What is an Intestinal Hernia?

Inguinal hernia is a common congenital abnormality of the abdominal wall. It is one of the common diseases in pediatric surgery. The main clinical manifestation is that there is a recurrent mass in the inguinal region shortly after birth. 80% of the inguinal hernias appear in 2 to 3 months after birth. As late as 1 to 2 years old. Inguinal hernias are divided into inguinal hernias and straight hernias, which are more common and straight hernias are rare. The incidence of hernia in children is generally 1 to 4%, and the incidence of men is 12 times that of women. It is more common on the right side. Preterm babies are higher and may occur on both sides.

Basic Information

nickname

Small bowel hernia

Visiting department

Pediatrics

Multiple groups

Male incidence is 12 times that of female, more common on the right

Common locations

groin

Common causes

Constipation, cough, ascites, abdominal tumors, and chronic crying

Common symptoms

Recurrent mass in the groin area

Causes of pediatric inguinal hernia

Because the testicles of the boy fell to the scrotum through the inguinal canal before birth, and the peritoneum that moved down formed a sheath-like process. About 90% of the peritoneal sheaths are not closed or incomplete at birth. About half of the peritoneal sheaths are still open. The opening of the sheaths and increased abdominal pressure such as constipation, cough, ascites, abdominal tumors and chronic crying Noisy so that the contents of the abdominal cavity (small intestine, omentum, ovary, fallopian tube, etc.) will burst from here to the body surface, forming a hernia. And because the right testicle dropped slightly later than the left, and the atresia of the sheath was delayed, the right inguinal hernia was more. Of course, girls can also form hernias due to weak abdominal walls, but the incidence is relatively low.

Clinical manifestations of inguinal hernia in children

A typical symptom is a round, resilient, reversible lump on one side of the groin, most of which occurs during infancy (which occurs days, months, or years after birth).

Recurrent hernia

Usually when a child is crying, strenuous exercise, dry stools, standing, abdominal force, the groin mass appears or enlarges, and sometimes it extends to the scrotum or labia; the lumps become flat when lying down, lowering abdominal pressure or pressing with hands The abdominal cavity is soft or still, and the sound of air and water can often be heard during the admission. After being absorbed, the subcutaneous ring on the side can be enlarged and the spermatic cord is thickened. When the child coughs or the abdomen is forced, the finger touches the subcutaneous ring. When the finger presses the inner ring mouth, the mass no longer appears, and the mass reappears when the finger leaves the subcutaneous ring. This condition is called reversible hernia. Hernia contents are generally asymptomatic when lowered, and older children may feel a sense of falling. 60% of male oblique hernias are on the right and 30% on the left.

Incarcerated hernia

Once the hernia is incarcerated (the hernia mass cannot return to the abdominal cavity), abdominal pain will increase, and crying will continue, followed by intestinal obstruction symptoms such as vomiting, abdominal distension, and poor bowel movements. Oval masses can be seen in the groin or scrotum. The texture is hard and the tenderness is obvious; if the incarceration time is long, the skin may be red and swollen. If the intestine cannot be returned for a long time, serious complications such as ischemic necrosis of the intestine may occur.

Diagnosis of inguinal hernia in children

Children with inguinal hernia should also pay attention to the presence of cryptorchid and hydrocele.

Differential diagnosis of inguinal hernia in children

The diagnosis of recurrent mass in the scrotum or groin of a typical case is not difficult, but it needs to be distinguished from the following diseases.

Hydrocele

There is a cystic mass in the scrotum or groin with a clear boundary. It is difficult to accept a positive light transmission test. Sometimes hernia and hydrocele are combined.

2. Testicular insufficiency

In this disease, the inguinal canal and testes can be found. The softness is substantial and it is not difficult to distinguish the intestinal canal from the abdominal cavity. Sometimes the two can be combined.

3. Testicular tumor

The mass in the scrotum is solid and hard, and cannot be returned to the abdominal cavity.

Pediatric Inguinal Hernia Treatment

The best treatment for pediatric inguinal hernia is surgery. The timing of surgery is best done after 6 months. However, if an incarcerated hernia occurs, surgery should be performed early to prevent repeated incarceration leading to serious consequences.

Non-surgical therapy

When children under 6 months are not suitable for surgery due to serious illness, they can temporarily take hernia band therapy and hope that they can heal by themselves. The method is to use the hernia band or gauze compression method to compress the inner ring mouth. To prevent the hernia contents from coming out. When in use, you should put it in place and observe the hernia contents at any time to see if it is prolapsed. Otherwise, not only the treatment effect will not be achieved, but the hernia contents will be incarcerated. Therefore, surgical treatment is still recommended for oblique inguinal hernia in children.

2. Surgery

Applicable to inguinal hernias with incarcerated history for more than 6 months. Transverse abdominal muscle incisions, high inguinal or transabdominal hernia sac high ligation are generally not recommended in China, unless a bilateral inguinal hernia has been diagnosed before surgery.

In recent years, pediatric laparoscopy has been used in children for hernia sac high ligation, which is less invasive, safe and reliable, and recovers quickly without affecting the development of spermatic cord and testis. It can be used to treat bilateral hernia or treat the opposite side without increasing pain.

Chronic cough, dysuria, constipation and other chronic diseases should be treated before hernia surgery to prevent recurrence after surgery.

Prognosis of pediatric inguinal hernia

With the exception of a few infant hernias, most inguinal hernias do not heal on their own. With the delay of the disease, the hernia mass gradually increases, which will bring difficulty to the treatment, and the inguinal hernia is prone to incarceration (hernia mass is stuck and cannot be received) and strangulation (ischemia of the intestinal segment of the hernia) Sexual necrosis), and even intestinal perforation threatens the lives of patients! Therefore, with the exception of a few special cases, pediatric hernia should be thoroughly treated as soon as possible.

Pediatric inguinal hernia prevention

1. Since hernia can occur during infancy, you should always pay attention to observe whether the child's groin or scrotum is swollen, or if there is a lump that appears and disappears, and see a doctor in case of doubt.

2. Although hernia is more common in boys, girls also develop hernias. Be more alert for hernias in girls, as ovaries and fallopian tubes often enter the hernia sac.

3. Do not wrap your child's abdomen too tightly during infancy to avoid increasing intra-abdominal pressure. Do not let your child stand prematurely to prevent the bowel from falling and forming an inguinal hernia.

4. Eat foods that are easy to digest and contain more fiber to keep the stools open. Laxative measures should be taken when your child's stool is dry.

5. Do not let your child cough loudly. Children with cough should take some cough medicine under the guidance of a doctor. Avoid crying out loud and prevent increased abdominal pressure.