An inguinal hernia in a child occurs when abdominal contents, such as intestines or an ovary, push through a weakness in the lower abdominal wall into the groin area. This condition stems from a developmental anomaly present at birth, specifically the incomplete closure of a passageway called the processus vaginalis. Pediatric inguinal hernias are a common surgical issue in children.
Understanding Pediatric Inguinal Hernias
The processus vaginalis is an embryonic out-pouching of the peritoneum that normally closes before or shortly after birth. If this tunnel fails to close completely, it creates an opening between the abdominal cavity and the inguinal canal, allowing fluid or organs to protrude. This condition is more common in boys, appearing in about 1-5% of full-term newborns, and significantly more often in premature infants, with an incidence of up to 30%.
Parents typically observe a soft, smooth bulge in the groin area or scrotum, which may become more noticeable when the child cries, coughs, or strains. The bulge might disappear or shrink when the child is relaxed or asleep. Diagnosis is usually made through a physical examination, where a healthcare provider looks for the bulge and may try to gently push it back into place.
When is Repair Recommended?
Surgical repair is generally recommended promptly upon diagnosis of an inguinal hernia in children to prevent complications. Unlike adult hernias, pediatric inguinal hernias do not close on their own and require intervention. For otherwise healthy infants and children, elective repair should be performed without significant delay because the risk of the hernia becoming trapped is highest in younger children.
In neonates and infants, the urgency for repair is particularly high due to an elevated risk of incarceration. More than half of all hernia incarcerations occur in infants under six months old, and two-thirds in those under one year. Premature infants face an even greater risk, with a reported incidence of incarceration around 16%, increasing to 21% if surgery is delayed beyond 40 weeks’ corrected gestational age. While some surgeons might consider delaying repair until a premature infant reaches a certain weight or is discharged from the neonatal intensive care unit, this decision is made on a case-by-case basis.
For older children, surgical repair is advised to prevent future complications. Waiting can increase the risk of the hernia enlarging or becoming incarcerated.
Why Timely Intervention Matters
Leaving a pediatric inguinal hernia untreated carries a risk of serious complications. One such complication is incarceration, where the herniated tissue becomes trapped and cannot be pushed back into the abdomen. An incarcerated hernia can cause severe pain, tenderness, irritability, vomiting, and abdominal distension.
A more severe complication is strangulation, which occurs if the blood supply to the trapped tissue is cut off. This can lead to tissue damage or death and is considered a surgical emergency requiring immediate medical attention. Symptoms of strangulation include sudden, intensifying pain, redness or bruising around the bulge, fever, nausea, vomiting, and inability to pass gas or stool. In boys, there is a risk of damage to the testicles if the hernia involves them and becomes strangulated, potentially leading to testicular atrophy.
What to Expect from Surgery and Recovery
Pediatric inguinal hernia repair is a common surgical procedure, typically performed as an outpatient operation under general anesthesia. The surgery usually involves a small incision in the groin area. The surgeon gently repositions any displaced organs back into the abdomen and then closes the opening or weakness in the abdominal wall with dissolvable sutures.
Recovery from the surgery is generally rapid for children. Most children can return home the same day, often within a few hours after the procedure. Pain management is typically achieved with over-the-counter medications. Activity restrictions are usually minimal; infants and younger children are often self-limiting in their activity, while older children and teenagers may have short-term restrictions from strenuous activities for a few weeks. Parents should watch for signs of complications, such as fever, spreading redness, bleeding, severe pain not relieved by medication, or persistent vomiting.