Inguinal Hernia in Children – Causes, Symptoms & Treatment
An inguinal hernia is a hernia that occurs in the groin region. When it occurs in babies, it is usually due to a congenital defect. It is more common in males, and it can be seen as a soft bulge in the groin area, or in the scrotum. It is a less common occurrence in female babies, but as they also have inguinal canals, an inguinal hernia is possible.
What is an Inguinal Hernia in Children?
A hernia occurs when, through a weak spot in the abdominal wall or muscles, a part of the intestines protrudes outwards, causing a bulge to appear. Generally, in children, this type of hernia is a congenital defect and not something that occurs due to external factors after birth. In adults, it can happen if the abdominal wall progressively weakens with age or due to a physical condition. But the chances of inguinal hernia occurring is rare in children or teenagers.
An inguinal hernia occurs in the groin region. It happens when the inguinal canal, through which the testicles move down from the abdomen into the scrotum, does not close, and the intestine starts protruding into the canal through weak abdominal muscles. There are two inguinal canals present in the human body, and thus, an inguinal hernia can occur on both sides. However, it is more common on the right side. The hernia can be felt as a soft bulge in the area between the abdomen and the top of the leg, or in the scrotum.
There are two main types of inguinal hernias:
1. Indirect Inguinal Hernia
This type of inguinal hernia is most commonly seen in children at birth. As mentioned, the inguinal canal is the opening through which testicles or ovaries descend down the abdomen. In both males and females, this canal closes prior to birth. But when it fails to close completely, abdominal organs such as the small intestines can protrude through it, causing a hernia.
2. Direct Inguinal Hernia
This type of hernia occurs due to a weakness in the abdomen walls due to strain or pressure, which allows the intestines to protrude through. This type occurs in adults and rarely in children, and is most common in males.
There are also a few cases where the inguinal canal in males fails to close, leading to the development of a hydrocele, a collection of abdominal fluids that drains down from the abdominal cavity and collects in the scrotum, causing it to swell. This can lead to the development of an inguinal hernia in boys.
Causes of Inguinal Hernia in a Child
In boys, the testicles develop within the abdominal cavity in the back, just below the kidneys. During the developmental phase of the foetus, the testicles normally descend from the abdomen to the scrotum, and as they do, the testicles drag a sac-like extension from the lining in the abdomen into the scrotum. This sac remains in the scrotum and covers it for the rest of the life, while the inguinal canal closes entirely. However, in cases of inguinal hernia in boys, the inguinal canal fails to close completely, leaving behind a path from the abdomen into the scrotum. As development continues, organs from the abdomen can spill through and end up protruding into the scrotum.
Inguinal hernias in newborns are only apparent when the contents of the abdomen move into the sac. Else, it is not possible to tell from external appearance unless the contents have escaped into the sac. But as the baby grows and the abdominal walls become stronger, they can start pushing contents through the opening and might even end up dilating it further. An inguinal hernia is possible in girls as well because they have the inguinal canal, and the tubes and ovary can fall into the hernia sac.
In some cases of inguinal hernia, the intestinal loop that protrudes through the inguinal canal gets stuck, and cannot be returned to the abdominal cavity by pushing it back. If this intestinal loop cannot be pushed back into the abdomen, it will eventually lose its supply of blood, and cause further complications. Intestines need plenty of blood supply to function properly and stay healthy.
Who Is at Risk?
Premature babies are at the highest risk of an inguinal hernia. This condition is also common in children who have:
- A family history of hernia
- Cystic fibrosis
- Un-descended testicles
- Developmental hip dysplasia
- Urethral abnormalities
Signs and Symptoms of Inguinal Hernia in a Child
Here are important indicators and symptoms of inguinal hernia in infants:
- An inguinal hernia will normally appear as a bulge in the scrotum, which may be accompanied by swelling.
- The swelling can become more prominent and noticeable when the baby cries and will shrink when the baby is relaxed.
- When the paediatrician applies gentle pressure on the swollen area, it may shrink, as the contents move back into the abdominal cavity (reducible hernia).
- If the organ is stuck in place and can’t be pushed back (incarcerated hernia), it leads to other symptoms such as a full and round belly, pain, fussiness, vomiting, redness or another abnormal color, and fever.
Some of the complications that arise due to an inguinal hernia include:
- Some parts of the intestine become dislodged in the abdominal muscles.
- Lack of blood flow to the intestine causes permanent damage.
An inguinal hernia is diagnosed by conducting a physical examination and checking about family history. The doctor checks if the hernia can be pushed back into the abdomen.
How Is Inguinal Hernia Treated in a Child?
An inguinal hernia does not resolve on its own, and surgery is necessary to fix the defect and prevent further damage to the abdomen. Especially in the instance of an incarcerated hernia, where the intestine becomes stuck without being able to retract into the abdomen, surgery is critical to avoid complications. A strangulated hernia, where blood flow to the intestine can become compromised, can make the child very sick. When a child shows signs of an incarcerated hernia, he should immediately be taken to a paediatrician.
Treatment for an inguinal hernia in infants involving surgical intervention. The infant can be taken home on the same day of surgery or the next day. If the baby is premature, he or she will be kept for an overnight stay for post-anesthetic apnea monitoring. The surgery is performed under general anesthesia, and the surgeon will discuss the best course of action with parents. The surgical procedure depends on the clinical situation; they can be:
1. Open Repair
Open repair is a procedure where a small incision is made in the groin along the crease of the skin’s fold. Sutures are used to close the hernia, and the overlying skin is sealed with a liquid adhesive that can keep the edges of the skin together as it heals and forms a waterproof dressing.
2. Open Repair and Laparoscopic Evaluation of the Other Side
This procedure is similar to the one given above, except that before the hernia is closed fully, a laparoscope with a tiny camera at its end is used to evaluate the other side for the presence of another hernia. If another hernia is found, a second incision is made on the other side, and the hernia is fixed. The laparoscopic evaluation for the opposite side is done based on the age of the patient. Since hernias on both sides are common in children, it is recommended to avoid further complications. The skin is then sealed with the liquid adhesive.
3. Laparoscopic Repair
A laparoscopic repair involves accessing the hernia through very small incisions in the belly button. A small laparoscopic camera helps with the procedure as the hernia is fixed. The repair is then held in place by sutures that dissolve over time while the overlapping skin is sealed with a liquid adhesive that stays in place for about a week. The liquid adhesive should not be peeled or picked from the skin as it could lead to the wound opening up before it heals.
Caring for a Child With Inguinal Hernia at Home
The post-surgery care for children with inguinal hernia depends on the specific condition and the instructions given by the doctors. But, in general, parents should follow these steps:
- The adhesive used to stick the overlapping skin can get wet in case you need to give the baby a bath. So be careful while your baby a bath. Also, avoid applying any ointments or petroleum jelly on it for about seven days after the surgery.
- Recovery time can vary depending on the complexity of the surgery. It is usually two weeks, and strenuous activities must be avoided the whole time.
- Your surgeon may also tell you to avoid bathing your child for 2-3 days, and give specific instructions regarding cleansing procedures.
When to See a Doctor
Your doctor will give you all the follow-up instructions about caring for the baby at home. However, there can be other reasons when it is good to call your doctor, such as:
- If you see any bleeding or fluid drain from the location of the incision
- Excess swelling or redness around the wound
- Fever higher than 101 degrees F
- Fewer soiled diapers than usual
After the inguinal hernia surgery, the outlook is positive for most children, as the chances for the hernia returning is very low. However, in cases of premature babies, there is some risk of hydrocephalus and secondary complications. In such instances, further corrective actions will be taken by the doctors.
An inguinal hernia is a congenital condition that causes the contents of the abdomen to make their way into the scrotum in boys. It is rare in girls, although they also have an inguinal canal. The condition can be easily treated with corrective surgery, and the children can go on to live a normal life.