HERNIAS AND HYDROCOELES

A hernia refers to protrusion of a part of an organ or tissue through a defect or weakness in the cavity containing it.

Hernias are named based on their location in the body. Several kinds of hernias may exist on different parts of the abdomen.

Hernias may also happen after a surgery, along the line of healing of the incision, in which case they are referred to as incisional hernias.

An inguinal hernia occurs in the groin, the region between the lower abdomen, the upper thigh and the genitals.

An inguinoscrotal hernia extends from the groin into the scrotum of the affected side. In children, the defect is usually present from birth (congenital).

A hernia occurs if the path is wide enough to let a small portion of intestine (usually) protrude.

A hydrocoele forms when the opening is narrower and allows only fluid to pass through, into the scrotum.

The defect in an inguinal hernia is the internal inguinal ring- which is the inner end of the path that the testis follows to get to the scrotum as part of its normal development.

An inguinal/inguinoscrotal hernia or hydrocele occurs when that path fails to close completely after the testis has descended into the scrotum.

Signs and Symptoms of Hernia and Hydrocoele

It is usually a swelling in the groin or extending from the groin to the scrotum in a male child.  In a girl, it also shows as a swelling in the groin. The swelling protrudes and then reduces on its own.

It is noticeable and then goes back in. Though it is generally about 4 times more common in boys, hernias may also occur in girls.

The swelling typically is noticeable or comes out when the child coughs, cries, sneezes or strains to pass stool or urine.

Any activity or any condition that increases pressure on the abdomen/tummy makes the swelling protrude/become noticeable.

The swelling is usually painless. Due to the fact that it becomes noticeable when a child cries, some mothers may think it is causing the baby pain, which is not so.  A hernia becomes painful when it is complicated.

It is important to note that a hernia, on its own does not cause a poor appetite or weight loss in a child. If a child with hernia is losing weight, other causes should be looked for.

A hernia becomes painful when it is complicated- comes out, gets stuck and does not go back inside; also referred to as being incarcerated.

Complication of Hernia

Complications of hernia are Obstruction and Strangulation – the loop of intestine within it gets obstructed and gradually losses its blood supply.

As such, an obstructed or strangulated Inguinal hernia is one of the causes of intestinal obstruction in children.

How to recognize a complicated Inguinal hernia

• The swelling comes out and does not go back inside on its own.
• The swelling becomes painful.
• There may be redness over the swelling (more noticeable in light skinned children and babies)
•  There may be associated vomiting, constipation and swelling of the tummy (abdominal distension)

When any such symptom is noticed , the child should be taken to the nearest Children’s Emergency room for urgent evaluation and treatment.

Time is of the essence because the involved intestine may ‘die’ (because the blood supply to it gets completely cut off over time).

• The blood supply to the testis on that side may also be cut off over time and result in its damage .
• In girls , the ovary on the affected side may get incarcerated/stuck in it and will be similarly affected like the testis.

Treatment of Hernia

The treatment of hernia in children is Surgical-the child needs to have an operation.

The operation is considered a minor one and is usually done as a day case that is the child has the operation and goes home the same day of surgery except if the distance from the hospital to home is far or if there is any other condition of concern associated, then overnight observation in the hospital may be required.

The opening through which the loop of intestine protrudes is closed during the operation. The child is usually put to sleep for the operation to be done.

There is need for some blood tests to be done before the date of surgery is fixed.

Any other requirement will be explained by the doctor taking care of the child.

This article is contributed by Dr Oge Idika, Consultant Paediatric Surgeon and one of the ATP professionals. Kindly post your questions in comments or for urgent response; post on our ATP Facebook group from Mondays to Saturdays or Download our ATP mobile app available for Free download on android and IOS devices.