Inguinal hernia in pediatric patients
Philomena Nwanmuo
Patrycja Skierka
Definition
A hernia that occurs in the groin area is called an inguinal area. Part of the
abdominal contents, such as intestines, can be pushed through this
opening. Inguinal hernias occur in 2 percent of all children but are more
common in boys than girls. They may occur on either side, but they are more
frequent on the right side.
Epidemiology
incidence ranges from 1-5%
60% of hernias occur on the right side
premature infants are at increased risk for inguinal hernia, with incidence rates of 2% in
females and 7-30% in males
incidence of inguinal hernia from birth to 15 years of age was 6.62% in males and
0.74% in females
occur equally among races
the male-to-female ratio is estimated to be 4-8:1
Causes
The following are associated with an increased risk of inguinal hernia:
Prematurity and low birth weight (Incidence approaches 50%.)
Urologic conditions
Cryptorchidism
Hypospadias
Epispadias
Exstrophy of the bladder
Ambiguous genitalia
Abdominal wall defects
Gastroschisis
Omphalocele
Family history
Cystic fibrosis
Connective tissue disease
Mucopolysaccharidosis
Congenital dislocation of the hip
Symptoms
bulge or swelling in the groin or scrotum
swelling may be more noticeable when the baby cries and may get smaller or
go away when the baby relaxes
a lump is bigger when the child is standing or straining (such as crying or
coughing) and disappears when the child is lying down or relaxed
Incarceration
When tissues get stuck in hernia sac and can’t go out
Called also non-reductible hernia
Children shows: irritability, loss of apetite, swelling and tenderness, pain
Offen connected with strangulation
Hernia is discolored and don’t go down
Diagnosis
No laboratory studies are needed in the assessment of a
patient with a suspected inguinal hernia and/or hydrocele
Imaging Studies
Ultrasonography
Peritoneography
Injectionof contrast in the peritoneal cavity has been used to determine
the presence of a patent processus vaginalis
possible complications include bowel perforation and sepsis
Differential diagnosis
Pediatric Hydrocele and Hernia Surgery
Varicocele in Adolescents
Why surgery is needed?
The intestine in the hernia usually moves in and out of the abdomen quite
easily. Sometimes the intestine may get stuck in the hernia leading to
blockage of, and possibly damage to the intestine.
If this happens emergency surgery may be needed and the intestine may be
damaged. In about half of baby girls the ovary can be felt in the hernia and
there is a risk that the ovary can become twisted (In case of boys hernia may
block the blood supply to testicles). If this happens the hernia will be very
tender and there is a danger that the baby could lose the ovary (testicle).
Surgery
Open surgery
Laparoscopic surgery
Mostly used in adults
Less effective in kids
Usually used on children for hernias which keep coming back
Open surgery
Under anaesthetic a cut will be made in the baby's groin. The hole in the
muscle will be repaired with stitches and the skin closed with stitches under
the surface. A small dressing may be applied. Local anaesthetic will also be
used to numb the skin so as to reduce any pain the baby may feel after
waking.
Attention should be paid for the contents of the inguinal canal
in males consist of the spermatic cord (with the genital branch of the
genitofemoral nerve) and the ilioinguinal nerve
in females, the contents include the round ligament, genital branch of the
genitofemoral nerve, and the ilioinguinal nerve
Inguinal hernia surgery in girls
In girls, a sliding hernia may contain the ovary or a portion of the fallopian tube. These
structures should be carefully dissected from the internal wall of the sac before suture
ligation. An alternate procedure involves incising the sac along the ovary and tube on
either side and folding the flap into the peritoneum. A pursestring suture can then be
used to close the sac. In the female, the sac can be sutured closed after division of the
round ligament because no important structures pass through the inguinal ring.
Pediatric Inguinal Hernia Repair – Male
Infant Right Open Inguinal Hernia Repair
Complications
decreased testicular size (≤ 20% of patients)
testicular atrophy (1-2%)
vas injury (< 1%)
development of sperm-agglutinating antibodies
risk of gonadal injury in females is low
