Inguinal hernia

Overview

An inguinal hernia forms when a sac protrudes through an opening in the lower abdomen called the inguinal ring. In developing baby boys, the inguinal ring allows the testicles to descend into the scrotum. In girls, a similar opening may exist even though the ovaries do not descend out of the abdomen. Normally, this hole closes before a baby is born. When the opening doesn't close and a sac forms, a portion of intestine or bowel may poke through into the sac, causing a hernia.

Signs & symptoms

Inguinal hernias leave a tender, painful and reddish bulge in a child's abdomen or groin area. In older children hernias can be seen when they are coughing or straining during a bowel movement. The hernia may disappear when the child is relaxed. In infants, the bulge may become more noticeable when a baby cries or moves around.

A child may have a fever, become fussy or refuse to eat if suffering from a hernia. If the intestine has become obstructed, a child may vomit or be constipated. If this occurs, your child will need emergency care.

Diagnosis

Hernias can be diagnosed with a physical examination by a doctor. The doctor will determine if the hernia can be pushed back into the abdominal cavity or whether it requires immediate surgery.

If only fluid comes through the inguinal ring into the sac, the problem is called a hydrocele. When a loop of bowel or other organ becomes trapped in the sac, this is called an incarcerated hernia. Once the organ is stuck, it can swell and compress the blood supply that is pulled along with it. Without enough blood, the organ can be damaged or die.

An X-ray or ultrasound may be performed to look closely at the child's intestine.

Treatment

Left untreated, inguinal hernias do not go away on their own and can have serious consequences for a child, such as a blocked bowel. If the hernia cannot be pushed back into the abdominal cavity, your child will need immediate surgery.

Inguinal hernia is the most common childhood urological problem that requires surgery. During the surgery, any herniated tissue that comes through the inguinal ring will be put in its proper place, all or part of the sac that comes through the inguinal ring will be removed and the opening will be closed. In children less than 1 year of age, there can be an open sac on the other side that could become a hernia later, so your child's surgeon may use a tiny telescope to look for it and close it. This is called the "LOOC" procedure. The stitches are all under the skin and will dissolve on their own but your child's skin will be covered with small bandages. There is very little blood loss in hernia surgery — about one to two teaspoons — so no blood is reserved for the operation.