Infantile hernia in the groin. Inguinal hernia in a child: symptoms and why surgery is inevitable. Are relapses possible?

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.

Many young parents are faced with the problem of inguinal hernia in children. Despite the fact that this diagnosis is very common, most people do not understand the essence of this disease.

The search for information about the causes, consequences and the need for surgery usually begins when the problem is already making itself felt. The most dangerous thing is the delay of parents in diagnosing and treating this disease, because complications of an inguinal hernia can seriously affect the baby’s health.

What is an inguinal hernia

An inguinal hernia occurs when part of the abdominal organs (omentum, intestines, and, in girls, the genitals) sag into the groin area.

The formation itself consists of three parts: the hernial sac (protrusion shell), the internal contents of the hernia and the hernial orifice through which the organs protrude.

The size of the hernia can vary and depends on how much internal organs have moved outside the abdominal cavity. In some children this is a small swelling in the groin area, in others it is a very large, voluminous protrusion, which is simply impossible not to pay attention to.

With increased effort, when the child coughs, sneezes, cries or lifts heavy objects, the hernia becomes more noticeable and bulging. At rest, it can even come into place spontaneously or with manual reduction (reducible hernia).

In more advanced cases, the contents of the hernial sac do not return to place (irreducible hernia). The most dangerous situation occurs if the hernia is strangulated.

In this case, blood circulation in the compressed area of ​​the organ is severely disrupted until it stops completely, and if medical assistance is not provided in time, these tissues die completely. If a girl’s ovary or fallopian tube is strangulated, sexual function is severely impaired, which can lead to.

An inguinal hernia can appear on one side, but it can also be bilateral.

Causes of inguinal hernia in children

Often, an inguinal hernia in children is congenital, and boys are more susceptible to this disease. The reason is that in some babies, during intrauterine development, the canal between the abdominal cavity and the groin region, through which the testicles should normally descend, does not close.

The situation is different for girls. The cause of an inguinal hernia in them is an abnormality of the ligaments that hold the genitals. But this disorder is more rare, so this disease is less common among girls.

The absence of an inguinal hernia at the birth of a child does not guarantee that the baby will not encounter such a problem in the future. This disorder can be acquired. its reasons may be the following:

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1 The baby has severe coughing, sneezing, vomiting, constipation, or frequent crying, which increases pressure in the abdomen. If the abdominal wall is not strong enough, the hernial orifice may open.

2 Violation of the normal position of organs can be caused by various injuries in the pubic area, which affect the integrity and tone of the anterior abdominal wall.

3 During some operations, incisions are made in the groin area that can cause an inguinal hernia. The reason for this complication may be the surgeon’s low professionalism.

4 If the canal between the abdominal cavity and the groin area does not heal in time, but the inguinal hernia did not appear before the birth of the child (congenital hernia), it may occur after birth (acquired hernia).

Inguinal hernias occur much more often in premature babies, as well as overweight babies.

Inguinal hernia in a child: symptoms

Determining the presence of an inguinal hernia in children can be quite difficult, especially if there is no clearly visible protrusion, or the child is too small to show the place that bothers him. The main symptoms of a hernia are:

1 The presence of swelling in the groin area, which increases when the child tenses. When you try to reduce it, it disappears if the hernia is reducible.

2 Anxiety, crying of a small child. Possible refusal of food or digestive disorders, vomiting. The baby becomes lethargic and there are signs of general malaise.

3 When an inguinal hernia is strangulated, the child’s well-being sharply worsens, pain and anxiety intensify. The contents of the hernial sac are not able to return to their place during manual reduction.

You should consult a doctor if you suspect an inguinal hernia in a child.

If the hernia is strangulated, the baby must be immediately sent to the hospital, where an urgent operation to remove the hernia will be performed.

Inguinal hernia in a child: treatment without surgery

Most parents faced with the problem of inguinal hernia in children strive to solve this problem without surgery. But, this treatment option is possible only in small children, up to four years old, and only in the absence of infringement.

When treating an inguinal hernia, various methods of strengthening the abdominal wall are used. For this purpose, physical exercises, outdoor games, and therapeutic massage techniques are being developed. You should not rely on traditional medicine methods. Like other medications, they have their side effects. A person without medical education cannot predict the consequences of using one or another folk remedy.

By engaging in such self-medication, parents not only delay the provision of effective assistance, but also risk harming their child.

Removal of inguinal hernia in children

Surgical removal of an inguinal hernia remains the most common and effective solution to the problem. The essence of the operation is to reduce the organs into the abdominal cavity and tighten the hernial orifice.

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The complexity and duration of the operation depends on whether the parents sought help in a timely manner. If the hernia has not yet been strangulated, the doctor examines the child, performs all the necessary tests and performs a planned operation.

When the hernia is strangulated and every minute counts, urgent surgery is required.

Otherwise, necrotic irreversible changes begin in the compressed tissues, and peritonitis develops in the abdominal cavity. If the tissue (for example, a strangulated intestinal wall) is already dead, this area is removed, and the living parts of the organ are stitched together.

In order to reduce the negative impact of anesthesia on the child’s body, local anesthesia is usually used together with general anesthesia. To do this, the surgical site is injected with painkillers.

When performing surgery on boys, doctors must take special care not to damage the reproductive system, in particular the vas deferens. Removal of a congenital inguinal hernia is recommended to be done between the 6th and 12th months of the baby’s life. This period is most favorable for such intervention, and it is easier for the child to tolerate it.

Surgical removal of an inguinal hernia is contraindicated in children who have severe pathologies of vital organs, such as the heart and kidneys. The operation is also dangerous if the child has a progressive infectious disease in the body.

Laparoscopy of inguinal hernia in children

Recently, an alternative to conventional surgery to remove an inguinal hernia has emerged.

The laparoscopy method differs from conventional surgical intervention in that it leaves virtually no noticeable scars, tissue damage is minimal, and recovery after surgery is much easier and faster.

If parents have the opportunity to choose this method of removing an inguinal hernia in a child, then preference should be given to it.

Complications after surgery

If the operation is performed by qualified specialists and using high-quality equipment, the likelihood of complications is minimal. But there are still cases when, during the postoperative period, a child develops a hematoma in the surgical area.

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, the bladder and intestines usually come out. 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 a preliminary diagnosis, the doctor sends the child for an ultrasound. An ultrasound examination examines the pelvis, inguinal canals and peritoneum.

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.

An inguinal hernia is one of the most common types of external hernia. Boys and adult men suffer from this pathology more often. This is due to differences in body structure. In women, the abdominal muscles and groin area are better developed, as nature intended for the purpose of bearing and giving birth to offspring.

An inguinal hernia is a pathology that can be acquired or congenital and will appear immediately after the birth of the baby.

What is an inguinal hernia?

An inguinal hernia in children is a protrusion of abdominal organs into the inguinal canal (a small gap between the abdominal muscles). Inside this gap in boys is the spermatic cord, in girls - the round ligament of the uterus.

A hernia consists of the hernial orifice, the hernial sac and the contents (what has fallen into the inguinal canal). The pathology looks like a small tumor-like formation in the groin area, increasing in size while standing. Protrusion can be successfully treated, especially if detected early.

Causes of inguinal hernia

Congenital hernia in boys

In early childhood, congenital hernias are more common. The testicles in boys are formed not in the scrotum, but in the abdomen, and gradually descend downwards, resulting in the formation of the vaginal process, which is a kind of pocket from the peritoneum. By the age of two, it closes and overgrows. If the process does not close, there is a risk of an inguinal hernia. A loop of intestine, greater omentum, bladder, and appendix can get into the hernial sac. Genetic predisposition increases the risk of hernia in children.

Congenital hernia in girls

In girls, the mechanism of formation of hernial sacs is similar. They arise due to pathology of the development of the round ligaments of the uterus. During intrauterine maturation, the uterus is located above its normal location. Gradually, it begins to descend into the small pelvis, pulling the peritoneum along with it. A pocket is formed - the same as in boys, into which internal organs can fall out.

Acquired hernia

Acquired inguinal hernias in children are rare. In infancy, they appear with excessive tension in the abdominal muscles during coughing, constipation or vomiting, significant body weight of the baby, and underdevelopment of the abdominal wall. During puberty, they appear more often in boys; the development of pathology is possible for the following reasons:

• weakness of the abdominal muscles;
• peritoneal injury or groin injury;
• increased intra-abdominal pressure;
• excessive physical activity;
• lifting weights.

There are many reasons that provoke the occurrence of an acquired hernia, but the main factor is weakened abdominal muscles due to genetic predisposition or a sedentary lifestyle. In athletic people who move a lot, hernias are extremely rare.

Types of disease

Inguinal hernias are either direct or oblique. Oblique hernias pass through the inguinal canal along with the spermatic cord, direct hernias pass outside it. There are three types of indirect hernias: canal, cord and inguinoscrotal. In the inguinal-scrotal variant, the hernial sac is located in the scrotum. There are also combined hernias. They consist of several hernias that are not connected to each other.

According to their characteristics, hernias are divided into reducible and irreducible. The former tend to appear and disappear on their own, while the latter cannot be eliminated (reduced) due to the fusion of the hernial sac with its contents.

Symptoms of pathology

Symptoms of abnormal protrusion are very characteristic:

1. Swelling in the groin area, which increases with tension (from loud screaming, hysterical crying, straining) and in an upright position.
2. An inguinal hernia in boys is often oval in shape, in girls it is round.
3. Reduction of an uncomplicated inguinal hernia is painless and not accompanied by any discomfort. It occurs by light pressure.
4. With a complicated process, pain, burning, and constipation appear. When loops of intestine enter the hernial sac, a soft rumbling sound occurs in the abdomen.

An inguinal hernia poses a danger to a child due to the possibility of strangulation of organs trapped in the hernial sac. As soon as parents suspect a pathology in their child, they should immediately contact a specialist (urologist or surgeon). The effectiveness of treatment depends on early diagnosis.

Diagnostics

The specialist will detect the pathology during the examination. The hernial sac becomes more noticeable when the body is in an upright position. Upon palpation, a soft elastic formation is detected. After this, ultrasound diagnostics of the abdominal cavity or pelvic organs (for girls) is performed.

If the decision is made to undergo surgery, a more detailed examination is carried out, including the following tests:

• clinical blood test;
• blood clotting;
• general urine analysis.

Sometimes an additional X-ray of the intestine with a contrast agent is done - irrigoscopy. The procedure determines the presence or absence of pathology in the colon in children. Diagnosis is more difficult in girls. When the fallopian tube or ovary is pinched, the pain is much weaker than when the omentum or part of the intestine is compressed.

Conservative therapy

After a child has been diagnosed with an inguinal hernia, in the absence of indications for surgical intervention, conservative treatment is carried out aimed at self-reduction of the hernial sac. The patient is prescribed Pantopon in a single dosage, after which he is immersed in a warm bath for 15 minutes (water temperature is about 38 degrees), or a heating pad is applied to the groin area.

After the procedures, the child calms down and falls asleep. Spontaneous reduction of the hernia occurs. A positive effect is observed in 1/3 of cases.

Conservative treatment lasts no more than 1 hour. This is the maximum duration of therapy. If after an hour the protrusion does not decrease, a decision is made to prescribe surgery. If spontaneous reduction occurred before the start of anesthesia or as a result of conservative measures taken, the baby is left in the hospital until a planned operation is performed.

Sometimes doctors recommend that the patient wear a special bandage (look at the photo to see what it looks like) that supports the anterior abdominal muscles and limits the movement of internal organs, which prevents protrusion. The bandage is worn during the day and removed at night. Sometimes it is left if the child coughs at night or wakes up screaming and crying.

Bandage is not an alternative to surgery, but a temporary measure. The patient is additionally prescribed massage and physical therapy to strengthen the abdominal wall. The child's condition is carefully monitored, even if the therapy gives a positive result, since the likelihood of a relapse before 4 years of age is high.

Methods of surgical treatment

Sometimes it is impossible to do without surgical treatment for such pathology. The procedure is carried out at one year of age. Using special instruments, the doctor separates the hernial sac and the abdominal cavity, placing the internal organs in their anatomical places. The patient is operated on under general anesthesia. Parents are concerned about how long the operation lasts. The procedure takes 15-30 minutes. The technique of performing the manipulation is simple, but the doctor must have the appropriate qualifications.

There are 2 ways to remove an inguinal hernia: open (hernia excision) and laparoscopic. Depending on the method of strengthening the walls of the inguinal canal, hernioplasty can be tension or non-tension. During tension plasty, the walls are sutured; with the non-tension method, the canal walls are reinforced with synthetic materials (polyester or polypropylene mesh).

If there are absolute indications for urgent surgery, preoperative preparation is not carried out.

The exception is late requests (4-5 days). Patients are admitted in serious condition with severe intoxication, dehydration and often with peritonitis - inflammation of the peritoneum.

Before the operation, the following manipulations are carried out:

• a 10% glucose solution is administered intravenously;
• perform blood transfusions;
• They give antipyretic and heart medications.

Hernia excision

Hernia excision is an outdated term for surgery to remove a hernia. There are about a hundred options for hernioplasty. The method is that when a hernia is removed, an external incision is made in the anterior wall of the abdomen at the site of the protrusion, the hernial orifice is sutured, and the walls of the inguinal canal are strengthened. This method is not dangerous for the child: the procedure lasts 15 minutes and is easily tolerated by the baby. The patient is discharged from the hospital on the same day.

At home, it is important to observe bed rest for 3-4 days. The child is prescribed laxatives and a special diet. Sutures are removed 7 days after surgery. Physical activity is not recommended for the next 6 weeks.

Laparoscopy

An alternative to the traditional surgical method is laparoscopy. This is a closed operation performed using a laparoscope. Removal of a hernia occurs without an incision in the peritoneum, through punctures in the navel area. Under the control of equipment, the doctor performs tissue plastic surgery with the installation of a reinforcing mesh. Laparoscopy of inguinal hernia has several advantages:

• the procedure is not as traumatic as hernia repair;
• the child’s recovery period is shorter;
• There are fewer relapses and complications such as damage to the spermatic cord are excluded.

A strangulated hernia is an indication for emergency surgery

The situation becomes critical when the hernia is strangulated. In this situation, surgical intervention is necessary immediately. Intestinal strangulation is considered the most life-threatening, as it can lead to intestinal obstruction and tissue necrosis.

Defining infringement is not difficult. Symptoms may worsen rapidly. The main symptom is a sharp and acute pain in the groin.

The child becomes restless, cries, screams loudly. At the beginning of the strangulation process, diarrhea, vomiting, and then constipation occur. If your baby develops similar symptoms, you should urgently take him to the hospital.

Postoperative therapy

After surgery, the patient must adhere to the doctor's recommendations. This will prevent inflammation of the sutures, relapses and other problems during the rehabilitation period. Necessary:

• take broad-spectrum antibiotics;
• wear special elastic panties that support the scrotum until it heals;
• follow a special diet (foods high in fiber and protein);
• give up physical activity.

Are relapses possible?

Hernia recurrence is a serious postoperative complication. Elimination of a newly emerging protrusion is a technically complex and traumatic operation. Recurrence of an inguinal hernia occurs in 1% of cases. This mainly occurs with connective tissue pathology and in premature infants.

An inguinal hernia in children is a protrusion through the inguinal canal of the vaginal process of the peritoneum, forming a hernial sac, which includes some internal organs (hernial contents). In children, inguinal hernias are usually congenital. Acquired ones are observed extremely rarely - they develop in school-age boys who have a weak abdominal wall or engage in weightlifting.

Inguinal hernias in children are most often congenital

Inguinal hernias in children are a widespread pathology. They are observed in 5% of full-term and 20-25% of premature babies. Often combined with other pathologies:

• spermatic cord cyst;
• Marfan syndrome and other connective tissue diseases;
• developmental anomalies of the spinal column;
• spina bifida;

Inguinal hernias in children are three times more common in boys. Presumably, this is due to the process of migration of the testicle into the scrotum from the abdominal cavity through the inguinal canal.

Causes and risk factors

The main role in the formation of congenital inguinal hernias in children belongs to the blind pouch of the peritoneum (vaginal process) protruding through the inguinal canal into the scrotum. After the testicle descends into the scrotum, the processus vaginalis becomes obliterated, i.e., overgrown. This usually happens around the time the baby is born. If for some reason obliteration does not occur, then the inguinal canal does not close and when intra-abdominal pressure increases, internal organs emerge through it. The hernial orifice is the outer ring of the inguinal canal, and the processus vaginalis of the peritoneum is a hernial sac, which may include intestinal loops, omentum, fallopian tube and ovary (in girls).

In the development of inguinal hernia in children, hereditary predisposition plays an important role. According to statistics, approximately 12% of children with this pathology also had an inguinal hernia in one or both parents.

Acquired inguinal hernias in children, as mentioned above, are extremely rare. Factors provoking their development:

• sudden weight loss;
• lifting weights;
• respiratory diseases accompanied by severe cough;
• chronic constipation.

Forms of the disease

Depending on the location, inguinal hernias in children are bilateral, left-sided and right-sided. In girls, bilateral hernial protrusions are observed in 50% of cases. In boys, bilateral inguinal hernias occur in 10% of cases, in 30% - left-sided, and in the remaining cases - right-sided.

As a rule, in children, inguinal hernias pass through the internal inguinal ring and are located in the inguinal canal, i.e. they are oblique. Direct inguinal hernias are extremely rare in pediatric practice. In this case, the hernial protrusion passes through a defect in the muscles of the anterior abdominal wall in the area of ​​the external inguinal ring.

Inguinal hernias in children are a widespread pathology. They are observed in 5% of full-term and 20-25% of premature babies.

In boys, the hernial sac can descend into the scrotum, which leads to the formation of inguinal-scrotal hernias, which, in turn, are divided into testicular (ovarian) and funicular (cordial).

Symptoms of inguinal hernia in children

The main symptom of an inguinal hernia in children is the presence of a tumor-like protrusion in the groin area. When the child strains, cries, screams, or coughs, it increases in size, at rest it decreases, and sometimes disappears completely.

With an inguinal-scrotal hernia in boys, deformation of the scrotum is observed due to the lowering of the hernial sac into it. In girls, the hernial sac may descend into one of the labia, causing it to thicken.

Inguinal hernias in children are often accompanied by pain localized in the lower abdomen or groin area. The pain may radiate to the lower back or sacrum. They can cause crying and whims in children in the first year of life. At an older age, children tell their parents about pain in the lower abdomen.

Diagnostics

An inguinal hernia in children is usually discovered either by the parents themselves or by a doctor during a routine examination.

Palpation reveals an elastic or soft consistency of the protrusion in the groin area. In an uncomplicated course, the hernial contents are easily reduced into the abdominal cavity. At the moment of reduction, you can hear a characteristic rumbling, which indicates the presence of an intestinal loop in the hernial sac. After the hernial protrusion is reduced into the abdominal cavity, the expanded external inguinal ring is palpated.

Inguinal hernias in children are three times more common in boys. Presumably, this is due to the process of migration of the testicle into the scrotum from the abdominal cavity through the inguinal canal.

To clarify the diagnosis, perform:

• ultrasound examination of the abdominal organs, pelvis, inguinal canals and scrotum;
• irrigography;
• cystography.

Inguinal hernia in children requires differential diagnosis with the following diseases:

• cyst of the round ligament of the uterus (in girls);
• cryptorchidism (in boys);
• spermatic cord cyst (in boys);
• hydrocele (in boys).

Treatment of inguinal hernia in children

Currently, conservative treatment of inguinal hernias in children using adhesive bandages and bandages is not carried out.

Removal of an inguinal hernia in children with an uncomplicated course is performed routinely after the age of six months. During surgery, the surgeon isolates, ties and cuts off the hernial sac, and then performs plastic surgery of the hernial orifice using the patient’s own tissue or using a special propylene mesh.

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Surgery for inguinal hernia in children can be performed using the classic open method or using laparoscopic technologies. The latter method is more preferable, as it is accompanied by minimal trauma to soft tissues, minor blood loss and a short rehabilitation period.

Removal of an inguinal hernia in boys should be performed with great care to avoid possible injury to the vas deferens and vessels of the testicle (spermatic cord). Their damage subsequently leads to testicular atrophy and/or male infertility.

The development of a strangulated inguinal hernia in girls is an indication for emergency surgery, since there is a very high risk of death of the fallopian tube or ovary. In boys in the first months of life, when strangulation develops in the first few hours, conservative therapy is carried out, aimed at self-reduction of the hernia. In this case, the following treatment regimen for inguinal hernia in children is used:

• warm bath or heating pad;
• intramuscular administration of drugs that have an antispasmodic effect;
• giving the child a position with an elevated pelvis.

If treatment does not lead to strangulation of the inguinal hernia, emergency surgery is resorted to. For strangulated inguinal hernias in children, the operation has its own characteristics. First of all, the surgeon must assess the viability of the organs included in the hernial sac. Reduction into the abdominal cavity is possible only if the viability of the intestine, omentum, ovary or other elements is beyond any doubt. Otherwise, they are resected.

Recurrence of inguinal hernias in children is observed in 1% of cases (most often after emergency interventions or in premature infants).

Possible consequences and complications

The main complication of an inguinal hernia in children is its strangulation. It develops as a result of compression of the hernial contents (ovary, omentum, intestinal loop, bladder wall) by the external inguinal ring, which leads to ischemia of the strangulated organs.

Constipation, flatulence, and severe cough can provoke the development of infringement.

The main symptoms of inguinal hernia strangulation in children are:

• pain in the groin (small children cry, press their legs to their stomach);
• the hernial protrusion becomes tense and sharply painful on palpation, it is impossible to reduce it into the abdominal cavity;
• nausea, repeated vomiting;
• delayed passage of gas and stool.

If surgical treatment is delayed, the child develops peritonitis.

Ovarian tissue is very sensitive to ischemia, so even short-term strangulation can cause ovarian necrosis and egg death.

Infringement is also dangerous for the male reproductive system. Thus, 5% of boys, after suffering an inguinal hernia strangulation, subsequently develop testicular atrophy.

Forecast

Removal of uncomplicated inguinal hernias in children is currently performed in most cases in a day hospital. The child is discharged for outpatient treatment on the day of surgery or the next morning.

Recurrence of inguinal hernias in children is observed in 1% of cases (most often after emergency interventions or in premature infants).

Complications of hernia repair occur extremely rarely. These include:

• infertility;
• high testicular fixation;
• lymphocele;
• testicular lymphostasis.

Prevention

Prevention of the formation of inguinal hernias in children includes:

• body weight control;
• treatment of constipation;
• treatment of respiratory diseases accompanied by cough;
• physical activity appropriate for age and muscle strength.

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