Hernia in Childhood
What is a hernia?
A hernia occurs when tissues from any part of the body (e.g., a section of the intestine) protrude from their normal position. A hernia most commonly appears as a soft bulge on the skin surface. Its size and shape may increase or decrease depending on how the child moves.
Several types of hernias are known. Hernias in infants and children typically occur as inguinal hernias, umbilical hernias, and diaphragmatic hernias.
The most common symptoms of a hernia are: mild pain, tenderness, bulging
What is an inguinal hernia?
In an inguinal hernia, an abdominal organ protrudes from the abdominal cavity through the inguinal canal, located at the junction of the abdominal and thigh muscles. This typically causes pain and discomfort in the groin area. In more severe inguinal hernias, the tissues of the affected organs may also be damaged.
This type of hernia is a common problem in children, with boys being more affected than girls.
Fundamentally, there are two types of this hernia: direct and indirect inguinal hernias.
What types of inguinal hernias exist?
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 develops due to weakness in the abdominal wall musculature. It causes pain and discomfort, accompanied by a palpable bulge in the groin area.
Direct inguinal hernias are common in childhood, especially in boys. In most cases, the cause can be traced back to hereditary predisposition. However, increased abdominal pressure (severe coughing, sneezing, crying, or laughing) can also contribute to hernia development.
In many cases, a direct inguinal hernia requires surgical intervention. During the procedure, the hernia contents are returned to the abdominal cavity and the abdominal wall is reinforced. If the hernia is not treated in time, the hernia contents may cause incarceration or other serious problems.
Indirect inguinal hernia
In an indirect inguinal hernia (inguinal hernia), the intestine or other internal organs break through a weakened area of the abdominal wall, descend into the groin area, and may reach the genitals. An indirect inguinal hernia typically develops from the abdominal cavity through a canal in the groin area (inguinal canal).
Indirect inguinal hernias are common in childhood, especially in infants and particularly in young boys. In this case, the inguinal canal does not close completely during fetal development, making indirect inguinal hernias not uncommon in infants. In older children, the persistence or weakness of the inguinal canal may also contribute to hernia development.
Indirect inguinal hernias rarely cause severe symptoms, but if the hernia contents become incarcerated, severe pain and discomfort may occur. In this case, the hernia requires surgical intervention. During surgery, the hernia contents are returned to the abdominal cavity and the inguinal canal is closed.
In many cases, a direct inguinal hernia requires surgical intervention. During the procedure, the hernia contents are returned to the abdominal cavity and the abdominal wall is reinforced. If the hernia is not treated in time, the hernia contents may cause incarceration or other serious problems.
What is an umbilical hernia?
In an umbilical hernia, the intestine or other internal organs break through a weakened area of the abdominal wall and descend into the umbilical area. The primary cause of an umbilical hernia is poor closure of the abdominal wall musculature.
Umbilical hernias rarely cause pain. In younger children, they most often heal spontaneously with growth and strengthening of the abdominal muscles.
If the umbilical hernia does not improve on its own, surgery may be necessary. During the intervention, the surgeon returns the hernia contents to the abdominal cavity and then reinforces the abdominal wall to prevent recurrence of the hernia.
Fundamentally, an umbilical hernia is not dangerous, but in case of severe pain, it is advisable to seek medical assistance.
What is a diaphragmatic hernia?
In a diaphragmatic hernia, part of the stomach breaks through the diaphragm in the chest and enters the thoracic cavity.
This type of hernia is less common in childhood. It is most often a congenital abnormality that develops due to incomplete development of the diaphragm during fetal life.
However, it can also be caused by a sagging diaphragm or other damage resulting from an accident.
Diaphragmatic hernias are often asymptomatic, but in many cases acid reflux indicates the problem.
What other types of hernias exist?
Just as the causes of hernias vary, so do the types, depending on which parts of the body they occur in.
The most common types include:
- Inguinal hernia (direct and indirect)
- Diaphragmatic hernia
- Umbilical hernia
- Abdominal wall hernia
- Scrotal hernia
- Femoral hernia
- Postoperative hernia (hernia developing at surgical scar sites)
What causes hernias in children?
Hernias in children typically develop due to congenital weakness or absence of musculature or tissues. This weakness may be hereditary or caused by developmental problems during fetal life.
The causes and main contributing factors for hernias:
- Severe coughing or sneezing, which increases abdominal pressure and increases strain on the musculature.
- Physical activity or sports involving sudden and vigorous movements.
- Constipation or chronic coughing that persists for an extended period.
- Continuous crying, which can lead to excessive strain on the abdominal muscles.
What risk factors increase the likelihood of hernia development in infancy and childhood?
The most common risk factors:
- Genetics
- Prematurity
- Low birth weight
- Decreased muscle tone
- High physical exertion
- Respiratory diseases, chronic coughing
- Abdominal wall muscle weakness
- Increased abdominal pressure associated with intense crying or defecation
- Severe trauma to the abdominal wall, such as an accident, fall, or blow
What are the symptoms of hernias in infants and children?
Hernias in infancy and childhood most commonly occur in the umbilical and groin areas. Symptoms may vary depending on the type of hernia:
- Protruding skin bulge or lump
- Pain
- Hypersensitivity
- In more severe cases, abdominal complaints such as abdominal pain, vomiting, or nausea
Do childhood hernias resolve on their own?
Childhood hernias generally do not cause serious problems and often improve spontaneously or disappear completely. However, in many cases, surgical treatment of the hernia is necessary.
It is important to keep in mind that every case is unique. The method of hernia treatment depends on its size and severity, as well as the child’s age. Hernia treatment is always determined by a physician or pediatric surgeon.
How can hernias be treated in children and infants?
Hernias are a common problem in children and infants. In most cases, they heal spontaneously, but sometimes medical intervention is required.
Several methods are available for treating hernias:
Surgical intervention
This is considered if the hernia does not retract on its own, is larger in size, or is painful. During surgery, the surgeon returns the protruding tissues to their proper position and then reinforces the weakened area to prevent further hernia formation.
Hernia truss
A hernia truss is a special bandage that the physician places around the hernia to help the protruding tissues retract.
Monitoring
This typically involves regular medical examinations so the physician can observe the size of the hernia and any changes
Prevention
Parents should avoid strong pressure on the child’s abdomen and lift their child with appropriate care.
Is childhood hernia surgery necessary?
The necessity of hernia surgery is generally determined by the size, severity, and specific combination of symptoms of the hernia. Intervention most commonly occurs in the following cases:
- The hernia does not improve or worsens over time
- It causes severe pain
- It interferes with daily activities
- It becomes twisted
- The hernia contents do not return to the abdominal cavity
- Its diameter is greater than 2 cm
- The child regularly participates in sports
It is important to know that every case is unique, so the pediatric surgeon and pediatrician jointly decide on the necessity of hernia surgery. When considering surgery, they take into account the child’s health status, age, and the size and severity of the hernia.
Surgical treatment of hernias is generally effective and safe. Early diagnosis and therapeutic intervention can help avoid serious complications, so it is advisable to seek medical assistance in a timely manner.
What is hernia incarceration?
During hernia incarceration, the hernia contents become trapped in the hernia site and cannot return to the abdominal cavity. This can interrupt the blood supply to the trapped tissues and organs, which may cause serious complications.
Signs of hernia incarceration
Hernia incarceration can occur with any type of hernia, but it predominantly happens with inguinal hernias.
The most common signs of hernia incarceration:
- Sudden, severe abdominal pain
- Hardening, cramping, stabbing sensation felt in the hernia area
- Tenderness in the hernia area
- Redness or swelling of the skin in the hernia area
- Fever and chills
- Vomiting
- Diarrhea
- Bloating
- Difficulty with bowel movements
If the blood supply to the incarcerated hernia deteriorates, significant complications may develop, such as tissue necrosis or peritonitis. Hernia incarceration is a life-threatening condition that requires emergency pediatric surgical intervention.
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