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Inguinal Hernia in Infants & Children

Inguinal Hernia in Infants and Children - Inguinal Hernia in Infants and Children -

An inguinal hernia happens near the groin area, between the belly and the thigh. With boys, you can often see a swelling in the scrotum. Does this mean girls are off the hook? Not exactly. While girls may not have testicles, they do have an inguinal canal and can get hernias, too.

About 3% to 5% of healthy, full-term babies are born with an inguinal hernia. In premature infants, the incidence is substantially increased―up to 30%.

If an inguinal hernia is not treated, it can cause serious problems. Learn more about the signs and symptoms of this condition and what to expect if your child needs hernia repair surgery.

What is an inguinal hernia?

The story of the inguinal hernia begins during a baby's development. When a baby boy is growing in the womb, the testicles first grow in his belly. As the fetus develops, their testicles travel down a tunnel into the scrotum. (This tunnel also exists in baby girls.)

Occasionally, the tunnel (called the processus vaginalis) does not close. This leaves an opening from the belly into the inguinal canal, where a piece of bowel or an ovary can become trapped.

When this happens, what should stay safely in the abdomenfluid, intestines, other tissuescan pass through and enter the groin. To avoid potential complications, inguinal hernias require surgery to repair.

How do I know if my child has an inguinal hernia?

Inguinal Hernia in Infants & Children -

Hernias can occur at any age but are most common in newborns. However, they may not be noticeable for several weeks or months after birth.

When your child has an inguinal hernia, you can usually see a bulge in the groin and/or scrotum or labia. The bulge will typically come and go, and is usually soft and squishy. It may get bigger after your child is straining or crying. It may go away or get smaller during the night while your child is asleep or relaxed. (Straining and crying do not cause hernias, despite some myths.)

NEVER ignore signs of pain or distress or any bulge in an infant or child. Call your doctor as soon as possible for a professional opinion or go to the emergency room.

  • Incarcerated hernia. If the bulge becomes trapped even when your child relaxes, it may mean that organs from inside the belly are trapped inside the hernia. This is called an "incarcerated hernia" and requires immediate medical attention. Your child will likely have pain or feel tenderness (or even have vomiting). The bulge may also become much firmer or even red when this happens.

  • Strangulated hernia. If the blood supply of the contents of the hernia is cut off, it is called a "strangulated hernia." These symptoms include severe pain, vomiting, decreased appetite, redness or bruising around the bulge, and sometimes fevers and bloody stools.

What is the difference between an inguinal hernia and a hydrocele?

The inguinal hernia is frequently confused with a similar but more benign condition, a communicating hydrocele. What's the difference?

A hydrocele is a fluid filled sac in the groin or scrotum. Like hernias, hydroceles occur when there is a patent processus vaginalis, but fluid—not organs—is found in the sac. Hydroceles can look like hernias and also have swelling in the groin and scrotum, and fluid can move back and forth from the scrotum into the belly, leading to a change in size of the scrotum ("communicating hydrocele"). Swelling of the hydrocele may cause discomfort but typically it does not.

A hydrocele does not require surgery right away. Most can be watched until 12 to 18 months of age; after that, they are unlikely to resolve on their own. Hydroceles can also become inguinal hernias if solid abdominal contents enter and stretch out the sac, in which case surgery is recommended.

Will any tests need to be done to see if my child has an inguinal hernia?

Most of the time, a doctor can diagnose an inguinal hernia by what they see when examining your child―seeing a bulge in the groin when your child cries or strains and seeing it disappear when your child relaxes.

When what the doctor sees is different from what you have seen at home, or if the bulge is always there and the doctor is worried that it might be a mass and not a hernia, an ultrasound can be done to help make the proper diagnosis. However, ultrasounds are not always necessary.

If it is not always obvious to see, it may be helpful to have a picture of your child's hernia when you go to an appointment with the doctor.

How is an inguinal hernia treated?

Surgery is needed to fix the inguinal hernia. Once a hernia is noticed, your doctor will refer your child to see a pediatric surgeon or a pediatric urologist for the procedure. Surgery will be scheduled to close the tunnel.

The timing of inguinal hernia surgery depends the severity of the symptoms. An incarcerated or strangulated hernia needs to be taken care of immediately.

What type of surgery is done to repair the hernia?

In hernia repair surgery, the contents of the hernia are pushed back into the abdomen. The inguinal tunnel where the organs are exiting from the belly (hernia) is closed.

  • If a laparoscopic (scope) approach is used for the surgery: Small cuts are made on the belly allowing the scope and instruments to be inserted to see inside the abdomen and repair the hernia.

  • If an open surgery is used: A small incision is made in the groin to repair the hernia.

  • If bowel (or another organ) is trapped in the hernia (incarcerated or strangulated): The surgeon will first ensure that the blood supply to the bowel has not been cut off for too long. If it has, a small piece of bowel may need to be removed and the bowel sewn back together. The hernia is then repaired.

Typically, this surgery takes between 30 minutes to 1 hour.

What should I expect on the day of the hernia surgery?

Before surgery, you will meet the anesthesiologist. Inguinal hernia surgery is typically done under a general anesthetic, although a regional anesthetic can be used. Your child will be asleep during the procedure. See Anesthesia and Children: The Day of the Procedure for more information.

As soon as your child wakes up after surgery, someone from the recovery room will call you and you will be able to be with your child again.

Your child may have some pain where the incisions were made. Some surgeons inject medicine at that area to control pain. Or, an anesthesiologist may inject medicine in the lower back ("caudal block") or in the abdominal nerves that supply the skin over the incision. Your child may also be given pain medicine for you to take at home.

When can we go home after surgery?

Typically, hernia repair surgery is an outpatient or "same day" surgery―meaning your child gets to go home a few hours after recovery. However, if your child has a medical condition or is a premature infant, an overnight stay may be required for observation and safety.

When it is safe for your child to go home you will review at-home care with your nurse or doctor.

How do I care for my child at home after surgery?

Post-surgical home-care instructions can be different depending on the hospital or surgeon, age of the child, and how complex the surgery was. However, some general principles may be similar:

  • Most children can eat a regular diet right after surgery.

  • Recovery time depends on the child. Most can go back to normal, non-strenuous activities in about 1-2 weeks or when they are pain-free.

  • Your child will be restricted from bathing for 2-3 days post-surgery. Your child's surgeon may give you different or more specific instructions.

When should I call the doctor's office?

You will receive specific instructions for follow-up with the surgeon when your child goes home after surgery. However, here are some key reasons to call:

  • Bleeding or drainage from the incision

  • Redness around the wound(s)

  • Fever above 101 F

  • Vomiting

  • Less peeing than usual or fewer wet diapers than usual

  • Pain that is severe even when taking the pain medications as recommended

What problems might my child have as a result of having an inguinal hernia?

Having an inguinal hernia in one groin may increase the chance of a hernia on the other side. The surgeon will talk to you about how to care for this possibility.

After an inguinal hernia repair, most children do not have problems with this again. But rarely, a hernia can come back. If this happens, a surgeon will need to see your child again.

Keep in mind that there are different types of inguinal hernias. Having an inguinal hernia corrected as a child does not mean that your child could not develop a different type of inguinal hernia as an adult, or a hernia on the other side.

More information

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American Academy of Pediatrics Section on Surgery, American Pediatric Surgical Association & American College of Surgeons (Copyright © 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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