Hernia repair is among the most common type of surgical procedure performed in children each year. The two most common types of congenital hernias in children are umbilical and inguinal hernias.
Umbilical hernias are fairly common among newborns and infants younger than 6 months of age. It is caused when the umbilical ring fails to close after birth. It presents as an outward bulging in the abdominal area at the umbilicus. Umbilical hernias can vary in width from less than 1 cm to more than 5 cm and may seem to expand when the child cries or strains.
It is diagnosed easily by clinical examination by the pediatric surgeon. It may not need any further investigation for diagnosis.
Umbilical hernia usually closes on its own by 1 to 2 years of age. Surgery is needed when hernia has not closed by 2 years of age. Emergency surgery is needed if the hernia gets complicated.
Sometimes the umbilical hernia becomes irreducible / strangulated i.e the bulge persists and doesn’t go back in. The baby becomes very irritable and the swelling gets red and painful. This requires emergency surgery. One needs to take the child immediately to a pediatric surgeon if this happens.
A hernia occurs when a part of the intestine pushes through a weakness in the belly (abdominal) muscles. A soft bulge shows up under the skin where the hernia is. A hernia in the groin area is called an inguinal hernia.
It is caused when the inguinal canal fails to close during fetal development and abdominal contents protrude through the opening. Although the defect is present at birth, it is often not visible until weeks, months or years later. Among premature infants born with an indirect inguinal hernia, there is a 60 percent higher risk of incarceration (when part of the fat or small intestine protruding from the abdomen becomes stuck in the inguinal canal or scrotum). Indirect inguinal hernias are much more common in males than in females.
Most pediatric inguinal hernias are detected in the first year of life, but hernias may remain asymptomatic and unnoticed by the parents until later in life or sometimes even in adults.
There will be a small bulge above the groin crease. The bulge may increase in size over time and usually disappears when the child is lying down. There may be discomfort or pain in the groin, especially when straining, coughing or playing, that improves when the child is at rest. Sometimes the swelling extends all the way into the scrotum.
Inguinal hernias are detectable on physical exam. Usually no investigation is needed for the diagnosis.
Inguinal hernias do not heal on their own and must be repaired surgically to prevent intestinal strangulation or incarceration. Surgery, called herniotomy, is recommended for all pediatric patients with inguinal hernias. It is a very common and safe procedure performed. It is done as a daycare procedure where in the baby / child is discharged the same day of surgery.
Inguinal hernias can get complicated and then the condition of the child deteriorates. Hence it should be operated once it is diagnosed, preferrably within a few days after the diagnosis.
Inguinal hernias can become irreducible or strangulated where the swelling doesn’t reduce when the baby is lying down and quiet. The baby become very irritable and the swelling in the groin becomes red and painful. This is a surgical emergency as the blood supply to the intestine gets compromised. Hence, you need to take yor child to a pediatric surgeon immediately.