What Is Inguinal Hernia In Children

Have you heard about inguinal hernia? It is common in the elderly, but we will let you know that children can have it as well!

What is an inguinal hernia in children? Inguinal hernia, or groin hernia, is when fatty tissue or a part of your abdominal organ, such as the intestine (bowel), pokes through into your groin, usually due to a weakness of the muscle or other tissue wall. This condition leads to one of the most common surgical operations, both in adults and children (pediatric surgery).¹

So, is there any difference between the condition in adults and children? What are the causes, and how do you diagnose them? What are the treatment options? Let's find out together!

Overview

Let's start with the word "hernia". A hernia is when any internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Therefore, the word can mean many types of bulging organs, including;

• Groin hernia refers to inguinal hernia and femoral hernia, which occur around your groin area at the inner thigh.
• An umbilical hernia, which is also found in children, means a hernia through the abdominal wall around the belly button.
• Hiatus hernia: This refers to the stomach protruding from the diaphragm, which leads to heartburn.
• Incisional hernia: which occurs after abdominal surgery and makes the tissue wall and belly muscles (abdominal muscles) easy to break.³

Focusing on inguinal hernia (which should be excluded from femoral hernia) is common in both adults and children but more common in males than females (around 10:1 in ratio).² There are two types of inguinal hernias, depending on where the herniated content and its wall, called the hernia sac, protruded;

1. Indirect inguinal hernias, the most common type, is when the hernia sac goes through a part called the inguinal canal and inguinal ring, which the spermatic cord or round ligament of the uterus of males and females, respectively, live in. If it occurs in a boy, it will push down directly on the spermatic cord and scrotum.
2. Direct inguinal hernias happen when the muscular abdominal wall is weakened; therefore, they protrude through the lower belly.

Typically, a hernia itself is not a life-threatening condition. However, in some situations, which should be highly aware of, there are complications;

1. Incarcerated hernia is when the intestine cannot be pushed back into the abdominal cavity. It may cause strangulation.
2. A strangulated hernia occurs after incarceration when the blood vessel to supply the intestine is obstructed and leads to infarction or infection, which is a fetal condition.

Causes of inguinal hernia in children

• For indirect inguinal hernia, it mostly originates from unharmful congenital defects called unclosed processus vaginalis. 

When an infant grows up, a part of the peritoneum (abdominal wall membrane) called processus vaginalis, which accompanies the testicle and descends into the scrotum, is supposed to close before birth. If there are preterm infants, it will be more likely to cause persistent processus vaginalis and lead to a hernia sac along the inguinal canal.

• Direct inguinal hernia, which is less common in a pediatric inguinal hernia, is caused by weakness of the abdominal wall, which sometimes occurs with high pressure in the abdominal cavity, such as when lifting heavy loads or sports. It will be more common in adults.

Signs and symptoms of inguinal hernia in children

Inguinal hernia symptoms in children are usually hard to notice. Presenting symptoms may be;

• A bulge or swelling near the groin or scrotum should be noticed when parents change the diaper of an infant.
• A baby may unexplainably cry or have fussiness due to pain around the groin, even if there is no mass at all.
• A visible bulge that gets bigger when an infant is crying or coughing.
• Pain in the child's scrotum.

However, incarcerated inguinal hernia and strangulated hernia should be aware of when these are noticed;

• A swelling lump is unable to move back into its place.
• Nausea, vomiting, or unexplained fever caused by intestine necrosis.
• Unable to eat, feed, vomit, or pass the stool and fart due to decreased bowel movement.

Diagnosis

It is mostly diagnosed by medical history and physical examination, primarily including;

• abdomen inspection
• The doctor may ask the child to stand, cough, or strain and check for a bulge around the child's groin. The child's scrotum and testicles might be examined as well
• The doctor may try to gently massage the hernia back into the belly

Types of hernias must be differentiated (femoral, direct/indirect inguinal hernia), and some other underlying conditions, such as hydrocele, must be excluded. The doctor should evaluate the severity, whether there is incarceration, strangulation, or further complications.

Additional tests could be done for occult hernias or obese patients.

• ultrasound.
• computed tomography (CT) scan.
• magnetic resonance imaging (MRI) scan.⁴

Management and treatment for inguinal hernia in children

After detecting symptoms and referring them to health professionals such as GPs or emergency departments, surgery is the most appropriate treatment. Inguinal hernia repair could be done electively if there is no strangulated hernia or incarcerated hernia, but if so, it would be an emergency condition.

Dealing with hernia choices are;

1. Manual reduction by doctors, preventing bowel infarction.
2. Surgical reduction, in case of unsuccessful manual reduction.
3. Hernia repair, if the emergency condition was solved.

Two types of inguinal hernia surgery performed are;

1. Open surgery, with a small incision at the child's groin, and putting a piece of unharmful mesh to strengthen the inguinal ring.
2. Laparoscopic surgery, sometimes called minimally invasive surgery (MIS), deals with the inguinal canal the same way as open surgery but possesses many positive outcomes, such as a concealed scar, being unharmful to other organs, reduced operation time and infection, and ability to detect other abnormalities.⁵

The child's healthcare provider should be consulted for options for hernia repair and the risks of surgery.

Risk factors^6,7

• History of hernia or prior hernia repair (risk of recurrence).
• Premature babies (preterm infants), or underweight.
• Boys are more likely to have hernias than girls.
• Newborn infants tend to have hernia than older children.
• Having a family history of hernia.
• A child with developmental dysplasia of the hip (DDH).
• A child with cystic fibrosis.
• A boy with undescended testes.
• Chronic cough.

FAQs

How can I prevent inguinal hernia in children?

If you or your couple are still pregnant, follow the GP's or obstetrician's recommendation to prevent having a premature infant or an underweight baby. It is hard to prevent congenital defects. Some controllable risk factors, such as chronic cough, could be dealt with by avoiding exposing your children to secondhand smoke, for instance.

How common is inguinal hernia in children?

The incidence rate of hernia varies from 0.8% to 5% in many studies.⁸ In premature babies, it is up to 9-11%. The peak of incidence is in the first year of life and peaks in the first month.

What can I expect if my children have an inguinal hernia?

You should be aware that the faster your children get to health professionals, the more they will be safe. You should monitor possible signs and symptoms, and if it occurs, you should seek advice. Then, if it comes to surgery, the children would go on general anaesthesia and have skin incisions, whose size depends on the type of surgery. The bowel or hernia content will be pushed back, and hernia repair should be done.

When should I see a doctor?

"You should seek health professionals to consult about paediatric surgery;

• Immediately: when a strangulated hernia occurs in your children, such as when a hernia bulge turns red, purple or dark
• Urgency or selective; when there is a bulge but with no strangulation or incarceration"

Summary

Inguinal hernia in children is common, but you can prevent serious complications to your children by awareness and paying attention to them. Accessing professional advice and emergency care is the next key.