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Hernia
 
This is an abbreviated version of the complete article.*
Basic Facts
A hernia is a condition in which part of an organ contained in a body cavity, usually the intestines, protrudes though a natural defect in the abdominal wall.
If not treated, a hernia can cause organ damage and may require emergency medical care.
In children, the two most common hernias are umbilical and inguinal.
A hernia must be repaired through surgery to prevent trapping of the intestines.
A hernia is a condition in which part of an organ, usually the intestines, protrudes through a naturally occurring defect in an infant's abdominal muscles into a finger-like saccular extension (the processus vaginalis) of the lining of the abdomen (the peritoneum). This produces a soft bulge below the skin that typically is not painful. The two kinds of hernia most common in children are inguinal hernia and umbilical hernia.

When applying gentle pressure can return a hernia to the abdomen, it is said to be reducible. If a hernia cannot be pushed back into the abdomen, there is a risk that it will become entrapped, incarcerated, or strangulated, leading to sepsis and/or death. Incarceration is the most common cause of bowel obstruction in children.

WHAT ARE THE SYMPTOMS?

The main symptom of a hernia is a painless bulge in the area around the belly button or a bulge in the groin area or an enlarged scrotum. A parent or caregiver should be concerned that a hernia has become incarcerated or strangulated if the child has the following symptoms:
  • A full, round abdomen;
  • Hard or tender bulge at the hernia site;
  • Pain at the hernia site;
  • Vomiting;
  • Fussiness or persistent crying;
  • Redness or discoloration (blue or dark brown) in the area of the hernia;
  • Diarrhea or constipation; and
  • Fever.
Parents should contact the pediatrician immediately if their child is vomiting, has colicky abdominal pain, or has severe, continuous constipation. If a parent cannot reach the pediatrician, he or she should immediately take the child to an emergency room.

CAUSES AND RISK FACTORS

One or more of the following factors may place a child at greater risk for developing a hernia:
  • Premature birth;
  • Low birth weight;
  • Cystic fibrosis;
  • Hip dysplasia;
  • Undescended testicle;
  • Urethral abnormality;
  • A parent or sibling who had a hernia as a child; or
  • Previous inguinal hernia on one side.
DIAGNOSIS

Often, information provided by the child's parent or caretaker is the sole basis for a diagnosis of hernia because a bulge or swelling may not be present during a doctor's visit. If the hernia is evident, a physician will diagnose it by palpation during a physical examination. The physician will examine the child lying down and standing and will determine whether the hernia is reducible. This is used to gauge the urgency of the repair.

TREATMENT APPROACH

Treatment for a hernia depends on the following:
  • The type of hernia;
  • The child's age, health, and medical history;
  • The child's tolerance of certain therapies; and
  • The parents' preferences.
Inguinal hernias must be repaired through surgery to prevent incarceration. Emergency surgery is not necessary for 80 percent of incarcerated hernias because they are reducible and the repair is done urgently but electively. While operating time varies among surgeons, a hernia repair generally takes a little over one hour.

Minimally invasive laparoscopic surgery is becoming more common for hernia repair.

Umbilical hernias that appear before 6 months old often close by themselves by age 1. Even large umbilical hernias can disappear by the time the child is 3 or 4. Surgery may be indicated if an umbilical hernia:
  • Is irreducible;
  • Grows larger with age; or
  • Exists after age 2.
*If you would like to read this article in its entirety, please call our office and ask to meet with one of our specialists to receive a Prescription Pad form.

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