Inguinal Hernia in Infants & Children

Inguinal Hernia in Infants & Children

Inguinal hernia, is one the surgeries performed frequently during childhood years. The prevalence of inguinal hernia is 1-3% in full term babies, 16-25% in preterm babies. The rate is higher in boys. Especially in male babies upon straining or crying the swelling in the groin will appear. Although inguinal hernia is not an inherited disease, it may be found in the family history in 5 to 20% of the cases.

Inguinal hernia seen in infants and children, is the swelling and protrusion which may be seen or felt in the inguinal region. Premature birth is a risk factor for this kind of hernias.

There are three types of inguinal hernia seen in infants and children:

  • Indirect inguinal hernias: Indirect inguinal hernia is the most commonly seen type of inguinal hernia in children. During fetal development there is an inguinal canal in the groin which leads from the baby’s stomach to the sexual organs. This canal, in boys allows descent of the testicles into the scrotum. However, in males as well as females it is necessary that this canal closes off before birth. This type of hernia occurs during fetal development if the inguinal canal fails to close off completely.
  • Direct inguinal hernias: Direct inguinal hernia is rarely seen in children. This type of hernia occurs due to a weakening of the abdominal wall which permits the herniation of the intestines. In some cases of male patients where the inguinal canal fails to close, fluids from the abdomen leak into the scrotum and pool around the testicles causing swelling subsequently potentially leading to hydrocele.  
  • Femoral hernias: Femoral hernias are also rarely seen in children and it is caused by a weakening which allows the herniation of intestines or tissues located in the femoral canal. This type of hernia is more common in girls.

Even though hernias can be seen in any age group, it is most commonly seen in the neonatal period. Yet it may take a few weeks or months for the herniation to be noticed during the neonatal period. If your child has a hernia you may be able to see a swelling in the groin region. This bulge, which typically goes up and down, can get bigger when your child strains or cries. The bulge will get smaller or disappear when your child relaxes or sleeps.

Inguinal hernia in infants and children is the failure of closure of the peritoneal membrane that extends into the inguinal canal during the development of the baby. For this reason, inguinal hernia can be called a congenital abnormality seen in children. The testicles in the abdomen pass through the canals in both groins and reach the boy's scrotum. These canals should close off completely close to the time of birth. With this closure, there is no connection between the inside and outside of the abdomen. However, if these channels are not closed properly, a piece of intestine may enter the scrotum and groin and cause hernia. This swelling, called a hernia, appears and is uncomfortable when the child strains or cries. Children who experience this situation cannot fully abduct their leg on the side of the hernia and typically  the children will limit their movements as well. In addition to this, although very rarely, yellow-green vomiting may be observed in children. Inguinal hernia is a condition that occurs in girls as well. However, the herniating organ in girls is the ovary.

Unlike abdominal hernias, inguinal hernias do not resolve on own and require surgery. Incarceration of the hernia occurs when the intestine gets trapped within the defect and unable to return to abdominal cavity.

This type of hernias are painful and cause a stiff swelling. If you notice such symptoms in your child you should go to the emergency services immediately. The surgery for inguinal hernia is a day surgery and it is typically performed under general anesthesia, however regional anesthesia can also be used. Your child will be sleeping during the surgery. However, babies younger than 60 weeks may need to stay for 1 night for apnea monitoring after the anesthesia procedure.

The instructions given to you after the treatment will differ according to the surgeon, your child's age and the procedure performed. However, in general, after the procedure, your child can continue routine feeding. Within 1-2 weeks, the child can start non-strenuous activities. It is also important that the child does not take a bath for 2-3 days after the procedure. If you observe some symptoms in your child who was discharged after the procedure, you should definitely consult a specialist. These symptoms are as follows:

  • High fever
  • Swelling, redness or pain including any signs of infection
  • Any discharge from the incision site
  • Any pain which does not resolve with the prescribed medications
  • Painful, hard swelling
  • Vomiting, nausea

For inguinal hernia, you need to make an appointment with the Pediatric Surgery department.

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