An inguinal hernia is a protrusion of a portion of the small intestine into the groin through an opening in the membrane enclosing the abdominal cavity. This intestinal protrusion causes a prominent, nontender bulge.
Inguinal hernias are common in infancy and childhood; about one out of every 20 children—mainly boys—develop them. A hernia usually develops on only one side of the groin, although hernias that appear on both sides occur in about 20 percent of babies afflicted with a hernia.
Inguinal hernias pose no threat to health unless the protruding intestine becomes trapped in the abdominal opening. Such a hernia is described as incarcerated, entrapped or strangulated. The entrapment will cut off the blood supply to the bulging piece of intestine, causing gangrene if the condition goes unrecognized and unrelieved.
WHAT CAUSES AN INGUINAL HERNIA?
An inguinal hernia occurs when the peritoneum (the membrane that lines the abdominal cavity) fails to close fully during fetal development. In the fetus, the peritoneum has two projecting sacs running into the groin, one down each side, via a short passageway between the abdomen and the groin. In boys, these projections extend into the scrotum; in girls, they extend into the labia majora.
Before birth, the projections separate from the peritoneum, which then closes to form an intact membrane around the abdominal organs. The pouches dissolve in girls; in boys, they form the protective sacs that house the testicles.
In many otherwise healthy babies, the peritoneum fails to close at the point where the projecting sacs were attached. The intestine pokes through the opening, causing the characteristic hernial bulge. Sometimes, the peritoneal opening is very small, allowing only abdominal fluid to pass through; the bulge it forms is known as a hydrocele.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS AN INGUINAL HERNIA?
A swelling or puffy area in the baby's groin indicates a hernia. The bulge may be visible all the time, or it may appear only after vigorous activity or coughing.
In an uncomplicated hernia (one that is not trapped) the bulge is soft and can be gently pushed back into place; this type of hernia rarely causes discomfort or pain. An incarcerated, or trapped, hernia feels harder to the touch, and it is likely to be quite tender.
IS MEDICAL ATTENTION NECESSARY?
Yes. Call your pediatrician if you note the following symptoms:
• A swelling or bulge on either side of the child's groin
• Pain or discomfort in the groin
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS AN INGUINAL HERNIA?
The physician can detect a hernia by visual inspection and physical examination. If a suspected hernia is not visible, the doctor may have to induce its appearance by pressing on the abdomen (which will make a baby cry and push the hernia out) or having an older child bear down on the abdominal muscles while standing.
WHAT TREATMENTS ARE AVAILABLE?
Surgical repair of the abdominal wall is always required for an inguinal hernia. An incarcerated hernia requires immediate surgery. If an uncomplicated hernia is diagnosed in an infant, surgery usually is scheduled as soon as the infant is strong enough and healthy enough. Older children have more leeway; surgery usually is scheduled some time within a month or two after the hernia is detected.
The surgical procedure to repair an inguinal hernia is relatively simple. The surgeon makes a small incision in the groin and pushes the intestine back into place in the abdomen. He then sews up the opening in the abdominal wall and closes the incision. The operation takes less than an hour and usually is performed on an out-patient basis.
CARING FOR A CHILD WITH AN INGUINAL HERNIA
Preparation for and recovery from surgery are relatively simple:
• Before the operation, have an older child refrain from strenuous activity that can aggravate the hernia.
• Despite some tenderness, the child will be urged to move about after the operation.
• Have the child refrain from athletics or rough play until the groin heals completely.
• Allowing the child to return to full activity is usually possible after a couple of weeks.
• Keep an eye on the incision until it heals. If redness or swelling occur, or if the child runs a fever, contact the physician; it may indicate an infection.
