One commonly associates hernia and hydrocele with elderly people but even children can suffer from the hernia. In fact, it is one of the most common surgical conditions in children. But the good news is that hernias in children can be treated easily with very minor surgery and has a 100% cure rate.
A swelling or a bulge in the groin or scrotum seen during crying or straining is commonly due to a hernia. It may be noticed incidentally while giving a bath and it may get smaller or go away when the baby relaxes. The swelling is usually not tender and does not cause any discomfort to the baby. Umbilical hernia in children younger than six months or newborns is more common
How does a hernia occur in children?
When the baby is inside the mother’s womb, the testicles or ovaries develop in the tummy near the kidneys. They gradually descend into the lower part of the tummy as the baby continues to develop. As they move down they make a small opening in the lower tummy or groin and the testicles come down to lie in the scrotum. This opening normally obliterates before the baby is born eliminating any connection between the tummy or abdomen and the groin. If for any reason the closure is delayed or incomplete, fluid and intestines from the abdomen may bulge into the groin. If only fluid comes out, it is called a hydrocele and if the intestines start coming out it is termed as a hernia. The intestines coming out is seen as a bulge or swelling in the groin which appears when the baby stains his tummy while crying or coughing and reduces when the baby is relaxed and the intestines go back into the tummy. It is different from a hernia in adults where the intestines bulge out due to weakness in the wall of the abdomen and hence the treatment of hernia in children is slightly different from adults.
The hernia is the commonest surgical problem in children. It occurs in 1-4% of all children. Approximately 80 - 90 % of inguinal hernias appear in boys. They are more common on the right side, but in about 10 percent of cases, they occur on both sides. The hernia is more common in babies who are born prematurely. Most of the children present within the first two years of life but a hernia can be detected at a later age too.
How to diagnose a hernia in children?
Usually, a thorough examination by a pediatric surgeon (surgeon specializing in surgery for children) is good enough to diagnose pediatric hernia and no further tests are required.
How to treat a hernia in babies?
Inguinal hernias are treated by pediatric surgeons and require minor surgery, carried out under general anesthesia. It may be done with a small open incision or through laparoscopy. Open surgery is done through a small incision in the groin while laparoscopy involves three-minute keyholes in the tummy to close the hernia defect permanently. Unlike adults, no permanent mesh is required in children. During the procedure, a long-acting numbing medicine (local anesthetic) is injected around the incision to help control pain. Most children who undergo hernia treatment usually go home the same day after a short recovery stay. However, premature infants may require an overnight stay. Most children are able to return to normal activities, even sports, with no restrictions within a couple of days. The procedure has a very few side effects like minor swelling in the scrotum which may persist for a week but is self-limiting. Once operated the hernia rarely re-occurs (< 0.5%).
If the doctor is able to gently press back the bulge into the abdomen, the hernia is termed reducible. But at times it may become irreducible or obstructed and cannot be pressed back into the abdomen. This causes obstruction to the blood supply of the intestine and unless treated urgently may cause localized irreversible death of the intestine (gangrene). Hence an irreducible hernia is a surgical emergency and needs to be operated on immediately. When a hernia becomes obstructed, babies will stop feeding, become irritable, and may vomit. The swelling does not go back and becomes tender and red. If any of these features appear one should immediately consult a pediatric surgeon. In order to avoid this complication, it is advised to get the hernia operated on as soon as possible.
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