Hernia in childhood

What is inguinal hernia?

In the case of an inguinal hernia, the abdominal organ protrudes from the abdominal cavity through the inguinal canal at the junction of the abdominal muscles and the thigh muscles. This usually causes pain and discomfort in the groin area. In more severe cases of inguinal hernia, even the tissues of the affected organs may be damaged.
This type of hernia is a common problem in children, and boys are more affected than girls.
There are basically two types of this type of hernia, direct and indirect inguinal hernia.

What are the types of inguinal hernia?

Direct inguinal hernia

A direct inguinal hernia is a condition where the intestine or other internal organs break through a weakened area of the abdominal wall and descend into the inguinal region.
A direct inguinal hernia is caused by a weakening of the muscles of the abdominal wall. It causes pain and discomfort, with a palpable bulge in the lumbar area.

Direct inguinal hernia is common in childhood, especially in boys. In most cases, the cause is due to a hereditary predisposition. But increased abdominal pressure (coughing, sneezing, crying or laughing) can also contribute to the development of a hernia.

Direct hernia of the groin often requires surgery. The hernia contents are then reinserted into the abdominal cavity and the abdominal wall is reinforced. If the hernia is not treated in time, the hernia contents can cause paralysis or other serious problems.

Indirect inguinal hernia

In the case of an indirect inguinal hernia, the intestine or other internal organs break through the weakened area of the abdominal wall, descend into the groin area and reach the genitals. An indirect inguinal hernia usually develops from the abdominal cavity through a canal (inguinal canal) that passes through the lumbar area.

Indirect hernia of the groin is common in childhood, especially in infants and especially in younger male children. In this case, the inguinal canal does not close completely during foetal life, so indirect inguinal hernia is not uncommon in infants. In older children, a hernia may also be caused by the inguinal canal remaining open or being weak.
Indirect hernia of the groin is rarely associated with severe discomfort, but if the hernia contents become trapped, severe pain and discomfort can occur. In this case, the hernia requires surgical intervention. Surgery is performed to reinsert the hernia contents into the abdominal cavity and close the inguinal canal.

Direct hernia of the groin often requires surgery. The hernia contents are then reinserted into the abdominal cavity and the abdominal wall is reinforced. If the hernia is not treated in time, the hernia contents can cause paralysis or other serious problems.

What other types of hernia exist?

As with the causes of hernias, the types of hernia can vary depending on which parts of the body they occur.

The most common types include:

• Inguinal hernia (direct and indirect)
• Diaphragmatic hernia
• Brow hernia
• Hasfali hernia
• Hereserve
• Thigh horn
• Postoperative hernia (hernia at the site of surgical scars)

What causes hernias in children?

Hernias in children are usually caused by congenital weakness or absence of muscles or tissues. This weakness may be hereditary or may be caused by a developmental problem in the foetus.

Causes of hernias, main factors in their development:

• Severe coughing or sneezing, which increases abdominal pressure and increases strain on the muscles.
• Physical activity or sport that involves sudden and strong movements.
• Constipation or chronic cough that persists for a long time.
• Constant crying, which can lead to excessive strain on the abdominal muscles.

What risk factors increase the chance of developing a hernia in infancy and childhood?

The most common risk factors are:

• Genetics
• Premature birth
• Low birth weight
• Reduced muscle tone
• High physical demands
• Respiratory diseases, chronic cough
• Abdominal muscle weakness
• Increased abdominal pressure with intense crying or defecation
• Severe trauma to the abdomen, such as an accident, fall or blow

What are the symptoms of hernia in babies and children?

In infancy and childhood, hernia most commonly occurs in the navel and groin area. Symptoms may vary depending on the type of hernia:

• Protruding skin bump or lump
• Pain
• Hypersensitivity
• In more severe cases, abdominal complaints such as stomach pain, vomiting or nausea

Do childhood hernias disappear on their own?

Childhood hernias are not usually serious problems and often improve spontaneously or disappear completely. However, in many cases a hernia needs to be surgically repaired.
It is important to bear in mind that each case is unique. The treatment of a hernia depends on its size and severity, as well as the age of the child. The treatment of a hernia is always determined by a doctor, a paediatric surgeon.

Is hernia surgery necessary in children?

The need for hernia surgery is usually determined by the size of the hernia, its severity and the exact combination of symptoms. The most common cases for hernia surgery are

• The hernia does not improve or gets worse over time
• Causes severe pain
• Impedes everyday activities
• Unraveling
• The hernia does not go back into the abdomen
• Diameter greater than 2 cm
• The child plays sport regularly

It is important to know that each case is unique, so paediatric surgeon, and the paediatrician decide together whether hernia surgery is necessary. When deciding whether to operate, the child's health, age, the size and severity of the hernia are taken into account.
Surgical treatment of hernias is usually effective and safe. Early diagnosis and treatment can help avoid serious complications, so it is worth seeking medical help early.

What is a hernia exclusion?

During hernia exclusion, the hernia contents become trapped in the hernia sac and cannot return to the abdominal cavity. This can cut off the blood supply to trapped tissues and organs, which can lead to serious complications.

Signs of hernia exclusion

Hernia dislocation can occur in any type of hernia, but is most common in inguinal hernias.
The most common signs of hernia exclusion:

• Sudden, severe abdominal pain
• Hardening, spasm, stinging sensation in the wound area
• Sensitivity to hernia
• Redness or swelling of the skin
• Fever and chills
• Vomit
• Diarrhoea
• Bloating
• Difficulties with emptying stools

If the blood supply to the trapped hernia is compromised, significant complications such as tissue necrosis or peritonitis can develop. Hernia exclusion is a life-threatening condition that requires emergency paediatric surgery.