary to include breathing exercises in the list of exercises. The child can resume active walking (sports), skiing, and pool visits three to four weeks following the procedure. During this time, massage is used to strengthen the abdominal muscles and prevent disorders related to intestinal peristalsis. This is accomplished by massaging the child’s back along the spinal column, circling the navel, stroking the oblique abdominal muscles, and massaging the abdominal area. It is customary to conclude the massage by massaging the lower body, first kneading and then stroking the legs.

Bandages, or special holding devices, are worn after surgery to help the child and prevent potential relapses. Unlike adult bandages, children’s bandages must be purchased from specialized orthopedic salons after consulting the attending physician about the product’s size and other features.

Following surgery to remove an inguinal hernia, a bandage might be:

• left-sided;
• right-sided;
• bilateral.

Special inserts that are fixed in the area where the hernia was (or is) present are included with the bandage. It should be noted that these orthopedic devices only support the hernial sac from falling out and marginally lessen the risk of strangulation; they cannot treat a groin hernia. For this reason, we have included information on bandages in the section on rehabilitation.

When given the proper care, inguinal hernias in children are a common condition that can be effectively treated. Parents may find it worrisome, but problems can be avoided by being aware of the symptoms and getting medical help as soon as possible.

It’s crucial to get medical advice for your child if you observe any swelling or discomfort in the groin area. A speedy recovery and the avoidance of further problems can be ensured by early detection and appropriate treatment, frequently involving surgery.

You can assist your child in overcoming this condition and continuing to grow up healthy and active by remaining informed and mindful of their health.

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