Inguinal hernia (inguinal hernia) is one of the most common surgical pathologies in the inguinal region in children. Inguinal hernia is seen in 1-5 out of every 100 children. Although it is very common, it can sometimes cause aggravation in case of delayed diagnosis.
What is an inguinal hernia?
Inguinal hernia is a condition in which the abdominal organs protrude under the skin from the inguinal region. Swelling in the groin area when children are laughing, crying or in situations such as constipation that increases intra-abdominal pressure usually disappears on its own when the child calms down. While direct inguinal hernia (proceeding directly under the skin from the anterior abdominal wall) is seen in adults, indirect inguinal hernia (running along the inguinal canal) is more common in children.
How does an inguinal hernia develop?
Inguinal hernia in children is a congenital anomaly rather than an acquired pathology after birth, and it results from not ending development in the mother's womb. The baby's gonadal organs (testes in boys, ovaries in girls) develop at the level of the kidneys and begin to descend towards birth. In girls, the ovary goes down to the pelvis, while in boys, the testicles come out of the abdominal cavity and go down to the sacs. During testicular descent in males, a path (processus vaginalis) consisting of the intra-abdominal membrane (peritoneal) is used, and after the descent is completed, this path closes by itself before birth. In girls, the ligaments that suspend the uterus to the inguinal region pass through this region. If this path consisting of the intra-abdominal membrane is not closed during development (patent processus vaginalis), an inguinal hernia may develop. causes.
In some rare cases, inguinal hernia can be seen together with other system diseases.
Symptoms
The classic symptom of inguinal hernia is manifested by a gas-filled swelling that is palpable under the skin in the inguinal region in boys and girls, which usually disappears when the child calms down or touches that area. As long as the inguinal hernia is not compressed, it does not bother the child and does not cause pain. Swelling While it is seen only in the groin in girls, it can be both in the groin and in the form of swelling extending towards the pouch in boys.
Diagnosis
Aaccording to the patient's history and the doctor's examination diagnosis of inguinal hernia is made. The family's description of the swelling in the inguinal region and the palpation of the hernia during the doctor's examination are sufficient for a definitive diagnosis. Rarely, ultrasound examination may be needed in cases where the hernia is not palpable during the examination and the family history is uncertain.
Who and when is it seen?
The incidence in boys is 3-10 times higher than in girls. About one out of every 9 children with a hernia has a family history of hernia.
Although it is mostly seen on the right side (60%), 10% can be seen on both sides. It is thought that the chance of developing a hernia on both sides in children with a hernia on the left side is higher than those with a hernia on the right side.
Most hernias in children occur in the first year of life, especially in the first few months. The average age of surgery is 6 months. Hernia is more likely to be seen in premature babies and this rate is 13% in those born before 32 weeks of gestation and 30% in those with a birth weight below 1000gr.
Treatment
The treatment of inguinal hernias is surgery. It does not heal on its own, there is no drug treatment. Although emergency surgery is not required in inguinal hernias, waiting too long may also be inconvenient due to the risk of suffocation of the hernia. After the diagnosis is made, planned surgery should be performed in a short time.
Preoperatively, as in all surgical procedures, a detailed history is taken and a physical examination is performed. Preoperative examinations are performed and the view of the anesthesiologist is performed.
The state of hunger is determined according to the age of the child before the surgery. The operation is performed under general anesthesia by putting the child to sleep. After the operation, the food was fed in the specified time. The child is discharged home within 3-4 hours on the same day. He is called for control on the first day after the surgery and at the end of the first month.
The surgery can be performed open or closed (laparoscopically) according to the surgeon and family's choice. In the open method, a 2-3 cm incision is made on the herniated side in the inguinal region, and the hernia sac is found and tied. In the closed – laparoscopic method, only the inside of the abdomen is viewed with special devices through a 5 mm incision made from the navel, and hernia repair is performed with a special technique with the help of a thin needle from the groin. attention
The intra-abdominal organs (intestines and sometimes ovaries in girls) that protrude under the skin during hernia often return spontaneously or with slight pressure to the abdomen. However, in some cases, the protruding intra-abdominal organ gets stuck in the neck of the hernia sac (incarceration) and cannot return to the abdomen. There is a risk of compression in 1 out of every 6 hernias. In this case, also known as hernia strangulation, the blood supply of the organ gradually deteriorates and can cause life-threatening situations.
In cases where the swelling in the groin area does not regress, redness, pain in this area, the child is restless, the general condition deteriorates, swelling in the abdomen, and vomiting, a doctor should be consulted without waiting. In case of a compressed hernia, if the hernia cannot be sent into the abdomen at the time of doctor's intervention, the child should be taken to emergency surgery.
Read: 0
