Inguinal hernia in a 5-year-old boy. What does an inguinal hernia look like in a child?

Article publication date: 04/28/2015

Article updated date: 11/08/2018

When an inguinal hernia occurs in children, one or more abdominal organs protrude under the skin in the groin area. This occurs when the baby has thin structures that make up the anterior wall of the abdomen, due to congenital (most often) or acquired causes.

Most often, the disease manifests itself in the first 2 years of a baby’s life.

The hernia itself usually does not bother children in any way, does not hurt - it manifests itself only as a cosmetic defect. But sometimes the contents of the hernial sac can be strangulated - then urgent surgery is required.

Surgery is the only treatment method. It can be performed even on an outpatient basis, is well established and is almost always successful.

If the operation is carried out as planned, the disease will disappear from the child’s life forever.

In the inguinal canal in boys there is the spermatic cord, and in girls there is the round ligament of the uterus. An inguinal protrusion is formed when the abdominal organs pass through the inguinal canal.

Reasons for the development of pathology

This pathology is very common: it develops in 5% of full-term newborns, and in premature infants – 3–5 times more often (15–25%).

The causes of the development of childhood inguinal hernia are conventionally divided into congenital and acquired.

Congenital causes

Congenital protrusions occur due to connective tissue pathology.

Boys get sick 3–10 times more often than girls. This is due to the fact that in boys with congenital causes, a hernia forms just during the movement of the testicles into the scrotum. They come from the abdominal cavity, where they were formed, and must pass into the subcutaneous inguinal canal.

Girls don't have testicles. The ovaries do not go through the stage of moving, but remain forever where they are formed. Therefore it occurs extremely rarely.

Congenital hernial protrusion is often combined with pathologies such as spermatic cord cyst, testicular hydrocele, developmental anomalies of the spine and hip joints.

Acquired causes – in childhood

The acquired form of pathology develops as a result of:

• operations on the organs of the scrotum or abdominal cavity, in which an incision is made in the groin area;
• injuries to the area near the pubis;
• significant physical activity (heavy lifting, coughing or uncontrollable vomiting).

Types of pathology

Inguinal hernias occur in children
Congenital	Purchased
Unilateral (that is, the formation is observed in the groin on only one side)	Double sided
Straight (located closer to the vertical midline of the body than the spermatic cord or round ligament of the uterus). This type of pathology develops only due to acquired causes.	Oblique (located outside the spermatic cord or round ligament of the uterus). This localization can be either congenital or acquired.
Reducible	Irreversible In irreducibles, the adhesive process is highly developed (special “bridges” appear between organs from connective tissue similar to the peritoneum), which does not allow the contents of the hernial sac to “hide” into the abdominal cavity.
Strangulated (compression of the organs present in the hernial sac occurs by the hernial orifice - a ring of connective tissue)	Undisadvantaged

A direct inguinal hernia lies outside the spermatic cord, and an oblique one passes through it. Click on photo to enlarge

Characteristic symptoms

Parents can detect symptoms of pathology at any age, starting from birth, but Boys under two years of age are most often affected.

The disease manifests itself in the form of an elastic seal in the groin area, which may extend into the scrotum or labia majora.

(if the table is not completely visible, scroll to the right)

Characteristic signs of a hernia	Signs of her infringement
Located on one or both sides (in boys, 60% of hernias are left-sided, in girls more than 50% are bilateral)	Severe pain in the protrusion area
Painless when pressed	The child is restless and crying
If there is intestine in the hernial sac, then when pressed it rumbles	Weakness
When coughing, crying or straining, the formation increases
When pressing on the protrusion and when in a horizontal position, it is reduced (optional sign)	Gases stop passing (the child does not fart, and at the same time he has bloating)
If the hernia is straight, it has the shape of a ball, oblique variants of the protrusion have an oblong shape	If you do not immediately contact a pediatric surgeon in the hospital with signs of infringement, then signs of peritonitis (inflammation of the peritoneum) develop: nausea, fever, vomiting, and possible loss of consciousness. This is already a life-threatening condition.
A bilateral hernia can only be oblique

Left-sided inguinal hernia: this is how it looks in a standing position with tension in the abdominal wall muscles

How does a doctor make the correct diagnosis?

A pediatric surgeon will diagnose the child. He will take into account:

symptoms of pathology;

the results of some tests (for example, does the mass protrude when you cough, strain, or walk);

ultrasound results (which will show which organs are in the hernial sac, whether there are adhesions there or not);

irrigography data - an X-ray examination with contrast (which will show the presence of intestinal strangulation located inside the hernial sac).

Treatment

An inguinal hernia is treated only surgically (in both adults and children). The operation is performed starting from 6 months of age.

Bandages, compresses, strengthening the hernial orifice with a plaster are ineffective treatment.

If the operation is performed as planned, without waiting for complications to develop, then it is performed laparoscopically through 3 small incisions. Laparoscopic intervention is performed in 15–30 minutes under anesthesia, and the child can be discharged home the next day.

Laparoscopic surgery is performed through small incisions on the anterior abdominal wall. The surgeon performs the intervention using manipulators, and he sees what is happening in the abdominal cavity on the monitor.

The essence of the operation is to dissect the hernial sac and move the organs in it “into place” – into the abdominal cavity. Then the hole through which the organs emerged is reinforced with one’s own tissue or polypropylene mesh to prevent recurrence of hernia.

After the operation, it is necessary to wear a bandage, which is put on only while lying down and initially removed only at night. After 14 days, they begin to lengthen the time of walking without a bandage during the day.

In the postoperative period, it is very important to engage in physical therapy and abdominal massage, which activates blood circulation in this area and will serve as an excellent prevention of hernia in the future.

Treatment for strangulation

If urgent hospitalization is required in a children's hospital, which has a surgical department. There, within 1–2 hours, doctors can reset the pinched organs into the abdominal cavity using conservative methods using:

• administration of drugs that relieve intestinal spasms;
• emptying parts of the intestine located further than the strangulation, with careful attempts to straighten the contents.

If there is no effect, urgent surgery is performed.

conclusions

An inguinal hernia in a child occurs mainly due to congenital pathology of connective tissue.

Since it is dangerous due to the infringement of the organs located in it, if it is detected, immediately contact a pediatric surgeon. He will tell you what examinations need to be completed in order to operate on the child. Such treatment is necessary so that the slightest increase in intra-abdominal pressure in a baby when straining, coughing or crying does not lead to infringement of the internal organs.

Owner and responsible for the site and content: Afinogenov Alexey.

The occurrence of an inguinal hernia in children is associated with disturbances in the intrauterine development of the fetus. During this period of growth, each baby develops a canal connecting the inguinal and abdominal cavities. This process accompanies the descent of the testicles in boys and the fixation of the round ligament of the uterus in girls. Sometimes such changes cause displacement of internal organs.

By the end of pregnancy, in most children, the canal connecting the inguinal and abdominal cavities closes on its own. In some cases, such changes may not occur, which provokes the appearance of an inguinal hernia. The main reasons that can cause this pathology include:

• genetic predisposition, heredity;
• difficult intrauterine development of the fetus;
• the presence of congenital developmental pathologies.

Inguinal hernia occurs more often in boys. The main reason why such a manifestation may occur is anatomical features. In most cases, oblique protrusion of the internal organ is diagnosed. Most often a loop of intestine enters the inguinal canal. In girls, the pathology may be associated with protrusion of the fallopian tube or ovary.

An inguinal hernia may not pose any danger until a certain point. Parents need to take all appropriate measures as soon as the first signs of pathology appear.

Symptoms

An inguinal hernia appears mainly in the first months of a baby’s life. A small swelling in the groin area may appear on the baby’s body from time to time or be constantly present. However, there are often cases when the manifestation of pathology can begin much later.

Observe your child when he is active. Some first signs will tell you about the presence of a hernia:

• when the child is active, a slight swelling appears in the groin area,
• the formation has an elastic shape,
• you can easily reduce the protrusion with gentle pressure from your hand.

As a rule, the child does not feel any discomfort when the hernia protrudes or reduces. He shouldn't feel pain either. If he behaves restlessly when you touch him, this condition indicates a possible strangulated hernia.

Infringement begins when the prolapsed organ is compressed. At the same time, blood circulation in it is disrupted. This condition is dangerous due to possible necrosis of the organ, which will lead to loss of viability. Complications of an inguinal hernia are indicated by symptoms such as nausea, vomiting, and problems with defecation.

In some cases, an inguinal hernia may appear in adulthood. This disease most often occurs in boys who experience excessive physical activity. Pathology also develops due to the weakened state of the muscles of the anterior wall of the abdominal cavity.

Diagnosis of inguinal hernia in a child

Most often, parents manage to independently recognize the first symptoms of an inguinal hernia in a child. After this, the doctor conducts an additional examination and prescribes an examination. To determine the diagnosis, the child is examined in a horizontal position. At an older age, a hernia can be easily diagnosed by bending, walking, or coughing.

To determine the details, the specialist prescribes an ultrasound examination. In boys, an ultrasound of the inguinal canal and an ultrasound of the abdominal organs are performed. For girls, ultrasound of the abdominal and pelvic organs. In some cases, additional tests and procedures are prescribed to diagnose an inguinal hernia, excluding other possible diseases.

Complications

Untimely contact with a specialist or delayed surgery can sooner or later lead to strangulation of the hernia. The main complication that makes this condition dangerous is necrosis of the prolapsed organ. That is why you need to carefully monitor the behavior, well-being and health of the child, identify characteristic symptoms in time and consult a doctor.

Attentive attention to the child’s health, as well as your responsibility, will help quickly eliminate the pathology. And within a few days the child will be able to lead his usual lifestyle.

Treatment

The only reliable way to treat inguinal hernias is surgery. This method makes it possible to eliminate the problem, as well as possible dangerous consequences.

What can you do

Some parents prefer to treat inguinal hernia in children by using special support garters. However, this method does not help eliminate the problem and is not used in modern medicine.

What does a doctor do

An experienced surgeon can cure an inguinal hernia in a child. The operation involves cutting the hernia and then removing the hernial sac. In some cases, the doctor strengthens the canal by tying tissue, muscles and ligaments. An experienced specialist knows what to do in such a situation and how to ensure a speedy recovery of the child’s body.

Surgery to remove an inguinal hernia in boys is usually performed after diagnosing the pathology as planned. In case of a strangulated hernia, surgical intervention is carried out urgently.

An inguinal hernia in girls is also an indication for urgent surgery. Failure to provide first aid in a timely manner by the surgeon can cause the death of the ovary or fallopian tube.

Prevention

The specific development of pathology determines the absence of specific preventive measures. However, you can protect your child from possible complications and prevent some consequences. To do this, it is necessary to contact a specialist in time when the first signs of the disease are detected, and also not to delay the operation after diagnosing a hernia.

Unfortunately, in modern pediatrics it is quite often diagnosed. Surgery is sometimes the only possible method of treatment. Of course, this pathology causes great concern among parents. That is why many are interested in questions about what a hernia is and what are the mechanisms of its formation. How dangerous can the disease be and what treatment methods does modern medicine offer? What are the reasons for the development of pathology and what external signs is she accompanied? The answers to these questions will be interesting and useful to many readers.

What is a hernia?

This pathology is considered quite common in pediatric surgery. An inguinal hernia is a protrusion of the contents of the abdominal cavity outward through the inguinal canal. Internal organs, such as a loop of the small intestine and the ovaries, protrude through the muscles of the abdominal wall.

It is worth saying that such a pathology is more often diagnosed in male newborns, and premature babies belong to the group with an increased risk. In most cases, a hernia can be diagnosed quite quickly - it looks like a small swelling in the groin area, and the hernial sac becomes more noticeable in an upright position. A hernia responds well to treatment, especially if it is diagnosed at an early stage. Nevertheless, it is worth studying in more detail the causes and symptoms of this pathology.

The main reasons for the development of an inguinal hernia in a child

Many parents ask why their child gets a hernia. The reasons can actually be very different. Here is a list of the most common risk factors:

• Quite often the cause is underdevelopment of the abdominal wall.
• Risk factors include physical overexertion. Naturally, if we are talking about a child, then stress is not associated with physical activity or lifting weights. If the abdominal wall is weak, protrusion of the abdominal organs may occur as a result of severe coughing or vomiting.
• Sometimes a hernia is the result of trauma to the abdominal wall, including during fetal development.
• This pathology may be the result of excess weight in a child.

Pathogenesis of the disease

As already mentioned, a hernia is more often diagnosed in boys, which is due to the peculiarities of anatomical development. Initially, the fetal testicles are located in the kidney area. Closer to childbirth, they descend into the scrotum, carrying part of the peritoneum with them. Thus, a kind of pocket is formed in the scrotum, the basis of which is connective tissue. Normally, the pocket is overgrown by the time of birth. But sometimes for one reason or another this does not happen. The presence of a pocket increases the likelihood of protrusion of internal organs.

In addition, the inguinal canal in men is much longer than in women, which also increases the risk of developing a hernia. As for girls, their pathology is usually associated with weakness of connective tissue, as well as physical overstrain. It is worth noting that a hernia can be congenital or begin to develop after the birth of the child. Protrusions can appear on one side (usually the right) or on both sides. Sometimes children are diagnosed with a postoperative inguinal hernia, although in fact the incidence of recurrence with a correctly performed procedure is minimal.

What symptoms accompany the disease?

Sazu is worth noting that the signs directly depend on the degree of protrusion. Typically, a hernia is a small, oval, sometimes triangular-shaped sac located either above the pubis or on the outside of the pubis. The bulge usually becomes more noticeable in an upright position. The hernia also increases with an increase in intra-abdominal pressure, which is observed, for example, during screaming or crying.

Sometimes it causes severe pain of a paroxysmal nature. Soreness makes the child restless, he often cries and sleeps poorly. Symptoms may also include nausea, loss of appetite, and vomiting.

If we are talking about boys, then the inguinal hernia can move towards the scrotum (it is called an oblique hernia). In such cases, an enlargement of the scrotum and swelling in the perineal area may be observed.

Now you know how an inguinal hernia in children is determined. Surgery is not necessary in all cases. However, if you notice alarming symptoms, then you should immediately show your baby to the surgeon. The sooner the diagnosis is made and treatment is started, the less likely it is to develop complications.

Complications arising from a hernia

In fact, an inguinal hernia is a rather serious problem. If the child has not been provided with qualified medical care, then over time the protrusion of the abdominal organs becomes more pronounced. Against the background of pathology, normal blood circulation may be disrupted, which entails a delay or abnormal development of organs. In boys, the consequence of a hernia can be pathologies of the reproductive system.

However, the most dangerous complication of an inguinal hernia is strangulation. This situation is associated with pinched tissue and disruption of normal blood circulation in a particular organ. In turn, this situation is fraught with tissue necrosis, inflammation, blood poisoning, etc.

Infringement and its symptoms

A strangulated hernia is a critical situation, especially if we are talking about a small child. In such cases, surgical intervention is simply necessary. A strangulated hernia can be provoked by an increase in abdominal pressure, which, for example, is observed with strong screaming and crying, physical stress, coughing, vomiting, etc.

Determining the presence of infringement is quite simple. becomes more convex and harder to the touch. Palpation causes pain. The child becomes restless, often cries and screams. Often the skin around the hernia takes on a reddish tint. Along with this, systemic symptoms appear, in particular increased body temperature, fatigue, loss of appetite, vomiting, drowsiness, and irritability. If you notice similar symptoms in your baby, you need to immediately take him to the hospital, since the lack of qualified assistance can lead to massive necrosis, painful shock, etc.

Modern diagnostic methods

The presence of pathology can be suspected already during a general examination. becomes visible in an upright position, as well as during coughing, crying, etc. With palpation, the doctor can feel a soft elastic formation. By the way, sometimes a hernia can be repaired - placing the internal organs back inside. Naturally, the procedure must be carried out by a specialist, and not all bulges are amenable to such manipulation. If the sac contains part of the intestine, a characteristic rumbling sound can be heard.

In the future, as a rule, an ultrasound examination of the abdominal cavity or pelvic organs (in girls) is performed. Only after this can the doctor decide whether surgery to remove the hernia is necessary.

If the specialist decides to undergo surgery, a more detailed medical examination is necessary, which includes general blood and urine tests, analysis of ESR and blood clotting. Sometimes additional irrigography is performed - an X-ray examination of the intestine with a special contrast agent. As a rule, a barium suspension is used as a contrast. The procedure allows you to determine the presence of pathologies or abnormalities in the development of the large intestine.

Are there effective conservative treatment methods?

It’s worth saying right away that conservative therapy is only possible in cases where the pathology was detected in the early stages. According to statistics, the disease in newborns can sometimes be eliminated without surgical procedures.

Quite often, doctors recommend wearing a special inguinal bandage. It is put on after the hernia has been repaired. This device supports the abdominal wall and keeps the internal organs from protruding. Typically, a groin bandage is worn during the daytime. However, it can also be left overnight if the child, for example, suffers from a night cough.

The bandage is not an alternative to surgery, but only a temporary measure. The little patient is also prescribed regular massage and special therapeutic exercises. These procedures are aimed at strengthening the abdominal wall. Even if the therapy gives a positive result, the child’s condition must be carefully monitored, since there is a high probability of developing a relapse in the first 4 years of life.

Inguinal hernia in children: surgery

Sometimes it is simply impossible to do without surgical intervention for such a pathology. This procedure is usually carried out at the age of 6-12 months. Its essence is quite simple. Using special instruments, the doctor separates the hernial sac from the abdominal cavity. In this case, you need to ensure that the internal organs remain in place. The surgery is performed under general anesthesia and lasts about 30 minutes. This is exactly what it looks like

The pathology of protrusion of internal organs in a child in the groin area is a visible descent of the abdominal organs under the skin.

Common causes of an inguinal hernia in a child are weak abdominal muscles, birth injuries, hereditary predisposition, overexertion and excessive pressure in the area of ​​the pelvic organs and peritoneum.

The disease almost always manifests itself painlessly; a pathological protrusion is noticeable to the naked eye, capable of increasing in size during physical activity and disappearing at rest.

If the hernia does not go away on its own for a long time and the patient experiences its enlargement, complications may develop: strangulation of the inguinal hernia, inflammation of the internal organs.

The disease requires complex diagnostics to determine the degree of complexity of the pathology and the likelihood of its self-healing. Most often, they resort to surgical treatment of inguinal hernia in children.

An inguinal hernia in a child develops before the age of two years and is more common in boys than in girls (in approximately 3 cases out of 5). Explained this feature development of the genital organs. During the process of maturation, the testicles migrate into the scrotum from the abdominal cavity, which can lead to the development of a hernia.

Congenital pathology, as a rule, is caused by a violation of the fusion of the vaginal process, through which cells are delivered for the construction of the genital organs. The vaginal process in this case becomes a hernial sac, which creates a predisposition to contract this disease.

The outer ring of the inguinal canal acts as a hernial orifice, through which the intestines, greater omentum, fallopian tubes, and ovaries enter the sac.

11.5% of cases of inguinal hernia in a child are hereditary. One or both parents have previously suffered from a similar illness. This is explained by the structure of the abdominal wall, which cannot cope with the pressure during the formation of internal organs.

The formation of protrusion of internal organs in the groove zone occurs in adolescents and adults engaged in heavy physical labor, while having undeveloped or weakened back and abdominal muscles. It may be accompanied by prolapse of the pelvic and abdominal organs, inflammation, and strangulation.

Kinds

Surgeons distinguish between congenital and acquired inguinal hernias that develop at an early age in children (boys). We talked about the reasons for different types of protrusion above.

The following types of congenital pathology are encountered in hospital practice:

• oblique, descending through the inguinal inner ring;
• straight, extending through the defect in the abdominal wall of the outer ring;
• right-sided;
• left-sided;
• bilateral;
• inguinoscrotal;
• cordial;
• testicular.

Symptoms

In the first years of life, the formation of hernial pathology can be noticed by the naked eye of the baby’s parents. It manifests itself in the form of a round or oval swelling in the groin area, which can increase with straining, crying, laughing, and decrease in a quiet position. When pressed, it can be easily pushed inward.

Most often, the protrusion does not bother the baby, creating only a visual defect. However, there are cases of pain, manifested by nagging pain in the lower abdomen and thigh.

Inguinal-scrotal pathology in children becomes noticeable when the hernial sac descends into the scrotum or labia majora, creating asymmetry of the genital organ.

There are individual symptoms of an inguinal hernia in a child that will help diagnose this pathology. To do this, you need to consult a doctor.

Complications

Doctors say that the most dangerous consequences of the development and treatment without surgery of an inguinal hernia in a child are strangulation of the hernia (it stops being reduced) and internal organs located close to it.

When strangulation occurs, the contents of the hernial sac are compressed and blood circulation in these organs is impaired.

The reasons for the development of complications of this type can be intestinal disorders, obstruction and constipation, and excessive stress on the abdominal muscles.

Children often cry and complain of bloating and pain in the groin area. The pathology becomes painful and inflamed in appearance, and ceases to be reduced when pressed. With constipation and intestinal obstruction caused by strangulation, the baby experiences bloating and vomiting. Such complications can lead to disastrous consequences - peritonitis.

Since infringement of the hernial sac and its contents extends to the pelvic organs (ovaries in girls, testicles in boys), this can lead to tissue necrosis, which will lead to the development of infertility in adulthood.

ATTENTION! Relapses are possible, even after removal of the hernia and restoration of normal function of the pelvic organs. At risk:

• premature babies;
• persons with weak core muscles;
• the presence of connective tissue diseases in a person;
• carrying out others, after which a complication appears in the form of a hernia.

If hernioplasty is performed incorrectly, the development of lymphostasis, abnormal fixation of internal organs, and infertility are likely.

Diagnostics

The pathology is easily detected by the parents of small children themselves or their relatives during bathing, massage and visual examination. It was said above that the symptoms of an inguinal hernia in a child are noticeable to the naked eye or palpable by palpation.

A pediatric surgeon makes a diagnosis of groin pathology based on tests and a medical examination. The baby needs to undergo an anamnesis, ultrasound of the abdominal and groin area, and irrigography.

During the examination, the surgeon will ask the child to remain in a natural position, and also to strain, cough, and bend over in order to create conditions under which the pathology can manifest itself more clearly, thereby confirming the diagnosis.

Treatment

An inguinal hernia in a child poses a great danger to the health of the reproductive system and other organs of the baby, therefore conservative treatment methods (such as exercise therapy) are not used for children.

Routinely, surgical herniotomy is used for children aged from six months to one year.

Hernioplasty involves removing the contents and removing the hernial sac, restoring the normal anatomical structure of the groin.

The operating method used is laparoscopy, which is performed under general anesthesia.

According to the doctor’s decision, the inguinal canals and muscles are strengthened, avoiding touching the seminal ducts and vessels of the testicles, so as not to cause the death of these structures.

Surgical intervention is required immediately if the surgeon has diagnosed a strangulated inguinal hernia in a child, because in such a situation the risk of death of the testicles increases: the ovaries and fallopian tubes (in girls), testicles and spermatic cords (in boys).

The peculiarity of hernioplasty is that it is important for the surgeon to assess the viability of the hernial contents before the start of surgery. If the organs in the infringement are dead, the doctor resects them during the operation. Hernioplasty is performed on an outpatient basis, the patient’s recovery lasts several hours, after which he will be discharged.

The result of an inguinal hernia operation in children is the restoration of the anatomical structure of organs, blood circulation in the pelvis, elimination of inflammation and the risks of developing serious complications. Lethal outcomes with this type of surgery are observed in 0.5% of cases.

Prevention

The occurrence of congenital pathologies is very difficult to predict, since external factors may not be at all specific to a particular disease.

Doctors advise parents of newborn babies to undergo regular surgical examinations to check for a predisposition to protrusion of internal organs.

It is also important to monitor the child’s health: perform muscle-strengthening massage, prevent or treat intestinal disorders, monitor normal bowel function, and not expose the baby to heavy physical labor.

An inguinal hernia is a condition in which the hernial sac protrudes through the peritoneum. Inside the sac are internal organs, so their location changes and their functions deteriorate.

Now let's look at this in more detail.

What is an “inguinal hernia”?

A hernia can occur in different areas; when localized in the groin, it usually comes out bladder and intestines. This happens through the inguinal gap, which is located between the muscles and ligaments. In girls, the hernial sac may also include the ligament of the uterus, and in boys, the spermatic cord.

Pathology can be congenital or acquired. It often occurs in premature babies. The protrusion itself may be painless, but during physical activity pain is felt and symptoms of disturbances in the functioning of internal organs arise.

Complete removal of a hernia is only possible through surgery, which is recommended for children whose pathology is visible from birth. Often the disease is combined with others - hydrocele, hip dysplasia, spinal abnormalities. The problem occurs several times more often in boys than in girls. This is explained by the peculiarities of intrauterine development, during which a canal is formed for the descent of the testicles into the groin area. Normally, the hole should close; if this does not happen, an inguinal hernia occurs. Clinical manifestations are not always immediately noticeable and may appear throughout the child's life.

The danger of the disease is that during physical activity the hernia may be strangulated, after which the internal organs cannot be reset into the peritoneum on their own. This leads to their dysfunction and the appearance of additional symptoms.

What does an inguinal hernia look like in children with photos

The degree of protrusion during a hernia can vary. It is often invisible when lying down and appears only when the abdominal muscles tense, for example, when a child cries or laughs. In boys, the hernia looks like hydrocele, in girls it has a more characteristic appearance. Examples of inguinal hernia are shown in the photo below:

The first signs of an inguinal hernia

Congenital inguinal hernias are noticeable immediately after birth. The first sign is protrusion of the skin in the form of swelling. It is painless, has a round shape and can completely disappear when the child is calm. If the hernia is large, it is not difficult to notice it; if it is small, it will be detected a little later, when the child begins to become active or cry.

Hernias can be right-sided or left-sided. In some cases, pathological protrusion forms on both sides. In addition, oblique and straight formations are distinguished, and several types are distinguished, depending on the degree of mobility, which is important for the doctor.

Symptoms of inguinal hernia

The swelling itself is painless, however, during the movement of organs through the hernial gap and back, the child may experience discomfort. Some complain of nagging pain, others complain of a feeling of heaviness in the lower abdomen.

In boys, a hernia leads to stretching and asymmetry of the testicles. At the location of the hernia, the scrotum will be enlarged. In girls, a similar thing is observed with the labia - one of them will be clearly larger. The hernial protrusion does not always descend into the genitals, but may remain in the lower region of the peritoneum. In this case, the swollen ball will be visible much better. Most often, the protrusion occurs on the right side.

Organs trapped in the hernial sac can be compressed when moving. This leads to strangulation of the hernia and closure of organs on the outside of the peritoneum. This condition is accompanied by poor circulation, increased intra-abdominal pressure, flatulence, and pain.

When pinching occurs, the child begins to cry sharply, becomes restless and complains of pain. The bulging area cannot go back down and becomes hard, tight and painful. Almost always, the intestine gets into the hernial sac, so its strangulation leads to intestinal obstruction. As a result, the child develops bloating, an inflammatory process develops, and later necrosis of the organ walls. In the absence of urgent help, there is a possibility of perforation of the intestinal wall and the development of peritonitis.

The disruption of blood supply that occurs during strangulation is especially dangerous for girls. Insufficient nutrition of the tissues of the ovary and genital organs leads to the death of eggs and necrotic processes.

Causes and prevention of inguinal hernia

In children, inguinal hernias are predominantly a congenital feature. At the stage of fetal formation, the child has a vaginal process, which at the 12th week of development resembles a protrusion. After performing its functions, the appendage overgrows, and disruptions in this process lead to the formation of cracks and the appearance of a hernia after birth. Premature babies are more likely to develop a hernia because the area does not have time to heal. This appendix is ​​the hernial sac into which the internal organs enter: in girls - the intestines, ovary and fallopian tube, in boys - the intestines, spermatic cords.

It is believed that the disease can be inherited. Approximately 11% of children with an inguinal hernia had a relative with a similar pathology.

It is widely believed that a hernia can be acquired if the child carries heavy loads or cries too much. In fact, this happens very rarely. Basically, acquired pathologies can occur in boys of school or puberty age who engage in intense physical activity and at the same time have congenital weakness of the abdominal wall.

Thus, an inguinal hernia forms even before the birth of a child, but the pathology can increase in size during intense physical activity, which is why many consider the hernia to be acquired.

Of the provoking factors that lead to protrusion of the hernial sac, doctors identify the following:

• cystic formations in the ovaries or spermatic cords;
• hip dysplasia;
• problems with the spine;
• obesity;
• constipation;
• coughing.

Prevention of hernia includes timely detection of pathology and regular visits to specialists to monitor the dynamics of hernia development. Children are advised to exclude the provoking factors described above, and then the number of protrusions and pinching will be significantly less.

To prevent acquired hernia, it is recommended to take care of the general health of the child. This includes moderate physical activity, which will help strengthen the abdominal muscles, treatment of constipation, as well as proper nutrition to normalize the functioning of the gastrointestinal tract.

Diagnostics

Typically, a hernia is diagnosed immediately after the baby is born. The pathological protrusion is noticed by the parents themselves or discovered by the doctor during a routine examination of the baby. To make an accurate diagnosis, the results of instrumental studies, visual examination and palpation, as well as anamnesis will be required.

To make it easier to identify a hernia, the child is asked to bend over, strain or cough. When the abdominal muscles tense, the protrusion becomes more noticeable. After this, the child is asked to take a horizontal position. With an uncomplicated hernia, the internal organs are easily reduced into place. If the intestine gets into the hernial sac, then as it moves from the peritoneum and back, characteristic rumbling sounds can be heard.

After preliminary diagnosis The doctor sends the child for an ultrasound. At ultrasound examination The areas of the pelvis, inguinal canals and peritoneum are examined.

The specialist must also differentiate an inguinal hernia from other diseases that have a similar appearance (inguinal hernia, femoral hernia, spermatic cord cyst).

Treatment of inguinal hernia

Only unstrangulated hernias can be set back. If the organs are nevertheless pinched, the pathology can only be corrected by surgical intervention. The quality of the result depends on the degree of neglect of the process and the stage at which treatment begins. Conservative therapy is theoretically possible, but is not currently used. It involves constantly wearing bandages or compression garments, which will prevent the organs from protruding outward.

For young children, surgery is performed at the age of 6-12 months. The procedure involves cutting off the hernial sac and restoring the normal anatomy of the inguinal canal. This may also require strengthening the affected area with your own tissue.

Surgical treatment can be performed openly and using laparoscopy. The second technique is preferable, as it has fewer side effects and requires minimal tissue incisions. When performing the procedure, the surgeon must be careful not to damage the spermatic cords, otherwise this will disrupt reproductive function.

The operation is performed by a doctor in a hospital setting and if the outcome is successful, the child can be transferred to home treatment.

If a girl's hernia is strangulated, emergency surgical intervention is indicated, as there is a high probability of ovarian atrophy and impaired reproductive function. If a hernia is strangulated in boys, measures can be taken to independently reduce the organs:

• take a warm bath;
• take antispasmodics to relax muscles and widen the hernial gap;
• position the child horizontally or lift his pelvis upward to make it easier for the organs to “return.”

The prognosis for a child with an inguinal hernia is, in most cases, favorable. For uncomplicated conditions, surgical treatment is very effective. Before surgical reduction of strangulated hernias, it is necessary to first ensure the viability of the organs. If their blood supply has been severely impaired and necrotic areas have appeared, the doctor performs a resection.

Complications

A complication is considered to be a pinched inguinal hernia and the consequences that this condition leads to. It is impossible to predict pinching in advance. It is a jamming of internal organs between the muscles of the peritoneum, so that they are sticking out. In this case, the muscles often spasm, which makes it impossible to return the contents of the peritoneum back. This often occurs when the intestinal loop is overcrowded, which gets into the hernial sac and falls out after physical exertion.

If a child is pinched, immediate surgical assistance is required. The process is acute and occurs suddenly. The child suddenly experiences severe pain in the groin, feels nausea and attacks. The area of ​​the hernia that sticks out becomes hard and irreducible. The patient's health deteriorates sharply and quickly.

In addition to painful sensations, pinching is dangerous because it interferes with normal blood flow in organs that are outside the peritoneum. Within a few minutes, tissue appears in them, and after a few hours necrotic processes develop. In 10% of cases when pinched, doctors diagnose gangrene. Such conditions are life-threatening for the child and can be fatal if timely help is not provided.

If parents are offered to undergo surgery to remove a hernia while the child is still small, they should agree. As you get older, the likelihood of getting pinched will increase. In addition, the baby will have to limit himself in many ways in everyday life until he gets rid of the problem. An inguinal hernia does not go away on its own and in any case will have to be removed at some age.

Rehabilitation

After surgery, the child is recommended to rest for the first time so that the functioning of the internal organs is restored and returns to normal. After about a month, doctors say to do special physical therapy exercises to strengthen the muscles of the abdominal wall and accelerate tissue regeneration.

It is recommended to add breathing exercises to special physical exercises, which improves homeostasis and the child’s overall immunity. Already a month after surgery, the doctor may allow you to visit the pool or engage in active walking.

It is very useful to attend massage sessions. Their goal is not only to strengthen the abdominal muscles, but also to normalize intestinal motility. Massage movements are performed in the navel, groin, oblique abdominal muscles, and also on the back along the spine.

Sometimes doctors recommend taking mild laxatives to avoid straining and straining the surgical area during bowel movements. Duphalac is an absolutely safe drug for children of any age. Postoperative bandages can be used as an aid. They need to be purchased in specialized places, taking into account the individual sizes of the child.