Inguinal Hernia
My son has a swelling in the groin: What is it?
It could be a hernia or a hydrocele. Usually it causes no pain and the parents notice it when the child is in the bath or during changing of clothes.
What is a hernia?
A hernia occurs when an internal organ protrudes through a weak area of muscle. The common sites for hernias are the groin, belly button and other sites in the abdomen operation.
A hernia can happen at any age. You may be born with a hernia (congenital) or develop one over a period of time. With Inguinal Hernia means a protrusion of the peritoneum above inguinal ligament down towards the scrotum (in males) or labials (in girls). This bulge may contain fluid and / or bowel (or ovary in girls).
What causes an inguinal hernia? During gestation, a boy's testicles develop inside his abdomen, and then, sometime before birth, they push through a tunnel in the tissue between the groin and the abdomen (called the inguinal canal) and descend into the scrotal sac. In girls, the ovaries descend through the tunnel and into the pelvis.
This connection with the abdominal cavity is usually obliterated in the first months of life. If the connection is small, only fluid from the abdomen pass into the hernia sac, resulting in hydrocele. If the connection is larger and the intestine passes through it then inguinal hernia occurs.
Incidence
Inguinal hernia is present as a transient state during the passage of testicle to the scrotum of all boys in the fetus. This explains why it is very common with inguinal hernia in premature babies.
Inguinal hernia occurs in 3-5% of all full-term infants and is more common in boys than in girls. The herniated usually sits on the right side, but it can be on the left side and less frequent on both sides.
How can I tell if my daughter has an inguinal hernia? It's much less common for a girl to have an inguinal hernia, but it does happen occasionally. In this case, a loop of the intestines (or ovary) has pushed through the abdominal wall into her groin area or sometimes all the way into her labia (the loose skin at the opening of her vagina).
The protrusion will feel like a firm oblong lump. An inguinal hernia in a girl can also be fixed with minor surgery.
About 10% of all inguinal hernias in children presented with obstruction when the bowels go outside and become entrapped there.
Diagnosis
The diagnosis is clinical. Fluoroscopy or trans-illumination test with a torch is sometimes difficult to distinguish hydrocele from inguinal hernia because the intestinal wall in neonates is very thin and therefore transparent to light. Sometimes, if there is uncertainty to differentiate between hernia and hydrocele, one can have the help of X-ray "KUB " ( which can sometimes prove the presence of gas in the hernia sac ) or ultrasound ( which sometimes shows circulation and peristalsis of the intestines in any hernia sac ) .
The crucial assessment shall be based on medical history, clinical examination and status of the investigation.
Treatment and prognosis
Inguinal hernia has only minimal ability to spontaneously disappear and therefore should routinely undergo surgery (unlike a hydrocele which usually resolves spontaneously during the first year) (a study by Dr. Naji was published in European Journal of Pediatrics in 2012: http://www.ncbi.nlm.nih.gov/pubmed/22105873). The operation of uncomplicated hernia is usually simple and done under general anesthesia. No need for mesh or net in children (unlike in adults where the cause of inguinal hernia is usually due to a weakening of the abdominal wall). In children older than six months, surgery is performed as an outpatient surgery which means that the patient can go home on the same day of operation. Surgical results are good and complications are rare.
There are two surgical techniques:
Follow-up
The wound of the operation needs to be checked after one week. If the hernia was obstructed in a boy, the child should be examined about 6 months post op to check testicle viability.
Recurrence of hernia is rare (about 1%) unless the child has been severely sick at the time of op.
Author:
Dr. Hussein Naji
Consultant Pediatric Surgeon
Swedish Board Certified in Pediatric Surgery
European Board Certified in Pediatric Surgery
It could be a hernia or a hydrocele. Usually it causes no pain and the parents notice it when the child is in the bath or during changing of clothes.
What is a hernia?
A hernia occurs when an internal organ protrudes through a weak area of muscle. The common sites for hernias are the groin, belly button and other sites in the abdomen operation.
A hernia can happen at any age. You may be born with a hernia (congenital) or develop one over a period of time. With Inguinal Hernia means a protrusion of the peritoneum above inguinal ligament down towards the scrotum (in males) or labials (in girls). This bulge may contain fluid and / or bowel (or ovary in girls).
What causes an inguinal hernia? During gestation, a boy's testicles develop inside his abdomen, and then, sometime before birth, they push through a tunnel in the tissue between the groin and the abdomen (called the inguinal canal) and descend into the scrotal sac. In girls, the ovaries descend through the tunnel and into the pelvis.
This connection with the abdominal cavity is usually obliterated in the first months of life. If the connection is small, only fluid from the abdomen pass into the hernia sac, resulting in hydrocele. If the connection is larger and the intestine passes through it then inguinal hernia occurs.
Incidence
Inguinal hernia is present as a transient state during the passage of testicle to the scrotum of all boys in the fetus. This explains why it is very common with inguinal hernia in premature babies.
Inguinal hernia occurs in 3-5% of all full-term infants and is more common in boys than in girls. The herniated usually sits on the right side, but it can be on the left side and less frequent on both sides.
How can I tell if my daughter has an inguinal hernia? It's much less common for a girl to have an inguinal hernia, but it does happen occasionally. In this case, a loop of the intestines (or ovary) has pushed through the abdominal wall into her groin area or sometimes all the way into her labia (the loose skin at the opening of her vagina).
The protrusion will feel like a firm oblong lump. An inguinal hernia in a girl can also be fixed with minor surgery.
About 10% of all inguinal hernias in children presented with obstruction when the bowels go outside and become entrapped there.
Diagnosis
The diagnosis is clinical. Fluoroscopy or trans-illumination test with a torch is sometimes difficult to distinguish hydrocele from inguinal hernia because the intestinal wall in neonates is very thin and therefore transparent to light. Sometimes, if there is uncertainty to differentiate between hernia and hydrocele, one can have the help of X-ray "KUB " ( which can sometimes prove the presence of gas in the hernia sac ) or ultrasound ( which sometimes shows circulation and peristalsis of the intestines in any hernia sac ) .
The crucial assessment shall be based on medical history, clinical examination and status of the investigation.
Treatment and prognosis
Inguinal hernia has only minimal ability to spontaneously disappear and therefore should routinely undergo surgery (unlike a hydrocele which usually resolves spontaneously during the first year) (a study by Dr. Naji was published in European Journal of Pediatrics in 2012: http://www.ncbi.nlm.nih.gov/pubmed/22105873). The operation of uncomplicated hernia is usually simple and done under general anesthesia. No need for mesh or net in children (unlike in adults where the cause of inguinal hernia is usually due to a weakening of the abdominal wall). In children older than six months, surgery is performed as an outpatient surgery which means that the patient can go home on the same day of operation. Surgical results are good and complications are rare.
There are two surgical techniques:
- Open Surgery: This is where the surgeon makes an incision into the area of the hernia.
- Laparoscopic surgery: This is where a tiny telescope connected to a camera is inserted through a small port, allowing the surgeon to see the hernia and surrounding tissue on a television screen. Other small ports are inserted into the lower abdomen to allow the surgeon to insert fine laparoscopic instruments into the abdomen in order to repair the hernia.
Follow-up
The wound of the operation needs to be checked after one week. If the hernia was obstructed in a boy, the child should be examined about 6 months post op to check testicle viability.
Recurrence of hernia is rare (about 1%) unless the child has been severely sick at the time of op.
Author:
Dr. Hussein Naji
Consultant Pediatric Surgeon
Swedish Board Certified in Pediatric Surgery
European Board Certified in Pediatric Surgery