Inguinal (groin) Hernias in Children - Hydrocele
Inguinal (groin) hernias are the most common surgical disorder in children. Many times inguinal hernias are noticed as an increase in volume in the inguinal (groin) area that can affect babies and older children. Hernias usually cause discomfort or pain that can be continuous or intermittent. Inguinal hernias always need surgical treatment because of the potential serious complications, content of the abdominal cavity (Intestine, abdominal fat, ovaries and other anatomical structures) can get trapped inside the hernia leading to tissue death (necrosis).
To prevent possible complications pediatric surgeons recommend that inguinal hernias be repaired as soon as possible after diagnosis. There are different types of inguinal hernias, in children the most common type is "indirect", in which a comunication or "channel" exists between the abdomen and the scrotum in boys, or between abdomen and labia majora in girls. Many times this communication is opened only in the beggining, near to the abdomen, so the child will present a constant or intermitent increase of volume in the inguinal area. When the communication is open all its lenght then the increase of volume (caused by intestine for example) will reach even the scrotum or labia majora. This "open channel" is known as a persistent processus vaginalis and the aim of the surgery is to close this channel.
Sometimes this open channel is narrow, so doesn't have enough space to let pass intraabdominal content but fluid can go through, which is specially noticeable in boys, causing an increase of scrotal volume that usually is visible after stanting for a while or in the afternoons. These cases, called communicating hydrocele, also have indication for surgery.
About 1-5% of babies develop hernias and boys are 10 times more likely than girls to have a hernia. Hernias are found in as many as 30% of prematurely born babies because birth occurs before natural closure of the processus vaginalis has been completed. The presence of a hernia is more common on the right side an in some cases is located on the left side or can even be bilateral.
Diagnosis of inguinal hernias in children can be difficult unless there is an obvious scrotal hernia. Often the mother discovers the hernia when the child is coughing or crying. Confirming the presence of a hernia through the inguinal canal is difficult because of its small size, and the diagnosis is often made by history rather than by physical examination.
Ultrasound can help to confirm the presence of an inguinal hernia when showing a persistent processus vaginalis.
The treatment is surgical and consists in a small incision in the affected inguinal area, dissection of the inguinal area, identification of the persistent processus vaginalis and its suture or resection of an hernia sac. Sometimes parents arrive to the surgeon and it is suspected that abdominal content is trapped in the hernia and can't return to the abdomen after manual maneuvers by the surgeon. This is known as an incarcerated hernia and can contain intestine, abdominal fat, an ovary or other abdominal contents that doesn't receive enough blood and oxygen because of local compression. The final result is necrosis of the tissue inside the hernia. This is a real emergency, to avoid this, parents must assist to the emergency service as soon as possible if the baby or child has continuous pain.
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