Inguinal hernia in children. Inguinal hernia treatment Inguinal hernia in a child

Your baby has an inguinal hernia? Learn about the features of surgical removal of the neoplasm, which will allow you to quickly get rid of the disease and potential danger to the baby's life.

Article for parents

An inguinal hernia is a neoplasm in the groin area, which is accompanied by the prolapse of internal organs into the inguinal canal.

Inguinal hernia formation and localization

At first glance, the ailment seems harmless, since at the first stages it does not cause pain in the child. But illness can be compared to a time bomb. In the absence of proper treatment, a neoplasm can disrupt blood circulation, which causes the death of tissue and internal organs.

Prerequisites

The disease has become widespread among children. According to statistics, hernia is observed in 6% of term babies and 15% of premature babies. Experts, speaking about the prerequisites of the disease, distinguish two groups of factors: congenital and acquired.

Congenital

When talking about congenital factors, it is important to pay attention to the fact that the disease is more common in boys than in girls. This is provoked by the fact that a hernia in male babies appears in the process of moving the testicles into the scrotum.

Note. Moving the testicles into the scrotum is a natural process associated with male physiology. The testicles from the abdominal cavity, where they were formed, move into the subcutaneous inguinal canal.

Inguinal hernia in children is more common among boys

In girls, testicles are absent, respectively, the ovaries do not go through the process of movement, but remain where they were originally formed. For this reason, inguinal hernia is rare among female children.

Acquired

As for the acquired factors provoking the disease, experts distinguish the following:

• surgery in the scrotum or abdomen, for example, removal of appendicitis;
• mechanical impact on the pubic area, for example, trauma, damage, etc.
• excessive physical activity, for example, lifting weights, prolonged crying, severe coughing, etc.

Note. For more information, check out our Qualified Surgeon Interview

https://www.youtube.com/watch?v\u003dhNJx0U1eSKg

Symptoms

The symptoms of the disease are difficult to see with the naked eye. In the early stages, the disease is practically not manifested. Among the characteristic symptoms are the following:

• pain when pressing on the affected area is absent;
• if the hernial sac contains intestines, it hums when pressed;
• with stress, for example, crying a baby, the hernia protrudes;
• can be oblong or rounded.

Note. The disease can be both unilateral and bilateral. Boys are characterized by a left-sided hernia - about 65%, while girls are faced with bilateral damage to the groin area.

Uncomfortable sensations begin to bother the patient at a later stage of the disease, when the hernia begins to infringe on neighboring organs. This is due to the fact that the protruding organs, when they enter the hernial sac, begin to squeeze.

Probing the abdomen will help to identify an inguinal hernia in a child

This process is dangerous for the child's life. Parents need to resort to urgent surgical intervention, otherwise, the baby will die of the affected organs (the cause of cell death is the impaired blood circulation of the affected organs).

The severe stage of hernia development is characterized by certain symptoms. Among them are the following:

• pain in the area of \u200b\u200bprotrusion;

Note. If the child previously experienced severe pain, but then they disappeared without surgery, there is a serious cause for concern. This state of affairs can be triggered by the death of the affected organ.

• the child is characterized by restless behavior, crying, which is a sign of inflammation in the area of \u200b\u200bthe neoplasm;
• feeling overly weak;
• constipation;
• bloating (the baby does not have gas).

Parents need to carefully "listen" to the body of their child. Untimely treatment causes an inflammatory process in the abdominal cavity. Its symptoms are high fever, vomiting and loss of consciousness.

Diagnostics

Parents of a sick baby will not be able to independently determine the disease. At the slightest suspicion, you need to contact a surgeon who, based on the following measures, will make an accurate diagnosis:

• Examination of the patient (for example, the doctor may ask the child to cough to fix the protrusion of the neoplasm).
• Ultrasound - allows you to identify which organs have fallen into the hernial sac.
• X-ray - makes it possible to identify whether the intestine has been pinched.

Preparing for surgery

Before the operation, the little patient must undergo the generally accepted preparation for the procedure. First of all, the safety of the baby depends on the measures taken.

Before removing an inguinal hernia, the doctor must examine the child and assess his health.

First of all, at the time of the operation, the child should not have concomitant diseases, for example, even a mild cold. For this reason, the child is examined by a pediatrician, who prescribes additional procedures:

• blood test;
• analysis of urine;
• analysis for the presence of infections in the body;
• coagulogram.

In the future, the baby should be examined by an anesthesiologist who will correctly select anesthesia for the patient. Surgery is usually performed under general anesthesia.

Surgical intervention

The operation is the only effective way to remove an inguinal hernia. In medical practice, it is customary to distinguish two types of surgical intervention:

• laparoscopy;
• open type operation.

Laparoscopy

Laparoscopy, as a relatively new surgical technique, has become widespread among patients. The main advantage of the operation is the complete absence of traces of surgical intervention - scars and scars.

During the operation, the little patient is under general anesthesia. In general, the procedure takes no more than 50 minutes.

Before laparoscopy, the child is given general anesthesia

During the operation, the specialist makes three small incisions in the affected area. Using a laparoscope, the surgeon displays an image of the patient's internal organs on the screen, examining the neoplasm. Later, with the help of miniature instruments, the doctor removes the hernia.

Note. Laparoscopy is performed only in the early stages of the disease. In the event that the neoplasm does not begin to infringe on neighboring organs. If the patient has complications, doctors recommend giving preference to the open type of surgery.

Open operation

Surgical intervention is possible for children from the age of three months. As a rule, the operation is performed as planned, the procedure takes no more than half an hour.

The child is under general anesthesia, and in the meantime, specialists perform the following procedures:

• The doctor makes an incision in the groin area, the size of which does not exceed 3 cm (within one month, an almost invisible scar remains).
• The specialist separates the hernial sac from the adjacent tissues and inserts the internal organs "into place".
• The hernial sac is then removed and the affected area is bandaged.
• The surgeon sutures the incision by applying cosmetic intradermal sutures.

Rehabilitation

As a rule, the recovery process after surgery takes place in a short time. First of all, the child's parents need to pay due attention to the cleanliness of the dressing, which is applied to the wound site. It needs to be changed at least once a day. If dressings are performed in a hospital, you should not ignore the trip to the hospital.

During laparoscopy, the child is discharged from the hospital after a couple of days. He can move freely, for example, go to kindergarten, but physical activity should be excluded for the first three weeks.

With regard to rehabilitation after open surgery, mainly experts recommend putting on a bandage for young patients. For two weeks, the baby needs to wear a bandage, you can only remove it during sleep.

As a rule, postoperative stitches are removed within the first week after the operation.

Note. It is strictly forbidden to wet the postoperative wound until the stitches are removed. If redness and swelling occur, contact a healthcare professional.

Complications

As practice shows, the likelihood of complications after surgery is minimized. However, some complications accompanying the postoperative period are rarely recorded:

• the formation of hematomas;
• the appearance of puffiness;
• hemorrhage in the seam area;
• damage to the bladder.

Note. In rare cases, after the operation, there is a relapse (reappearance of a hernia). Such consequences are caused by the low level of professionalism of the surgeon.

Price

Most healthcare facilities have identical prices for groin hernia repair.

On average, the cost of an open operation varies within 20-30 thousand rubles. As for laparoscopy, the price of the service is 40 - 45 thousand rubles. As a rule, the presented price includes payment for the following services:

• hospital accommodation (1 - 2 days);
• anesthesia;
• operating materials;
• the imposition of a cosmetic suture.

Thus, an inguinal hernia is a neoplasm characterized by the ingestion of internal organs into the inguinal canal. Parents, if symptoms of the disease are detected, it is urgent to show the child to the doctor.

Thanks to the high development of medicine, the operation will be not only painless, but also effectively relieve the baby of the disease.

Inguinal hernia in boys is a phenomenon quite commonin children.

This pathology in children is most often congenitalhowever, in some cases, for example, with excessive physical activity, overweight, the defect is acquired.

general information

Inguinal hernia in infants - photo:

The disease is a specific bulge that can be observed in the scrotum and groin area. Most often, such a protrusion appears on the right side. An inguinal hernia may be bilateral.

The disease develops when the abdominal organs are out of place, but fall into the groin area. A hernial sac is formed, the contents of which become an intestinal loop, an omentum.

The defect is most often congenital when a boy has the process of lowering the testicles is disrupted from the abdominal cavity to the scrotum.

Thus, the prerequisites for the development of pathology are found even in the prenatal period, and after the birth of the baby, the manifestations of the disease progress.

In some cases, an inguinal hernia proceeds stably, without giving the child unpleasant sensations, but in most cases the presence of a hernia hurts the boy, negatively affects his general well-being.

Reasons for the appearance

In newborns, the cause of the development of the disease is congenital.

It is known that in the prenatal period the boy's testicles are located in the abdominal cavity, they descend into the scrotum after the baby is born.

If this process is disturbed for some reason, not only fragments of other organs of the abdominal cavity can get into the groin area.

This happens as a result of intrauterine abnormalities, for example, when there is threatened abortion, fetal hypoxia, other unfavorable factors complicating the course of pregnancy.

In older children, an inguinal hernia may result from excessive physical activity, for example, when doing heavy sports, when lifting weights.

The risk of developing pathology increases if the child is overweight.

How to recognize?

Inguinal hernia in boys is a disease that has a number of characteristic symptoms... Among them are noted:

1. Specific groin education seals, protrusions.
2. The lump has various sizes, from small to very large, when several intestinal loops fall into the groin area.
3. Education has round or oval shape.
4. The lump is easily detected by palpation, it feels soft.
5. If there are no complications (pinching), small protrusions can be easily adjusted with slight pressure.
6. When pressing on the seal, a characteristic gurgling sound.
7. When the baby is straining the abdominal muscles, for example, with severe crying, coughing, induration increases in size.

In some cases, when a child has a pinched hernia, symptoms of body intoxication, disruption of the digestive tract are manifested.

In particular, this is nausea and vomiting, bloating as a result of a violation of gas discharge, a violation of the process of defecation, a sharp temperature increasebody to high values, pain in the groin area.

All this negatively affects the child's health and well-being. This phenomenon requires urgent hospitalization, emergency surgery.

What is the danger of a hernia of the white line of the abdomen in a baby? find out right now.

Features of the inguinal and scrotal

Inguinal-scrotal hernia develops if there is weakness of the connective tissue of the inguinal ring, which in this case is a natural opening through which the abdominal organs fall into the scrotum.

The inguinal ring tends to contract and expand, as a result of which the risk of hernia pinching increases significantly.

Inguinal-scrotal hernia, in the absence of complications, often has latent symptoms, the presence of a protrusion can only be noted if the child is straining the abdominal muscles. In a calm state, clinical manifestations may be absent.

Why is it dangerous?

The most common complication of the disease is considered pinchinginguinal hernia.

This phenomenon is considered very dangerous for the health of the child, as it provokes a disruption in the functioning of the digestive system, contributes to the development of symptoms of intoxication of the body.

In addition, the restrained organ dies off over time ( necrosis), this leads to irreversible consequences.

In some cases, when the appendix falls into the hernial sac, the child develops with symptoms characteristic of this disease. The inflammatory process begins, poisoning of the body. The child needs urgent medical assistance.

The lack of competent treatment of an inguinal hernia in childhood can further lead to serious problems in the functioning of the organs of the genitourinary system.

In particular, the processes of urination are disrupted, it may appear infertility.

Diagnostics

In order to determine the presence of the disease, it is necessary to show the child surgeon... To make a diagnosis, the doctor examines the patient, reveals the clinical picture of the disease.

Outwardly, the symptoms of an inguinal hernia resemble signs of dropsy, therefore, when making a diagnosis, it is important to pay attention to the symptoms that are characteristic only of a hernia.

An experienced specialist can easily make the correct diagnosis.

However, in some cases, to confirm it laboratory methods are also required diagnostics:

• general analysis of urine, feces;
• biochemical blood test;
• Ultrasound to determine the contents of the hernial sac, assess the condition of the abdominal organs.

Conservative treatment methods

Children under the age of five are usually prescribed conservative treatment for an inguinal hernia (the exception is the presence of infringements). Others contraindications for surgeryare considered:

• diseases of the kidneys, organs of the cardiovascular system;
• peritonitis, sepsis, acute infectious diseases;
• blood clotting disorder;
• intestinal dysfunction (intestinal obstruction);
• obesity;
• recently transferred other surgical interventions.

Non-surgical methods of treatment give a positive result if the size of the hernia is small and it can be repositioned well.

In this case, the child is prescribed the use of special bandage, which helps to hold the abdominal organs in their place, prevents them from falling out into the groin.

In addition, it is necessary to systematically strengthen the muscle tissue of the walls of the abdominal cavity, the inguinal ring.

To do this, developed special set of physical exercises:

The exercises must be repeated 2 times a day, daily. At the same time, it is important to ensure that the child does not overexert himself, does the exercises easily, and does not experience excessive stress.

When is surgery necessary?

Surgical treatment is considered the most effective method, allowing you to eliminate the defect. However, surgery is usually not prescribed for young children.

Emergency surgical intervention is necessary if the disease progresses rapidly and gives the child severe pain. The presence of infringement is also an indication for urgent surgical intervention.

The operation is considered quite simple and safe for a child. Its duration usually does not exceed half an hour. On day 4-5, the baby is discharged from the hospital. The stitches are removed 7-10 days after the operation.

Rehabilitation

In the postoperative period (within 2 months), the child must wear special elastic swimming trunks... This helps maintain the scrotum in a physiological position, promotes early wound healing, and reduces the risk of recurrence.

It is necessary to pay attention to the child's lifestyle. Strong physical activity, overly active games are not recommended for the kid.

The diet should include high-calorie foodsrich in protein.

To prevent wound infection, the baby is prescribed a prophylactic reception antibioticsa wide spectrum of action.

For the treatment of hematoma on the head of a newborn after childbirth, you will find on our website.

Prevention

It is possible to reduce the risk of developing an inguinal hernia in a child if simple rules, such as the:

• timely treatment of severe cough, prevention of constipation, which can provoke a hernia;
• proper nutrition, taking vitamin preparations, strengthening the child's immune system;
• limiting excessive physical activity.

An inguinal hernia is a phenomenon that can not only cause discomfort to the baby, but also threaten his health if complications.

The disease can be congenital (it develops even in the prenatal period), or acquired when there are unfavorable factors that contribute to its appearance.

Pathology has a number of specific symptoms; in the presence of complications, the clinical picture becomes more extensive.

The main method of treatment is surgicalhowever, in some cases, conservative therapy is used.

Dr. Komarovsky about hernias in children in this video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

One of the most common surgical pathologies in children is an inguinal hernia. It manifests itself as an oval or round protrusion in the groin and scrotal area. Very often it is detected by a neonatologist in the first hours of a child's life, or by a pediatrician in the first half of a baby's life.

Content:

The abnormal process is a characteristic protrusion in the anterior thigh folds of babies, in the zone of the slit-like space (channel) passing through the thickness of muscle fibers in the wall of the lower peritoneum. The protrusion is caused by not overgrowing of a special canal (vaginal process), which is a conductor of the testicle, which descends into the groin.

Boys can get into the hernial sac: various parts of the intestinal loops, or areas of the movable omentum. The oviducts (tubes of the uterus) and the fixing ligaments with the ovary fall into the hernial "pocket" of girls. The manifestation of pathology is observed in almost 8% of newborns and premature babies. Increases the likelihood of formations of bulging in the groin in children, genetic pathologies that provoke the development of connective tissue dysplasia (with abnormal or insufficient development).

It is not uncommon for pathologies in the groin to combine:

• with orthopedic diseases - congenital dysplasia of the hip joints or their inferiority:
• with defects of a neurological nature;
• with congenital malformations of spinal pathologies.

The manifestation of an inguinal hernia in boys is almost ten times more common than in girls. In most cases, it is localized in the right groin area, only in 10% they are found with bilateral localization. Bilateral localization of protrusion appears in girls initially, although other options are not excluded.

Types of groin hernias

Inguinal protrusion can manifest itself in children in two forms - a straight hernia, passing through the internal fossa of the groin, and an oblique hernia, going through the middle of the inguinal ligament. Among the forms of oblique inguinal hernia, a canal hernia is distinguished (the bottom of the hernial sac located at the level of the external opening of the inguinal canal), cord (the bottom of the hernial sac is located in the inguinal canal at different levels of the spermatic cord), inguinal-scrotal hernia (the bottom of the hernial sac descends into the scrotum, bringing to its increase).

• localization of direct hernias is located above the pubic abdomen;
• the manifestation of the oblique variety is characterized by the formation in the lower pubic zone and lowering into the scrotum. More often they are congenital pathology.

According to their characteristics, pathologies are reducible and irreducible:

• the property of self-reduction into the peritoneum has reducible hernia of the inguinal zone;
• irreducible protrusions are not amenable to manipulation and remain unchanged.

The danger of the very existence of such a pathological formation in a child is due to the threat of possible infringement of organs in the hernial sac by the hernial orifice.

Causes of the manifestation of an inguinal hernia in children

The etiological process is associated with the prolapse of the omentum, intestinal loops and parietal sheet of the peritoneal cavity into a narrow intermuscular gap - an open vaginal process. It is this organ that plays an important role in the development of bulging in babies. Its main role is the prolapse of the female and male genital organs, laid high in the peritoneal cavity, to their rightful anatomical place by the end of the third trimester of pregnancy.

Upon completion of the process of lowering the testicles to their rightful place, the process of infection begins ( obliteration) "Blind pocket", which depends on the hormonal levels of the mother and fetus. Violation of the obliteration process creates the prerequisites for the development of hernial and other pathologies in the groin area.

The development of pathologies of a congenital nature is due to various provocative factors:

• the formation of hernias in boys is associated with the abnormal development of the outlet of the inguinal fissure, which does not allow free descent of the baby's testicle into the scrotal bed, as well as as a result of a delay in the advancement of the testicle in the fibrous thickness of the muscles of the peritoneum, or in the inguinal fissure of the canal;

• in girls, the formation of hernial sacs occurs due to the pathology of underdevelopment of the round ligaments of the uterus. In the period of antenatal development, the location of the uterus is significantly higher than the anatomical position. After childbirth, the process of gradual descent of the organs of the reproductive system into their legal, anatomical bed begins. The uterus, connected with the intraperitoneal lining, pulls it along with it when descending, provoking the formation of a fold. Muscle failure of the walls of the peritoneum contributes to the development of protrusion of this fold in the deepening of the transverse fascia. This pathology in girls is caused by prolapse through the "open ring" of the ovary and fallopian (fallopian) tube.

The main reasons for the development of pathology of a congenital nature include a genetic factor. Not the very phenomenon of hernial formations in close and distant relatives, but the genetic inheritance of defects that disrupt the functions of connective tissues.

Acquired inguinal hernias are rare in children. Manifest mainly in puberty ( adolescent) period. Are the consequence:

• weakness and underdevelopment of the fibrous structure of the connective tissues of the peritoneal wall;
• damage to the peritoneum;
• increased pressure inside the peritoneum, provoked by screaming or strong crying;
• excessive physical exertion (weight lifting).

The main symptoms of an inguinal hernia in children

Symptoms of pathological protrusion in the groin area are very characteristic. It manifests itself as a swelling in the groin area, increases under the influence of stress (strong screaming, straining or excessive activity of children). Stretching the hernial sac to the scrotal floor forms an inguinal-scrotal formation. It has an elongated shape with a prominent prominent part. In boys, the usual protrusion has an oval shape; in girls, it is predominantly round in shape.

The hernial sac has an elastic dense structure. In a recumbent child, the protrusion may decrease in size or disappear completely. In a standing position - increase sharply in size. When trying to reposition, you can clearly feel the expansion of the ring hole. Reduction of the protrusion into the peritoneum takes place with light pressure.

Entering the hernial sac of intestinal loops causes a slight rumbling sound. Reduction of uncomplicated hernias is not accompanied by pain symptoms or other inconveniences. Pain, burning, the development of constipation is a characteristic manifestation in the case of complicated processes.

At the slightest suspicion of an inguinal hernia in children, it is necessary to consult a specialist doctor (surgeon, urologist). It depends on the correct behavior of the parents how easily and effectively the treatment process will pass, when the diagnosis is confirmed.

Inguinal hernia treatment in children

The presence of pathology is confirmed by ultrasound diagnostics of the peritoneum and groin area. The tactics of the treatment protocol is determined by the indications of the condition of the hernia, its contents and size. Timeliness of treatment prevents the risk of developing probable complications.

Treatment without surgery

The principle of treatment of bulging in babies under four years old is conservative therapy, aimed at strengthening the tissues of the peritoneum and muscles adjacent to the slotted canal. For this, exercise therapy techniques, relaxing massage and gymnastic exercises are used. The most common method of conservative medicine is a unilateral or bilateral support bandage.

The main purpose of such a device is to hold the peritoneal organs and prevent them from falling into the hernial sac. They put on such a bandage on the child only for the period of daytime wakefulness, in the supine position. An exception may be a child's illness, accompanied by a cough, then the bandage is also worn at night.

It should be noted that conservative techniques are used as temporary measures, and when there are compelling contraindications to the main treatment - hernioplasty.

Contraindications to surgical intervention

A number of factors can serve as a relative contraindication to hernioplasty due to:

• the manifestation of exudative diathesis in children;
• the age of the baby and the discrepancy between his weight;
• recently transferred infectious diseases;
• infectious carriage (latency period).

Failure to comply with these standards can cause the development of possible complications in the postoperative period.

Hernioplasty

The most optimal age for surgery is the second half of the first year of a baby's life. Earlier terms are not considered, which is associated with the special conditions of nursing babies. Hernioplasty is not a complex operation. It takes no more than half an hour in time.

It is carried out in two ways - closed or open. Open surgery involves a standard surgical incision method up to 10 centimeters long. The open access allows you to quickly cut off the excess tissue that forms the hernial sac, "close" the hernial window using the baby's connective tissue and strengthen the peritoneal wall with autoplasty or propylene mesh. The operation is performed under general anesthesia using the latest inhalation anesthetics, which provide an easy recovery from anesthesia.

The second method, laparoscopy, is the most popular. Access to the peritoneum is performed through three small (2-3 cm) punctures into which surgical instruments and a video camera are inserted. The video camera broadcasts all the surgeon's manipulations to the monitor. Laparoscopy refers to minimally invasive techniques, allows you to cope with pathology in a short time with minimal tissue trauma, greatly reducing the rehabilitation period.

Consequences and complications

• Together with the babies, their inguinal hernias also grow. An increase in their size causes squeezing of the intestinal loops, which leads to complete or partial obstruction.
• The syndrome of intestinal obstruction is also provoked by inflammatory processes in the hernial sac
• Infringement of organs is the most dangerous condition of all complications of inguinal pathologies. It leads to inflammatory processes of the peritoneal tissues, their necrosis, and the development of acute intestinal dysfunctions.

A particular danger is caused by infringement of hernial protrusion in girls. The death of the ovaries, as a result of tissue necrosis, occurs in just two hours.

Signs of pinching appear:

• muscle tension and sharp pain in the groin area;
• urge to vomit and nausea;
• feeling of lethargy and weakness, general malaise;
• swelling and redness of the groin area;
• dense structure of hernial protrusion with signs of cyanosis
  

Directions of the restrained organs are often unsuccessful. In such cases, urgent surgical intervention is necessary no later than six hours later. Operation in the early stages gives a chance for a complete cure of the disease.

Consequences after an inguinal hernia operation in children

Postoperative complications in children are rare, but they do occur. Baby tissues and skin are delicate and very vulnerable. The careless action of the surgeon can easily injure them, which leads to the development of various kinds of complications. This includes the incorrectly chosen tactics of the operation, which contributes to the manifestation of relapses. Complications can manifest themselves:

• in the form of high fixation of the testicle;
• postoperative lymphocele - accumulation of lymph in the testicular membranes;
• suppuration of the seams;
• inflammation of the testicle and its appendages;
• testicular atrophy - a decrease in the size of the testicle with the loss of its functions;
• bleeding and hematoma;
• pain symptoms.

Rehabilitation and recovery

The growing body of the child quickly bounces back after the operation. Rehabilitation will take place without complications if parents pay maximum attention to their child. The child needs a diet that excludes stool retention and bloating. The baby's diet should be made taking into account the normalization of the digestive tract, avoiding overload and squeezing of the stomach.

Exclude from the menu:

• dishes that cause increased gas production (yeast baked goods, dishes from cabbage, legumes, tomatoes and radishes, apples and grapes);
• dishes that contribute to the formation of constipation and heaviness in the stomach - meat and fish related to fatty grades, preservatives and smoked meats, rich broths and wheat porridge;
• exclude sparkling drinks, concentrated tea and homemade milk.

The first few days, prepare liquid dietary food for the baby - cutlets, steamed meat and fish, dried fruit drinks and dried white bread, boiled eggs (1 per day).

Exercises

A set of gymnastic exercises to strengthen the muscles of the abdominal wall is selected by the doctor, individually, depending on the type of surgical intervention.

Do not allow the child to be too active. Follow all medical recommendations, then the rehabilitation period will take place in the shortest possible time.

Reading 6 min. Views 1.8k. Posted on 04/29/2018

Good time, dear readers.

In addition to the usual runny nose, allergies and other minor troubles, babies often have more serious diseases that require long-term treatment, and sometimes surgery. Why does an inguinal hernia occur in children, how to recognize the problem in a timely manner? How to treat, and whether surgical intervention is always necessary - we will talk about all this today.

Inguinal hernia - what is it

Inguinal hernia is the most common type of external hernia. Due to the more developed muscles of the press and groin, pathology in girls is less common than in boys. The disease can be congenital and acquired.

In the abdominal cavity there is a small gap called the inguinal canal, inside is the spermatic cord in boys or the round ligament of the uterus in girls. If through this gap, due to certain circumstances, the peritoneal organs protrude, a hernia is formed.

Types of hernias

1. Oblique - pass through the inguinal canal and spermatic cord. A hernia is a cord, canal, with an inguinal-scrotal type of tumor, the hernial sac is in the scrotum.
2. Direct hernias do not affect the spermatic cord.
3. Recoverable - often disappear on their own.
4. Irreducible - the hernial sac is fused with the contents, it is impossible to correct such a neoplasm.
5. More often in boys at an early age, a hernia is diagnosed on the right side, less often protrusion occurs on the left, bilateral pathology occurs only in 10% of young patients.

A small tumor in the groin area consists of a hernial orifice, a sac with various contents, the neoplasm is more noticeable in a standing position. With timely diagnosis, the pathology is successfully and quickly treated.

Causes of congenital inguinal hernia

Boys' testicles are formed in the abdomen, gradually descend into the scrotum, in the process of moving, a vaginal process is formed - a pocket from the peritoneum. If this process does not close in time, an inguinal hernia will form in boys. The bladder, omentum, bowel loops, appendix enter the hernial sac.

Hernia is often inherited, so if you or your husband or next of kin have had a similar problem, be sure to inform your pediatrician about it.

Congenital inguinal hernia in girls is formed due to abnormal development of the round ligaments of the uterus. During intrauterine development, the uterus is high, gradually descends into the small pelvis, pulls the peritoneum with it, the same pocket is formed as in boys.

A hernia often appears in combination with spermatic cord cystosis, hip dysplasia, spinal anomalies, dropsy of the testicles.

Why does a hernia develop after birth

Acquired inguinal hernia is a rare occurrence; in infants, pathology most often occurs against the background of frequent strong tension of the abdominal muscles.

• coughing;
• constant crying;
• constipation;
• prolonged vomiting;
• underdevelopment of the muscles of the abdominal wall;
• swelling is more common in children who are underweight.

In adolescence, a hernia can occur due to weak muscles of the abdominal wall, groin injuries, high intra-abdominal pressure, sudden weight loss or weight gain.The main provoking factors are heavy lifting, excessive physical activity or a sedentary lifestyle.

If your child is mobile, plays sports, then the risk of developing a hernia is minimal.

How to recognize an inguinal hernia

Abnormal protrusion has pronounced characteristic symptoms, which makes it possible to notice it in a timely manner.

Signs of a hernia:

1. A swelling appears in the groin area, which increases during screaming, crying, straining, when the child is moved to an upright position.
2. In boys, the tumor is oval in shape, in girls it is round.
3. Deformation of the scrotum or thickening of one of the labia.
4. Reduction of a simple hernia occurs by light pressure, the baby does not experience discomfort during the procedure.
5. If the hernia has a complex structure, then pain appears, frequent constipation, if there are bowel loops in the hernial sac, you will often hear a quiet rumbling.

Self-loading can be confused with a hydrocele - both protrusions are outwardly similar, but with a hydrocele, there is fluid inside the neoplasm, not tissue.

The main danger of pathology is infringement of organs that have fallen into the hernial sac, therefore, when the first signs of pathology appear, it is necessary to contact a surgeon or urologist.

Diagnostic methods

The doctor will be able to make an initial diagnosis after examination and collection of anamnesis, to clarify the severity of the disease, an ultrasound of the abdominal organs is prescribed, the girls are additionally examined by the pelvic organs. Sometimes an X-ray with a contrast agent is additionally prescribed.

If the doctor decides on the need for surgery, it is necessary to do a general blood and urine test, a coagulation test and a blood group.

Treatment without surgery

If a child is diagnosed with an inguinal hernia, and there are no indications for surgery, treatment is carried out using conservative methods.

The child is prescribed Pantopon, after taking the medicine, the baby should be placed in a bath for a quarter of an hour, the water temperature is 37-39 degrees, go to put a warm heating pad on the groin area. After procedures that last no more than an hour, the baby falls asleep, and the hernia is repositioned on its own. The effectiveness of the method is 30–35%.

If such manipulations have not decreased, it is necessary to perform an operation.

Will a bandage help?

A special device supports the anterior abdominal muscles, prevents displacement of internal organs, which reduces the risk of increasing protrusion.

The bandage is recommended to be worn only during the day, it can be left at night only if the child has a severe cough, or he screams and cries a lot in his sleep. Additionally, physiotherapy exercises are prescribed, massage to strengthen the peritoneum.

But all these activities are temporary, even if the treatment is successful, the probability of relapse in children under 4 years of age is more than 70%.

Hernia surgery

Surgical removal of congenital protrusion is performed on children aged 6–12 months, surgeons are increasingly resorting to laparoscopy - several small holes are made in the abdomen, the progress of the entire operation is displayed on monitors. The doctor separates the sac and the peritoneum, moves the organs into the correct position.

You should not be afraid of the operation, it is carried out under general anesthesia, the duration of the manipulations is no more than half an hour. If there are no complications, then the very next day you and your baby will be at home.

What to do after surgery:

• take antibacterial drugs with a wide spectrum of action;
• wear special supportive underwear;
• the diet should be dominated by foods high in protein and fiber;
• physical activity is contraindicated, but after a month it is necessary to start doing physiotherapy exercises, the complex will be selected by a physiotherapist.

Are there any relapses?

Repeated protrusion is diagnosed in 1% of patients, a repeated complex, traumatic operation is required. Most often, such a complication occurs against the background of connective tissue abnormalities in premature babies.

Why is a hernia dangerous?

Infringement of a hernia requires immediate hospitalization, in the case of a pinched intestine, intestinal obstruction and tissue necrosis develop. Signs of infringement - sharp pain in the groin area, severe diarrhea and vomiting, which is replaced by constipation, fever, the skin in the affected area becomes red, hot to the touch. All symptoms develop rapidly.

For girls, even a short-term infringement can cause the death of eggs, necrosis of the gonads, in boys, due to impaired blood circulation, ovarian atrophy develops. Therefore, pinching a hernia in childhood can cause infertility.

Conclusion

An inguinal hernia (according to the ICD code K40) is a common problem, in most cases of a congenital nature, but there is also an acquired form of the disease. The mechanism of the formation of pathology is associated with a feature of the intrauterine development of the child.

An inguinal hernia in boys is called a pathological protrusion of parts of the internal organs located near the inguinal ring. The disease does not bother for some time, but at any time serious complications may develop that require immediate treatment.

Inguinal hernia formation in boys

The formation of protrusion of internal organs in the groin area in boys is predominantly congenital and occurs much more often than in girls. This is explained by the fact that in boys during intrauterine development, the testicles are located in the peritoneum, from where they descend during the formation of the fetus. Descending, the testicles capture with them a part of the peritoneum, which subsequently forms a small pocket, it is called the processus vaginalis.

With normal development, it should overgrow, but sometimes due to some peculiarities it remains open, due to which a hernial cavity is formed, into which internal organs can fall out.

The acquired type of pathology in boys arises from:

1. Intense loads on the press area.
2. Weakness of the muscles of the inguinal ring.
3. Diseases accompanied by severe cough, vomiting, constipation.
4. Abdominal trauma.

Increased pressure inside the peritoneum provokes additional stress on the muscular wall of the abdominal cavity, the inguinal opening is stretched, which can provoke the formation of a hernia.

How a hernia works

The most common hernial contents in boys in the groin area are loops of the small intestine, since this part has great mobility. In children after 3 years, the omentum may become hernial contents. Less often, the cecum, part of the bladder, protrudes.

All hernias have the same structure:

1. The hernial gate is the hole through which the protrusion occurs.
2. The bag is a part of the connective tissue, the fatty tissue surrounding the organs that have gone beyond the peritoneum.
3. Hernial contents - intestinal loops, omentum and other organs.

Outwardly, the formation resembles a rounded protrusion, which is clearly visible during tension of the muscles of the peritoneum. In newborns, the hernia is clearly visible during crying, laughing, coughing. In older boys, pathology is visible while walking and running. At rest, the protrusion may be completely hidden or barely noticeable.

Often, a pathology such as dropsy of the spermatic cord or testicle can join the acquired type of inguinal hernia in a child, sometimes a cyst of the spermatic cord develops.

Classification of pathology

Inguinal hernia is divided into congenital and acquired forms. Congenital pathology occurs in 90% of cases. Depending on the structural features, protrusions are straight, oblique, combined.

Direct

Prolapse occurs through the medial region of the inguinal ring. In this case, the inner wall of the channel is destroyed. Passing through the inguinal ring, a straight hernia is located medially from the spermatic cord. The scrotal region is not affected.

Oblique

It occurs both in the congenital form of the disease, and as a result of acquired pathology. The hernial sac here passes through the lateral fossa, the inguinal canal, and exits through the opening in the ligaments of the groin. The spermatic cord is in front of the hernial sac, the inguinal ring is located under the spermatic outer fraction.

Combined

Another type is a combined hernia with the presence of several bags at once that are not connected with each other. An oblique and straight inguinal hernia can develop here at the same time.

At the site of localization, the disease is divided into bilateral and unilateral views. In most cases, the protrusion is right-sided. Bilateral inguinal form is a rather rare occurrence in pediatrics. In the case of organ prolapse into the scrotum, the hernia takes the form of an inguinal-scrotal hernia.

Manifestations

It is difficult to confuse clinical manifestations of pathology with another disease, therefore, differential diagnosis is not difficult. Symptoms of an inguinal hernia in children of boys are, first of all, the formation of a bulge in the groin area, which increases with tension of the abdominal muscles. In infants, pathology is clearly visible at the moment of laughter, crying, bowel movements. If the child is in a horizontal position, the hernia completely or partially disappears.

Pathology may look like this:

• pulling pain in a child;
• rumbling intestines;
• groin pressure.

Less common are constipation, urinary disorders, nausea. An inguinal hernia in boys, the clinical symptoms of which are erased, is the most common course in children.

Acute manifestations of pathology are observed due to the development of complications, such as infringement, indigestion due to intestinal obstruction.

Danger of disease

Untimely referral to a specialist can provoke a number of serious consequences, including infringement, appendicitis, intestinal obstruction.

Restrained inguinal hernia

The most common type of complications due to which squeezing of parts of internal organs by the hernial gates occurs. The main sign of tissue compression is severe pain, which often leads to painful shock. The symptoms of infringement are nausea, vomiting, a sharp deterioration in general health, weakness, tearfulness, and loss of appetite. The main danger in children, as well as for adults, is tissue necrosis, the spread of the inflammatory process to other organs of the abdominal cavity.

The reasons for squeezing are excessive physical exertion, as a result of which the inguinal ring expands, passing a significant part of the organ through itself, but the squeezed tissues do not return back.

A feature of the treatment of infringement in childhood is that sometimes a hernia is repaired by a doctor without surgery. This is explained by the weakness of the muscles of the abdominal wall and the elasticity of the tissues of the intestines of the child.

Appendicitis

The development of appendicitis is rare. Complication occurs due to falling into the hernial sac of the appendix, which entails a sharp violation of the blood circulation of tissues, inflammation, intoxication of the body, the risk of rupture of the appendix. Treatment of complications is carried out surgically on an emergency basis.

Irreducibility

It occurs due to the achievement of large sizes by the formation. Here, the hernial contents do not fall into place even at rest, which brings a lot of unpleasant sensations to the patient.

Intestinal obstruction

It is extremely rare in children. Intestinal obstruction is a consequence of the combination of a hernia with diseases of the digestive system, which are characterized by a deterioration in gastric motility. Symptoms of complications are pain, inability to pass gas, absence of stool, nausea, vomiting. The child becomes pale, lethargic, and loses appetite.

Regardless of the type of complication, it is extremely important to seek medical attention in the first hours of the development of anxiety symptoms. A negligent attitude towards the health of a child is unacceptable.

Methods for treating an inguinal hernia in a child

The disease is diagnosed with the help of a visual examination of the child by a specialist and methods such as ultrasound examination, plain radiography. The success of therapy depends on the timeliness of seeking medical help.

Is treatment possible without surgery?

Conservative therapy is used among babies up to the fourth year of life. The principles of treatment here are strengthening the muscles of the abdominal cavity with the help of therapeutic exercises, massage or swimming, wearing a bandage in order to prevent complications.

Treatment with medications is not carried out, since it does not give the desired effect. Medicines are used for the development of the inflammatory process, severe pain and some other manifestations.

Non-surgical treatment at an older age is carried out due to the presence of serious contraindications to surgical treatment.

How is surgical treatment performed?

The operation to remove the hernia is performed on babies only after reaching six months after birth. Hernioplasty is the most commonly used. The procedure is easy to perform, takes no more than half an hour, and is performed under anesthesia.

Hernioplasty can be done in several ways:

1. Open - is carried out through an open access to the hernia, in which the tissues in the area of \u200b\u200bthe protrusion are dissected. Hole repair is performed by superimposing the child's tissues on top of each other or using special mesh implants.
2. Closed (laparoscopy) - the surgeon operates with punctures through which the necessary equipment is inserted into the abdominal cavity to perform medical procedures.

The second method is considered more popular, rarely causes complications, does not leave large scars on the body.

Possible complications after surgery

Postoperative complications are rare in children. The most common cases include:

• suppuration of the seams;
• development of the inflammatory process of the testicle;
• the formation of hematomas;
• bleeding;
• severe pain syndrome;
• divergence of seams.

Sometimes there is such a consequence as too high fixation of the testicle and the accumulation of lymphatic tissue in the membranes of the testicle.

To prevent complications, after the surgical intervention, the child should be under close medical supervision.

Rehabilitation and prognosis for a child

The child's body tolerates the operation well and in most cases the prognosis for recovery is favorable. To avoid complications, parents must adhere to the following rules:

1. The baby's nutrition should be complete, products that lead to gas formation and constipation should be excluded from the diet.
2. If the boy is breastfed, the mother keeps the diet.
3. It is necessary to protect the baby from physical activity. In the postoperative period, it is undesirable to allow the child to cry for a long time.

For older children, you can strengthen the walls of the peritoneum with the help of a special complex of therapeutic exercises, which the doctor will select.

A timely response to the problem, proper treatment and implementation of the doctor's recommendations during the recovery period after surgery will help to get rid of the pathology once and for all.

According to the well-known pediatrician Komarovsky, no popular conspiracies will help a child recover from pathology, especially if the baby has a bilateral inguinal hernia.