Causes, prevention and treatment of hernia in children

Pediatric hernia refers to the movement of a child's organs or tissues away from their original positions and into another part of the body through weak points or gaps in the body. It is more common in the groin and umbilicus, and is mostly caused by congenital developmental deficiencies. It can occur in the neonatal period, and some may heal on their own with age. The main manifestation is the appearance of a retractable mass in the groin or umbilicus, which may grow larger with crying, coughing, and holding breath, and become smaller or disappear after quieting. If the symptoms are not obvious, conservative treatment can be used. Those who cannot heal on their own and have symptoms such as abdominal pain and vomiting require surgical treatment. Most patients have a good prognosis and generally do not have sequelae. Only a few develop intestinal obstruction and intestinal necrosis, which endanger the patient's life.

Hernias in children are divided into inguinal oblique hernias, umbilical hernias, and white line hernias according to different locations. In general, inguinal oblique hernias are more common in clinical practice. Inguinal oblique hernias in children are more common in males than in females, and are more common on the right side. Incarcerated hernias are common in infants under 2 years old.

Causes of hernia in children:

Reduced abdominal wall strength and increased intra-abdominal pressure are the two main causes of external indirect hernia. In the early embryonic period, the testicles are below the kidneys, and at 8 months they descend to the bottom of the scrotum along with the gubernaculum. At the same time, the peritoneum in front of the testicles also forms a sac-like protrusion downward, which surrounds the testicles and is called the processus vaginalis. The processus vaginalis was originally connected to the abdominal cavity and began to close before birth. 90% of it has not yet closed at birth, but the closure process continues within 6 months after birth. The processus vaginalis remains open, which creates the opportunity for hernia. Increased intra-abdominal pressure is a predisposing factor for hernia. The right testicle descends later than the left, so the closure of the processus vaginalis is also later than the left, which may be the reason for the high incidence of right indirect hernia.

Symptoms of hernia in children:

The typical symptoms are smooth, neat, slightly elastic and reducible masses in the groin and/or scrotum. When the child cries, stands, coughs or exerts force to increase the intra-abdominal pressure, the mass appears or increases, and there is a sense of expansion and impact. After lying flat, it gradually shrinks until it disappears completely. You can also use your fingers to gently press the mass from bottom to top to help return the mass to the abdominal cavity. Sometimes you can hear the sound of air passing through water during reduction. Some children have incarcerated hernias, that is, the contents of the hernia cannot be returned, and pain may occur in the mass. As the disease progresses, it leads to intestinal necrosis. Children may have systemic poisoning symptoms, increased body temperature and pulse, and a few children have blood in their stools. The hernial mass is red, swollen, hot and painful.

Treatment of hernia in children:

Hernias in children under 1 year old can be treated conservatively through observation. If inguinal hernias in children cannot heal on their own after 1 year old, surgery is an effective means of radically curing inguinal hernias. Because the probability of incarcerated hernias in the groin is high, high ligation of the hernia sac should be performed as soon as possible. Laparoscopy and minimally invasive surgery with small incisions can be selected for surgical methods.

Prevention of hernia in children:

1. Since hernia can occur in infancy, you should always pay attention to the child's groin or scrotum during this period to see if it is swollen or if there is a lump that appears and disappears from time to time. If you have any questions, consult a doctor in time to diagnose whether it is a pediatric hernia.

2. Although hernias are more common in boys, they can also occur in girls. Girls should be more vigilant about hernias because the ovaries and fallopian tubes often enter the hernia sac.

3. Do not wrap the baby's abdomen too tightly during infancy to avoid increasing intra-abdominal pressure and inducing hernia. Do not let the baby stand too early to avoid the intestines falling and forming inguinal hernia.

4. Eat foods that are easily digestible and rich in fiber to keep bowel movements smooth. When children have dry stools, laxative measures should be taken and children should not be forced to defecate to avoid inducing hernia.

5. Do not let your child cough loudly. Children with coughs are prone to hernia. They should take cough medicine under the guidance of a doctor. Avoid children crying loudly to prevent increased abdominal pressure, which can also induce hernia.

Popular Science Doctor: Guo Linsen

Workplace: Yangbu Town Central Hospital, Pingyu County