Inguinal hernia in boys treated without surgery. Inguinal hernia in a child: symptoms and why surgery is inevitable. How is anesthesia performed?

An inguinal hernia in children is often congenital; a newborn develops a protrusion of the navel from the first days of life, and even then it is necessary to take therapeutic and preventive measures to quickly get rid of the defect and prevent progression. The disease is diagnosed less often in girls, and more often in premature infants, which is due to genetic predisposition.
Acquired hernias practically never occur in children under one year of age; they begin to form at an age when the body already experiences high physical stress. In the formation of protrusion in girls or boys under one year of age, the processus vaginalis takes part, which acts as a conductor of the gonads into the scrotum from the peritoneum. In a healthy child, it gradually becomes overgrown, but disruption of the normal process, which occurs in premature babies, creates favorable conditions for the appearance of a protrusion in the groin area, both in girls and boys.

In children under one year of age, this process simultaneously acts as a hernial sac, which contains the peritoneal organs: omentum, intestinal loop, fallopian tube or ovary in girls. In this case, the hernial orifice forms the ring of the groin canal.

Types of disease

Congenital pathology in the groin in children can be oblique or straight, as well as right-sided or left-sided. An oblique hernia in a child under one year of age passes through the internal ring of the inguinal canal; straight hernias are relatively rare and pass through a muscular opening in the peritoneal wall in the projection of the inguinal ring. In boys under one year of age, a right-sided oblique hernia is more often diagnosed (60%), direct protrusions form with age. A severe clinical case of a hernia in a one-month-old baby is a bilateral hernia, which more often occurs in girls.

Only boys under one year old experience inguinal-scrotal hernias, when the testicle is compressed, which in the future can lead to male infertility. Inguinoscrotal hernia is divided into testicular and cordic (diagnosed in 90% of cases).

Causes

The direct causes of the defect in a premature baby lie in the underdevelopment of muscle tissue and incomplete closure of the abdominal opening. This disease does not occur among healthy boys and girls, therefore every child with a hernia up to one year old is examined by a pediatric surgeon to find the true cause. About 15% of newborns with hernias under one year of age had a genetic predisposition, so parents with an inguinal hernia should be prepared for the birth of a child with such a defect.

An inguinal hernia in children is not dangerous as long as it is controlled by parents and doctors, therefore, from birth it is necessary to take therapeutic measures to prevent complications, given that congenital protrusion does not always go away on its own. The anatomical features of a child’s body may not allow self-healing even if all the rules are followed.

Pathology of muscle tissue in premature babies leads to complications if the doctor’s recommendations are not followed. The cause of the complication is the child’s tension during screaming, crying, or incorrect body position during sleep. In case of complications, it is necessary to undergo surgery, but in 95% of cases it is possible to get rid of the defect without surgery.

Clinic and diagnostics

A hernia in the groin area looks the same in girls and boys: a bulge appears on one or both sides in the form of a lump, which reaches up to 5 cm (it can increase during tension). When you put the child on his back, the protrusion disappears, but in a standing position or while crying, it sticks out as much as possible. When pressing on inguinal hernias in children, the protrusion also disappears, which does not happen in the case of pinched organs in the hernial sac.

How does an inguinal hernia manifest in a child?

1. The protrusion is painless, rarely accompanied by aching pain in the lower abdomen, which can be the reason for the child’s constant crying and even greater protrusion of the hernia.
2. The hernia has an oval shape; with an inguinal-scrotal hernia, the defect descends and compresses the scrotum, which leads to asymmetry of one of the halves. In girls, a prolapsed hernia can lead to enlargement of the labia.
3. Symptoms of complicated protrusion change: severe pain, enlargement of the defect, and impossibility of reduction. Pinching of organs in the hernial sac leads to poor circulation and ischemic changes occur. With such manifestations, it is necessary to urgently undergo surgery and then the inguinal hernia in children will be completely eliminated.

Accompanying symptoms of complicated pathology are: intestinal obstruction, preceded by constant constipation, vomiting, and bloating.

Important! Premature girls have a high risk of egg death due to ovarian necrosis during pinching, therefore the complication may serve as a factor in reproductive dysfunction in the future.

What to do if you have a hernia?

Conservative treatment of inguinal protrusion for up to a year includes wearing a support bandage, bandages; surgery should be done immediately in case of infringement. As planned, the operation is carried out up to six months and consists of cutting off the hernial sac to restore the normal anatomical structure of the inguinal canal and peritoneal organs. During surgery, the doctor may install a mesh or strengthen the inguinal canal with nearby tissue.

Operating on children requires special care; the surgeon must exclude accidental injury to the spermatic cord in boys, otherwise reproductive function will be impaired. After opening access to the pathological area, the viability of the organs located in the hernial sac is assessed. In case of tissue necrosis, the surgeon performs resection of part of the intestine or omentum.

After the operation, it is recommended to do gymnastics, massage treatments, and swim with the child in the pool to prevent relapse. A recurrence of the disease can occur in an adult, but after surgery with mesh installation this happens extremely rarely.

Inguinal hernia (according to ICD code K40) is a common problem, in most cases it is congenital, but an acquired form of the disease also occurs. The mechanism of formation of pathology is associated with the peculiarities of intrauterine development of the child.

An inguinal hernia in boys is a pathological protrusion of parts of internal organs located near the inguinal ring. The disease does not bother you for some time, but serious complications that require immediate treatment can develop at any time.

Formation of inguinal hernia in boys

The formation of protrusion of internal organs in the groin area in boys is predominantly congenital and occurs much more often than in girls. This is explained by the fact that in boys during intrauterine development, the testicles are located in the peritoneum, from where they descend down during the formation of the fetus. As they descend, the testicles take with them part of the peritoneum, which subsequently forms a small pocket called the processus vaginalis.

During normal development, it should be overgrown, but sometimes, due to certain features, it remains open, which is why a hernial cavity is formed, into which internal organs can fall out.

An acquired type of pathology in boys occurs due to:

1. Intense loads on the abdominal area.
2. Weakness of the muscles of the inguinal ring.
3. Diseases accompanied by severe cough, vomiting, constipation.
4. Abdominal injuries.

Increased pressure inside the peritoneum provokes additional stress on the muscular wall of the abdominal cavity, the inguinal opening is stretched, which can provoke the formation of a hernia.

How does a hernia work?

The most common hernial contents in boys in the groin area are loops of the small intestine, since this part has great mobility. In children after 3 years of age, the omentum may become the hernial contents. Less commonly, the cecum, part of the bladder, protrudes.

All hernias have the same structure:

1. The hernial orifice is the opening through which protrusion occurs.
2. The sac is part of the connective tissue, fatty tissue surrounding organs that extend beyond the peritoneum.
3. Hernial contents include intestinal loops, omentum and other organs.

Externally, the formation resembles a rounded protrusion, which is clearly visible when the abdominal muscles are tense. In newborns, the hernia is clearly visible when crying, laughing, or coughing. In older boys, the pathology is visible while walking and running. At rest, the protrusion may be completely hidden or barely noticeable.

Often, an acquired type of inguinal hernia in a child may be accompanied by a pathology such as hydrocele of the spermatic cord or testicle, and sometimes a cyst of the spermatic cord develops.

Classification of pathology

Inguinal hernia is divided into congenital and acquired types. Congenital pathology occurs in 90% of cases. Depending on the structural features, protrusions can be straight, oblique, or combined.

Direct

The prolapse occurs through the medial region of the inguinal ring. In this case, the inner wall of the channel is destroyed. Passing through the inguinal ring, the direct hernia is located medial to the spermatic cord. The scrotal area is not affected.

Oblique

It occurs both in congenital forms of the disease and as a result of acquired pathology. The hernial sac passes here through the lateral fossa, the inguinal canal and exits through the opening in the ligaments of the inguinal region. The spermatic cord is located in front of the hernial sac, the inguinal ring is located under the spermatic outer fraction.

Combined

Another type is a combined hernia with the presence of several bags at once that are not interconnected. Here, an oblique and direct inguinal hernia can develop simultaneously.

According to the location, the disease is divided into bilateral and unilateral. In most cases, the protrusion is right-sided. The bilateral inguinal form is a fairly rare occurrence in pediatrics. If organs prolapse into the scrotum, the hernia takes on the appearance of an inguinoscrotal hernia.

Manifestations

The clinical manifestations of the pathology are difficult to confuse with another disease, so differential diagnosis is not difficult. Symptoms of an inguinal hernia in male children are, first of all, the formation of a bulge in the groin area, which increases with tension in the abdominal muscles. In infants, the pathology is clearly visible at the time of laughter, crying, or defecation. If the child is in a horizontal position, the hernia completely or partially disappears.

The pathology may look like this:

• nagging pain in a child;
• rumbling intestines;
• pressure in the groin area.

Constipation, difficulty urinating, and nausea occur less frequently. Inguinal hernia in boys, the clinical symptoms of which are subtle, is the most common course in children.

Acute manifestations of pathology are observed due to the development of complications, such as strangulation, indigestion due to intestinal obstruction.

Danger of disease

Failure to consult a specialist in a timely manner can provoke a number of serious consequences, including strangulation, appendicitis, and intestinal obstruction.

Strangulated inguinal hernia

The most common type of complication, as a result of which parts of the internal organs are compressed by the hernial orifice. The main sign of tissue compression is severe pain, which often leads to painful shock. Symptoms of infringement include nausea, vomiting, a sharp deterioration in general health, weakness, tearfulness, and loss of appetite. The main danger in children, as well as in adults, is tissue necrosis, the spread of the inflammatory process to other organs of the abdominal cavity.

The causes of compression are excessive physical exertion, as a result of which the inguinal ring expands, allowing a significant part of the organ to pass through, but the compressed tissue does not return.

A peculiarity of the treatment of strangulation in childhood is that sometimes the hernia is reduced by a doctor without surgery. This is explained by the weakness of the abdominal wall muscles and the elasticity of the child’s intestinal tissues.

Appendicitis

The development of appendicitis is rare. The complication occurs as a result of the appendix getting into the hernial sac, which entails a sharp violation of the blood circulation of the tissues, an inflammatory process, intoxication of the body, and the risk of rupture of the appendix. The complication is treated surgically as an emergency.

Irreversibility

Occurs due to formation reaching large sizes. Here the hernial contents do not return to place even at rest, which brings the patient a lot of unpleasant sensations.

Intestinal obstruction

It is extremely rare in children. Intestinal obstruction is a consequence of a combination of a hernia with diseases of the digestive system, which are characterized by a deterioration in gastric motility. Symptoms of complications include pain, inability to pass gas, lack of stool, nausea, and vomiting. The child becomes pale, lethargic, and loses appetite.

Regardless of the type of complication, it is extremely important to seek medical help in the first hours of the development of alarming symptoms. Negligent attitude towards the health of a child is unacceptable.

Methods for treating an inguinal hernia in a child

The disease is diagnosed using a visual examination of the child by a specialist and methods such as ultrasound and radiography. The success of therapy depends on the timeliness of seeking medical help.

Is treatment possible without surgery?

Conservative therapy is used among children up to the fourth year of life. The principles of treatment here are strengthening the abdominal muscles through therapeutic exercises, massage or swimming, and wearing a bandage to prevent complications.

Treatment with medications is not carried out, as it does not give the required effect. Medicines are used for the development of the inflammatory process, severe pain and some other manifestations.

Non-surgical treatment at older ages is carried out due to the presence of serious contraindications to surgical treatment.

How is surgical treatment performed?

Surgery to remove a hernia is performed on babies only after they reach six months after birth. Hernioplasty is the most commonly used procedure. The procedure is easy to perform, takes no more than half an hour, and is performed under anesthesia.

Hernioplasty can be done in several ways:

1. Open – is carried out through open access to the hernia, in which the tissue in the area of ​​the protrusion is dissected. Hole repair is performed by superimposing the child’s tissues on top of each other or using special mesh implants.
2. Closed (laparoscopy) - the surgeon operates using punctures through which the necessary equipment is inserted into the abdominal cavity to perform medical procedures.

The second method is considered more popular, rarely causes complications, and does not leave large scars on the body.

Possible complications after surgery

Postoperative complications are quite rare in children. The most common cases include:

• suppuration of sutures;
• development of the inflammatory process of the testicle;
• formation of hematomas;
• bleeding;
• severe pain syndrome;
• divergence of seams.

Sometimes there is a consequence such as too high fixation of the testicle and accumulation of lymphatic tissue in the membranes of the testicle.

To prevent complications, after surgery, the child should be under close medical supervision.

Rehabilitation and prognosis for the child

The child’s body tolerates the operation well and in most cases the prognosis for recovery is favorable. To avoid complications, parents must adhere to the following rules:

1. The baby's nutrition should be complete; foods that lead to gas formation and constipation should be excluded from the diet.
2. If the boy is breastfed, the mother keeps the diet.
3. It is necessary to protect the baby from physical activity. In the postoperative period, it is undesirable to allow the child to cry for a long time.

For older children, the walls of the peritoneum can be strengthened with the help of a special complex of therapeutic exercises, which will be selected by the doctor.

A timely response to the problem, proper treatment and following the doctor’s recommendations during the recovery period after surgery will help get rid of the pathology once and for all.

According to the famous pediatrician Komarovsky, no folk conspiracies will help a child recover from pathology, especially if the baby has a bilateral inguinal hernia.

Does your baby have an inguinal hernia? Learn about the features of surgical removal of a tumor, which will allow you to get rid of the disease and potential danger to the baby’s life in a short time.

Article for parents

An inguinal hernia is a neoplasm in the groin area, which is accompanied by prolapse of internal organs into the inguinal canal.

Formation and localization of inguinal hernia

At first glance, the disease seems harmless, since in the first stages it does not cause pain in the child. But the disease can be compared to a time bomb. In the absence of proper treatment, the neoplasm can impair blood circulation, which causes the death of tissue and internal organs.

Prerequisites

The disease has become widespread among children. According to statistics, hernia is observed in 6% of full-term babies and 15% of premature babies. Experts, speaking about the prerequisites for the disease, distinguish two groups of factors: congenital and acquired.

Congenital

Speaking about congenital factors, it is important to pay attention to the fact that the disease is more common in boys than in girls. This is caused by the fact that a hernia in male babies appears during the process of moving the testicles into the scrotum.

Note. The movement of the testicles into the scrotum is a natural process associated with male physiology. The testicles move from the abdominal cavity, where they were formed, into the subcutaneous inguinal canal.

Inguinal hernia in children is more common among boys

Girls do not have testicles, so the ovaries do not undergo the process of moving, but remain where they were originally formed. For this reason, inguinal hernia is a rare occurrence among female children.

Purchased

As for acquired factors provoking the disease, experts highlight the following:

• operations in the scrotum or abdominal cavity, for example, removal of appendicitis;
• mechanical impact on the pubic area, for example, trauma, damage, etc.;
• excessive physical activity, for example, heavy lifting, prolonged crying, severe coughing, etc.

Note. For more information, check out our interview with a qualified surgeon

https://www.youtube.com/watch?v=hNJx0U1eSKg

Symptoms

Symptoms of the disease are difficult to notice with the naked eye. In the first stages, the disease practically does not manifest itself. Typical symptoms include the following:

• there is no pain when pressing on the affected area;
• if the hernial sac contains intestines, it rumbles when pressed;
• under stress, for example, when a baby cries, the hernia protrudes;
• may be oblong or round in shape.

Note. The disease can be either unilateral or bilateral. Boys are characterized by a left-sided hernia - about 65%, while girls are faced with bilateral damage to the groin area.

Discomfort begins to bother the patient at a later stage of the disease, when the hernia begins to infringe on neighboring organs. This is due to the fact that the protruding organs, when they enter the hernial sac, begin to be compressed.

Palpation of the abdomen will help identify an inguinal hernia in a child.

This process is dangerous for the child's life. Parents need to resort to urgent surgical intervention, otherwise the baby will experience death of the affected organs (the cause of cell death is impaired blood circulation in the affected organs).

The severe stage of hernia development is characterized by certain symptoms. Among them are the following:

• pain in the area of ​​protrusion;

Note. If your child previously experienced severe pain, but then it disappeared without surgery, there is serious cause for concern. This state of affairs can be provoked by the death of the affected organ.

• the child is characterized by restless behavior and crying, which is a sign of inflammation in the area of ​​the tumor;
• feeling of excessive weakness;
• constipation;
• bloating (the baby does not pass gas).

Parents need to carefully “listen” to their child’s body. Untimely treatment causes an inflammatory process in the abdominal cavity. Its signs are high fever, vomiting and loss of consciousness.

Diagnostics

Parents of a sick child will not be able to independently determine the disease. At the slightest suspicion, you should contact a surgeon, who, based on the following measures, will make an accurate diagnosis:

• Examination of the patient (for example, the doctor may ask the child to cough to fix the protrusion of the tumor).
• Ultrasound - allows you to identify which organs are in the hernial sac.
• X-ray - makes it possible to determine whether the intestine has been pinched.

Preparing for surgery

Before the operation, a small patient must undergo standard preparation for the procedure. First of all, the safety of the baby depends on the measures taken.

Before removing an inguinal hernia, the doctor must examine the child and assess his state of health.

First of all, at the time of the operation the child should not have any concomitant diseases, for example, even a mild cold. For this reason, the child is examined by a pediatrician, who prescribes additional procedures:

• blood analysis;
• Analysis of urine;
• analysis for the presence of infections in the body;
• coagulogram.

In the future, the baby should be examined by an anesthesiologist, who will correctly select anesthesia for the patient. As a rule, surgery is performed under general anesthesia.

Surgical intervention

The operation is the only effective way to remove an inguinal hernia. In medical practice, it is customary to distinguish two types of surgical intervention:

• laparoscopy;
• open type operation.

Laparoscopy

Laparoscopy, as a relatively new surgical technique, has become widespread among patients. The main advantage of the operation is the complete absence of traces of surgical intervention - scars and cicatrices.

During the operation, the small patient is under general anesthesia. In general, the procedure takes no more than 50 minutes.

Before laparoscopy, the child is given general anesthesia.

During the operation, the specialist makes three small incisions in the affected area. Using a laparoscope, the surgeon displays an image of the patient's internal organs on the screen, examining the tumor. Subsequently, using miniature instruments, the doctor removes the hernia.

Note. Laparoscopy is performed only in the first stages of the disease. In the event that the neoplasm does not begin to infringe on neighboring organs. If the patient experiences complications, doctors recommend giving preference to the open type of surgery.

Open surgery

Surgery is possible for children aged three months and older. As a rule, the operation is performed as planned, the procedure takes no more than half an hour.

The child is under general anesthesia, and in the meantime, specialists perform the following procedures:

• The doctor makes an incision in the groin area, the size of which does not exceed 3 cm (within one month, an almost invisible scar remains).
• The specialist separates the hernial sac from the adjacent tissues and inserts the internal organs into place.
• The hernial sac is then removed and the affected area is bandaged.
• The surgeon closes the incision by placing intradermal cosmetic sutures.

Rehabilitation

As a rule, the recovery process after surgery takes place in a short time. First of all, the child’s parents need to pay due attention to the cleanliness of the bandage that is applied to the wound site. It needs to be changed at least once a day. If dressings are performed in a hospital, you should not ignore going to the hospital.

When laparoscopy is performed, after a couple of days the child is discharged from the hospital. He can move freely, for example, go to kindergarten, but physical activity should be excluded for the first three weeks.

Regarding rehabilitation after open surgery, experts generally recommend wearing a bandage for small patients. The baby needs to wear a bandage for two weeks; it can only be removed while sleeping.

As a rule, postoperative sutures are removed during the first week after surgery.

Note. It is strictly prohibited to wet the postoperative wound until the sutures are removed. If redness or swelling occurs, you should contact a medical professional.

Complications

As practice shows, the likelihood of complications after surgery is minimized. However, some complications accompanying the postoperative period are rarely recorded:

• formation of hematomas;
• the appearance of swelling;
• hemorrhage in the suture area;
• bladder damage.

Note. In rare cases, after surgery there is a relapse (recurrence of the hernia). Such consequences are caused by the low level of professionalism of the surgeon.

Price

Most medical institutions set identical prices for inguinal hernia removal.

On average, the cost of an open operation varies between 20-30 thousand rubles. As for laparoscopy, the price of the service is 40–45 thousand rubles. As a rule, the price presented includes payment for the following services:

• placement in a hospital (1 – 2 days);
• anesthesia;
• operating materials;
• applying a cosmetic suture.

Thus, an inguinal hernia is a neoplasm characterized by penetration of internal organs into the inguinal canal. Parents, if symptoms of the disease are detected, urgently need to show the child to a doctor.

Thanks to the high development of medicine, the operation will not only be painless, but will also effectively relieve the baby of the disease.

One of the most common abdominal pathologies in children is an inguinal hernia. It is usually detected at an early age, and parents are faced with the fact that treatment is necessary. At the same time, it is advisable to have a good idea of ​​what exactly is happening to the child and why it happened. In this article we will answer these and other questions.

What it is

An infantile hernia in the groin is a condition in which the vaginal process of the peritoneum protrudes out through the inguinal canal. What seeks exit through the inguinal canal is called a hernial sac. Inside it are parts of internal organs, for example, the bladder or intestines. The inguinal canal is a small gap passing in the groin area between muscle tissue and ligaments. Inside the gap in female children there is a round ligament of the uterus, and in boys there is a spermatic cord.

According to statistics, hernias in the groin are most often found in boys. The risk of developing this disease in them, according to various estimates, reaches 25-30%, while in girls it is only about 3%. According to pediatricians, for every girl with this diagnosis, there are 6 boys with a similar problem.

In premature babies, the risk of developing an inguinal hernia is significantly higher than in babies born on time. The risk of development in the first is at least 25%, in children born at term – 5%.

Reasons for appearance

Hernia disease in the groin is considered congenital, acquired forms are the lot of adults and older people. In boys and girls, the prerequisites for the appearance of lumps in the groin area are always created when they are in the mother’s stomach.

In future boys, during the embryonic period, the testicles form in the abdomen. They begin to descend down to the inguinal canal only at 5-6 months of pregnancy. At the same time, they somewhat “pull” the peritoneum along with them. The testicle finally descends closer to childbirth, in the 9th month of pregnancy. That same tightened pocket of the peritoneum, which was formed as a result of prolapse, is called the vaginal process.

Normally, it is completely healed by the time the boy is born. If for some reason this does not happen, the connection between the inguinal canal and the abdominal cavity remains open. This can lead to the fact that a loop of intestine or another internal organ can follow the path that the testicle took. This is what will become a hernia in the groin.

If everything is more or less clear with boys, then girls usually have more questions about the mechanisms of the appearance of a hernia. The answers lie in the anatomical features of the female embryo. In girls, the uterus is also not in its place from the very beginning. First, this important reproductive organ is laid down and formed much higher than it should be. And then, from about 4-5 months of pregnancy, the uterus begins its journey down, in a similar way, pulling part of the peritoneum with it.

Behind it remains a similar vaginal process. And if by the time of birth the connection with the abdominal cavity is not closed, the release of the hernial sac is not excluded. Thus, it becomes clear why inguinal hernias occur five times more often in premature babies than in full-term babies.

But the risk of occurrence and the hernia itself as a fact are not the same thing. There may be a risk, but there is no hernia.

The most common reasons why the hernial sac still protrudes outward are:

• genetic predisposition to peritoneal weakness;
• cystic neoplasms of the spermatic cord;
• hydrocele (dropsy of the testicle);
• herniated formations of the spinal cord, problems with the spine.

Hernias later (after 9-10 years) appear in the groin very rarely, and their underlying causes may be different than in newborns and infants. With the congenital predisposition described above, inguinal hernias can appear in children with severe obesity, in children who lead an inactive lifestyle, move little, do not play sports, in those who suffer from frequent and severe constipation, as well as respiratory diseases associated with severe chronic cough.

Classification

Depending on which side the hernia appeared on, it is classified as right-sided or left-sided. Right-sided ones are more common in boys; little princesses rarely suffer from this localization of the hernial sac. Hernia formations on the left in the groin area are recorded in a third of all cases.

In the vast majority of cases, a hernia appears on both sides simultaneously in girls. Bilateral hernia in male children is found in approximately 12% of cases.

Like many other hernia formations, the inguinal ones are also divided into oblique and straight. The obliques enter the inguinal canal, completely repeating the path of the testicle in perinatal age - from above, passing through the inguinal ring. Direct type hernias occur very rarely in children; in them, the hernia sac comes out through the peritoneum.

In boys, a separate type of disease stands out - scrotal or inguinal-scrotal hernia.

Based on the mobility or immobility of the bag, they are distinguished:

• strangulated hernia;
• elastically strangulated hernia;
• hernia with fecal impaction:
• hernia with Richter's entrapment (parietal entrapment of the intestinal loop);
• hernia with retrograde strangulation (when two or more organs are pinched);
• undisturbed.

It is possible to reduce only non-strangulated inguinal hernias. All types of pinching are subject to treatment using operative surgical procedures.

Dangers and complications

The main danger of an inguinal hernia lies precisely in the likelihood of its strangulation. No one can predict what it will be like. In the fecal type of pathology, strangulation occurs due to overcrowding of the intestinal loop, which has entered the pouch, with feces; in the retrograde type, not only the intestinal mesentery, which is in the pouch, is pinched, but also the intestinal mesentery, which is located in the abdominal cavity.

In all cases of entrapment, without exception, the child needs immediate and emergency surgical care. Infringement, no matter what type it develops, is associated with insufficient blood supply to the compressed organ, which quite quickly (sometimes within a few hours) can lead to tissue death and necrosis. Even in our advanced age with surgical medicine, doctors register cases of gangrene of strangulated organs in 10% of cases. Fatalities account for approximately 3.9%, with gangrene the mortality rate is higher - from 20 to 35%.

Infringement is always acute. Severe unbearable pain appears in the groin area, nausea, and sometimes repeated vomiting, the hernia becomes irreducible, and the deterioration in health increases very quickly. Delay and attempts at self-medication are dangerous. It is necessary to urgently transport a small patient to a surgical hospital.

To be fair, it should be noted that in childhood, most inguinal hernias are not complicated by strangulation. But the parents of a child who has been diagnosed with this, and who cannot decide to undergo surgery, must be prepared for such a turn of events. The older the child gets, the higher the risk of entrapment becomes.

Symptoms and signs

An acute condition associated with strangulation is not difficult to diagnose. It can be much more difficult to find an inguinal hernia before it becomes complicated by strangulation. The fact is that the only symptom is the formation of a hernia in the groin itself. It looks like a round or irregularly shaped lump that protrudes slightly.

It is easiest to notice pathology in children. For example, in children under one year old, a one-year-old child, whose parents regularly change clothes and bathe them, the hernia will be visualized during moments of strong crying, screaming, or coughing. In a calm state, when the child does not strain the abdominal wall or during sleep, the hernia will not be noticeable in the baby.

The location of the sac for a scrotal hernia in boys is inside the scrotum, so it will be the one that is deformed. In girls, the hernia usually prefers to descend into the labia, resulting in a strong enlargement of one labia compared to the other. With bilateral pathology, both lips will be unnaturally large.

In children 5-6-7 years old and older, finding a hernia can be more difficult, because parents no longer have access to all parts of the child’s body for ethical reasons. But such children can communicate in words what worries them. Complaints of aching pain in the lower abdomen, as well as pain and a feeling of fullness in the scrotum and groin after a long walk or run cannot be ignored.

An unstrangulated hernia should not bother the child much.

Symptoms that should cause parents to rush their child to the hospital are:

• bloating of the abdomen, lack of gas discharge;
• increased nature of pain in the groin area - from tingling and pulling sensations to acute pain;
• the hernial sac becomes hard, tense and immobile; touching it causes severe pain in the child.

Diagnostics

Usually an inguinal hernia can be detected in the first months of a child’s life. Often it is found by the parents themselves, in other cases - by a pediatric surgeon during the next routine examination at the clinic. It is customary to examine a child from birth to 1 year in a horizontal position.

Children who are already 2 years old can be examined in a standing position, with a mandatory assessment of the hernia when bending the torso forward. For children who are already 4 years old, the surgeon will give one more “task” - to cough, since with the cough reflex it is possible to examine the hernia in more detail and assess its size.

The doctor will compare whether the testicles in boys are symmetrical, what is the shape and size of the labia in the girl. Next, the doctor gives a referral for an ultrasound examination. Boys undergo an ultrasound of the inguinal canal, girls - an ultrasound of the pelvic and abdominal organs. Boys are additionally prescribed diaphanoscopy of the scrotum. This procedure is simple and painless; it involves assessing how the organ is able to transmit light rays through itself. This method allows you to establish or refute testicular hydrocele as a possible root cause of a hernia in the groin.

When an ultrasound shows that part of the bladder has descended into the hernia sac, cystography will be prescribed - a procedure in which a special substance is injected into the bladder, which is then clearly visible on an x-ray, this allows a detailed examination of the condition of the compressed organ. Irrigoscopy is prescribed if it is determined by ultrasound results that there is a loop of intestine in the contents of the sac. A contrast solution is injected into the child's rectum using an enema, after which an x-ray is taken to assess the characteristics of the strangulated organ.

Treatment

When it comes to inguinal hernias, doctors are usually quite categorical and offer surgical removal of the hernial sac as a treatment. Indeed, there are risks of complications, and by and large there is no point in preserving the hernia.

An inguinal hernia will not go away on its own, as happens with an umbilical hernia in babies.

The vaginal process by itself, by analogy with the umbilical ring, will not tighten or become overgrown. If this did not happen at the time of birth, then doctors must act further. There is no point in sticking it with a band-aid or hoping for help from a special bandage; you need to have surgery. An operation called herniorrhaphy is the only possible solution to the problem. However, statistics show that about 10% of patients after such surgery experience genitofemoral pain syndrome. Therefore, children with small, unstrangulated hernias are given a “delay”, choosing the method of watchful waiting.

The operation itself is not considered the most difficult; even a novice surgeon can perform it(this is what often happens in reality; it is at hernia repair that yesterday’s graduates of medical universities receive their first “baptism of fire”). Therefore, parents who naturally worry about the consequences of surgery should inquire about the qualifications of a specialist before undergoing a planned operation. For children, the operation is performed under general anesthesia. First, doctors gain access to the inguinal canal through an incision, then find the hernial sac and remove it. After which the inguinal canal is sutured to normal, natural size, and if it is destroyed, canal plastic surgery is performed.

The hernia can be closed with a mesh if it can be reduced during surgery and without removal. Most often they try to carry out operations using the non-cavitary method. To do this, use the capabilities of laparoscopy. Laparotomy (an incision in the abdominal wall) is performed only when part of the intestine, due to a strangulated hernia, is not viable and needs to be removed. After laparoscopic surgery, children quickly come to their senses, get up within a few hours, and the recovery period is short. The chance of relapse is about 1-3%. Uncomplicated small hernias in the groin of children are removed as planned; the child can be discharged home if he feels normal in 3-4 hours.

Doctors assess the prognosis as conditionally favorable. If the operation was performed correctly, and the patient subsequently follows all instructions, the inguinal hernia can be forgotten for the rest of his life.

After the operation, the child is indicated for physical therapy about a month later. You can do it in a physical therapy room in a clinic at your place of residence. Exercises with balls, sticks, and against a gymnastics wall are designed to help the child return to normal life as soon as possible. In addition, such physical education accelerates the process of tissue regeneration in the area of ​​surgical intervention, improves homeostasis, and strengthens the muscles of the abdominal wall.

Breathing exercises must be added to the set of exercises. 3-4 weeks after the operation, the child can engage in active walking (sports), skiing, and visiting the pool. Massage during this period is aimed at preventing disturbances in intestinal motility and strengthening the abdominal muscles. To do this, massage the child’s back along the spinal column, make massaging circular movements in the abdomen, around the navel, and stroke the oblique abdominal muscles. You should always complete the massage with the lower body, stroking and then stretching the legs.

Special restraining devices worn after surgery - bandages - will also help the child and protect him from possible relapses. Children's bandages are not similar to those for adults; you need to buy them in specialized orthopedic salons, having previously asked the attending physician for the size and other design features of the product.

A bandage after surgery to remove an inguinal hernia can be:

• left-handed;
• right-handed;
• bilateral.

The bandage comes with special inserts that are fixed in the place where the hernia was (or is). It should be understood that such orthopedic devices cannot cure a hernia in the groin; they only support the hernial sac from falling out and slightly reduce the risk of strangulation. That is why we placed information about bandages in the section on rehabilitation.

How treat inguinal hernia in children and in what cases can you do without surgery? Today we will talk about what modern treatment of inguinal hernia in a child completely eliminates the problem and does not have a negative impact on the functioning of adjacent organs.
An inguinal hernia is a tumor that occurs in the groin area. If the formation has spread to the scrotum, the hernia becomes inguinal-scrotal. This tumor (hernial sac) contains the ovary, omental strand, intestinal loop, and other organs. If you press on the hernial sac, you can hear some kind of rumbling, then the formation disappears, and reduction occurs.
Often in children an indirect inguinal hernia is diagnosed. The disease occurs in the same way as a cyst of the spermatic cord or communicating ovarian hydrocele. The vaginal process of the peritoneum (wide, not closed) acts as a hernial sac, which connects the abdominal cavity and the scrotum. From the abdominal cavity, through a process, everything is discharged into the inguinal canal. Inguinal hernia in children- a fairly common disease nowadays and in most cases it is indicated surgery to remove hernial sac to avoid destruction of the structure of the inguinal canal under the pressure of a hernia that grows with age.

For a child, an inguinal hernia is a serious illness that must be treated. The use of traditional medicine recipes in most cases aggravates the problem. In babies, hernias are predominantly congenital, caused by weak muscle tissue on the front of the peritoneum. Doctors notice them immediately after the baby is born. Sometimes muscle weakness is caused by the baby’s prematurity; not all of its organs are sufficiently developed.

If an inguinal hernia is detected in a child You should immediately consult your pediatrician. After the examination, he will explain how to deal with the disease in a particular case.
An inguinal hernia is repaired using operations, which is performed on a small patient no earlier than six months. When exactly is decided by the pediatric surgeon.

But if a child’s inguinal hernia is strangulated, then it should be repaired immediately. If this is difficult to perform, urgent surgical intervention is indicated (within 6 hours from the moment of injury).

Herniotomy is performed on the baby on the day he goes to the hospital. During the operation, the surgeon removes (sutured) the hernial sac, realigns the displaced organs, returning the inguinal canal to its normal structure. The spermatic cord and vas deferens are partially connected to the hernial sac; it is necessary to operate on a male patient very carefully.

An umbilical hernia is almost never strangulated; it is often possible to do without surgical intervention. Girls are operated on if the umbilical ring is dilated. Bloodless operations, without incisions, are now becoming popular. Children tolerate them well, do not feel severe pain and do not encounter complications. Mom during surgery next to her child. The body recovers quickly, and after a couple of hours you can return home.

It is important to keep in mind that inguinal hernia in children is a very dangerous disease and if you detect obvious symptoms of an inguinal hernia in your child, you should seek qualified help from a pediatric surgeon as soon as possible. Only a specialist should decide what treatment the baby needs. In some cases, it is enough to perform a reduction (at an early stage of hernia formation). But in most cases, surgery is indicated to restore the anatomy of the abdominal canal as quickly as possible and remove the hernial sac.

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