Diseases

Inguinal Hernias in Children – Lexicon for Medicine & Health

Hernia in children

In children, bowel hernias or hernias , so-called hernias, usually occur in the umbilical ring and in the groin area, with inguinal hernias being the most common. The following developmental processes in the human embryo should make it clear why hernias are relatively common.

Causes of Inguinal Hernias in Children & Babies

The neural tube, the building block for the central nervous system, forms from the neural groove by invagination. Ursegments then develop on both sides of the neural tube, which protrude into the primary abdominal cavity. From these ursegments develop the urinary gland and the kidney rudiments, with the urinary kidney becoming the germinal gland rudiment. The further development and change in position of the gonad system depends on the sex of the seedling. While the ovary only approaches the anterior abdominal wall in female embryos, the changes in position in male embryos are much greater.

The male gonads move into the scrotum, i.e. into a part located outside the abdominal cavity, taking the peritoneum leaves with them. This process can be explained by the heat conditions that are necessary for the formation of the sperm cells and are around 36 degrees Celsius. Since the temperature inside the abdominal cavity, the so-called core temperature, is around 37.5 degrees Celsius, the lower heat conditions in the scrotum caused by the outside temperature are more favorable for the development of the sperm cells.

During their displacement into the scrotum, the gonads take with them an extension of the peritoneum, which envelops them together with blood vessels and the spermatic cord. Normally, the wall sections of the peritoneal process stick together again at the time of embryonic maturity, which means that the peritoneal process (now called the testicular sheath) separates completely from the abdominal cavity. Only the inguinal canal remains open, because the blood vessels that nourish the gonads and the spermatic cord must still have a passageway, which is usually covered by strong muscle bundles.

However, if this peritoneal process does not close, then there is an open connection between the abdominal cavity and the testicular sheath, which can become a hernial sac if intestinal loops and other parts of the contents of the abdominal cavity slip in. These anatomical and developmental relationships also explain why inguinal hernias are found in boys in about 90 percent of all cases.

Parts of the intestine can slip into the hernial sac if the child presses the abdominal wall hard for various reasons, for example when trying to regularly empty hard stool from the intestine. Then a bulge in the groin can be seen externally. The contents of the hernial sac are mostly intestinal loops, less often they are network parts that normally cover the intestinal loops.

Frequency & Characteristics

A right-sided inguinal hernia (60%) occurs more frequently than a left-sided (25%) or bilateral (15%) because the complete displacement of the right gonad into the scrotum occurs at a later time than the left side, causing the right peritoneal process stays open longer. In addition to these congenital hernias, so-called acquired hernias are also known. They pass directly through a part of the abdominal wall where the abdominal wall is not completely covered by muscle bundles going in different directions. So you don’t have to follow the inguinal canal. However, such hernias are rare in children.

Symptoms & Signs

Congenital hernias usually only become visible a few weeks to months after birth. Weak and premature babies are far more prone to it than other children. The often severe whooping cough that occurs with whooping cough or other serious inflammatory diseases always puts a strain on the abdominal walls, increases the pressure within the abdominal cavity and thus promotes the occurrence of a hernia, especially in infants and young children. It will be understandable that muscle training of the abdominal wall, which begins in early infancy with light gymnastic exercises and occasional prone positions and then continues throughout kindergarten and school, contributes to the prophylaxis (prevention) of such fractures.

The hernia can appear as a small protrusion in the groin, often only the size of a hazelnut. If it persists for a long time and bulges more frequently, considerable sizes are reached. It then often descends into the scrotum, which can sometimes assume the size of a fist, which greatly affects the children’s well-being. They are then often restless and cry a lot, have a poor appetite , vomit easily and for these reasons gain little weight.

If the child lies still or is placed in a warm bath, the hernia often retracts into the abdominal cavity by itself. If this does not happen, the contents of the hernial sac must be carefully pushed back by hand. Such a fracture only becomes problematic (for parents and child, not for the surgeon) when the contents of the hernial sac become trapped in the hernial orifice, which can have many causes, of which two conditions are particularly important.

Let’s assume that there is a loop of small intestine in the hernial sac. In such a case, the contents of the intestine pass through the afferent leg into the part of the intestine that lies in the hernial sac, and then further into the efferent leg. The contents of the intestine (which always contain bacteria and in which chemical processes take place) have to pass through the narrowed section of the intestine in the hernial orifice twice. A spasmodic contraction of the abdominal wall muscles would narrow the hernial orifice. A congestion of the intestinal contents within the hernial sac and damage to the intestinal wall through chemical and bacterial processes would be the result.

Hernia Symptoms & Signs

In addition to this first condition, as already mentioned, there is a second condition for the incarceration of the contents of the hernial sac: if bacteria and toxins pass through the intestinal wall, they cause inflammation of the peritoneum in this section, which causes suppuration , pain in the intestinal muscles and adhesions. The other dangerous side of herniation is that the bowel loops inside the hernial sac are accompanied by vessels (arteries and veins).

A narrowing of the hernial orifice also always leads to an impairment of the circulatory conditions, insofar as the thin-walled veins are narrowed at first and the blood flow is thus impeded. If the arterial inflow into the intestinal loop of the hernial sac remains, blood congestion occurs, blood leaks from the vessels into the tissue gaps, which in turn promotes inflammatory processes.

The first signs of entrapment are restlessness and expressions of pain on the part of the child. Suddenly, apparently for no reason, she starts crying and cannot be calmed down. Children often vomit . Since there is still stool below the constricted section of bowel, normal bowel movements can be simulated by the passage of the same.

After that, however, the contents of the intestine build up above the incarceration. Stool and flatulence no longer go away. The children vomit , and vomiting faeces is a serious sign of the disease.

Eating is also refused , and the abdomen is slowly distended. The skin over the externally visible hernia becomes red, and the swelling hurts as soon as pressure is applied to it. It is advisable to consult a doctor at the first sign of a hernia that has been trapped. Although many entrapments in childhood resolve spontaneously, which often happens during transport to the hospital, for example, immediate elimination of the entrapment must be sought.

Treatment & Surgery

There are basically two ways to treat an inguinal hernia : the conservative and the surgical. The treatment that the doctor will carry out depends primarily on the age and general condition of the patient. Until recently, non-incarcerated inguinal hernias in early infancy were treated with a hernia ligament that was supposed to prevent the hernia from escaping by putting pressure on the inguinal canal. It was thought that this would promote closure of the patent peritoneal process.

Today, however, we know that an inguinal hernia no longer heals spontaneously after the first few months of life, either with or without a hernia ligament. In addition, wearing the hernia brace for a longer period of time is always unfavorable because the skin in the vicinity of the belt and underneath it easily becomes inflamed in the infant. The underlying muscles also gradually weaken and atrophy, and there is never a guarantee that the peritoneal process has closed.

Therefore, if the child can be expected to have the operation, one should not wait too long. The operation process is easy to understand. The surgeon repositions the contents of the hernial sac into the abdominal cavity, first sutures the peritoneum and then the other layers of the abdominal wall together over the former hernial orifice. Finally, he cuts away superfluous skin parts that have been severely overstretched due to the fracture and sews a skin suture.

Today, the procedure can be carried out without significant risk and relatively quickly. Infants, toddlers and babies can be operated on as early as three months old. Only in exceptional cases, for example in the case of entrapment, does an even earlier point in time have to be chosen. Postponing the operation until the child is one or two years of age does not in itself pose any danger to the child, even if it means that the fracture can become trapped at any time and thus endanger the child’s life.

If the healing process is uneventful, the children can be discharged from the hospital just a few days after the operation. To facilitate the final healing, it is still necessary to avoid flatulence and excessive abdominal exertion for a while. For this reason, the doctor exempts school-age children from school sports for about three months after a hernia operation. Spoiling the child because of the healed operation scar and relieving it of physical household chores is fundamentally wrong. Prolonged immobilization only debilitates, so those who spare themselves are prone to hernia recurrence.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.