If you notice a small lump or bulge in your child’s groin area or an enlargement of the scrotum, you may have discovered an inguinal hernia. This condition, which is present in up to five of every hundred children (most commonly in boys), occurs when an opening in the lower abdominal wall allows the child’s intestine to squeeze through. This inguinal hernia is frequently confused with a more benign condition, a communicating hydrocele.
The testicles of the developing male fetus grow inside his abdominal cavity, moving down through a tube (the inguinal canal) into the scrotum as birth nears. When this movement takes place, the lining of the abdominal wall (peritoneum) is pulled along with the testes to form a sac connecting the testicle with the abdominal cavity. A hernia in a child is due to a failure of this normal protrusion from the abdominal cavity to close properly before birth, leaving a space for a small portion of the bowel to later push through into the groin or scrotum.
Most hernias do not cause any discomfort, and you or the pediatrician will discover them only by seeing the bulge. Although this kind of hernia must be treated, it is not an emergency condition. You should, however, notify your doctor, who may instruct you to have the child lie down and elevate his legs. Sometimes this will cause the bulge to disappear. However, your doctor will still want to examine the area as soon as possible.
Rarely, a piece of the intestine gets trapped in the hernia, causing swelling and pain. (If you touch the area, it will be tender.) Your son may have nausea and vomiting as well. This condition is called an incarcerated (trapped) hernia and does require immediate medical attention. Call your pediatrician immediately if you suspect an incarcerated hernia.
Even if the hernia is not incarcerated, it still should be surgically repaired as soon as possible. The surgeon also may check the other side of the abdomen to see if it, too, needs to be corrected, since it is very common for the same defect to be present there.
If the hernia is causing pain, it may indicate that a piece of intestine has become trapped or incarcerated. In that case, consult with your pediatrician immediately. He may try to move the trapped piece of intestine out of the sac. Even if this can be done, the hernia still needs to be surgically repaired soon thereafter. If the intestine remains trapped despite your doctor’s efforts, emergency surgery must be performed to prevent permanent damage to the intestine.