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Surgery for Hernias in Children

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What Are Hernias?

Parts of organs or tissues (such as a loop of intestine) can protrude into areas where they don’t belong. They push through openings or weaknesses in a muscle wall, so a bulge or lump appears. These bulges are hernias, which are common in children. Most common in babies and children are external hernias: inguinal (in the groin) and umbilical (near the belly button). Umbilical hernias are very common, especially in premature babies and babies with certain diseases. Inguinal hernias occur more in males than females and premature babies. Congenital diaphragmatic hernia and hiatal hernia are the most common internal hernias (inside the body) in children.

If hernias bulge only during pressure or strain, they’re called reducible and aren’t very harmful. Tissues trapped in an opening or pouch that can’t pull back are incarcerated hernias, which are serious problems. The most dangerous hernia is strangulated. In these, trapped tissue loses the blood supply and dies.

What Causes Hernias?

Indirect inguinal hernias, present at birth, are caused by mistakes during development. Direct inguinal hernias form after birth. Umbilical hernias occur when the umbilical ring doesn’t close properly. In other hernias, membranes, wall muscles, or other structures don’t form correctly or are hurt, so they slowly weaken.

What Are the Symptoms of Hernias?

Symptoms of inguinal and umbilical hernias are painless swellings, which may go away on their own. They’re most obvious with crying, straining, coughing, or standing. Inguinal hernias in boys can make the scrotum (sac holding testicles) large. In girls, labia (tissue around the vagina) can swell. Internal hernias may have no symptoms or may cause vomiting and heartburn. Incarcerated hernias cause tender firm masses, pain, vomiting, constipation, and irritability. Strangulated hernias lead to fever and swollen, red, inflamed, and very painful areas.

How Are Hernias Diagnosed?

The health care provider uses the medical history and physical examination with the child lying down and standing. Blood tests or laparoscopy are rarely needed. Imaging studies in certain cases include X-rays and ultrasonography.

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How Are Hernias Treated?

Treatment is based on type of hernia. Umbilical hernias usually cause no discomfort, and most tend to close on their own by age 1 or 2. Doctors can often easily push them back in. Doctors usually suggest waiting and watching these hernias. Operations are needed only if hernias don’t heal by age 4 or 5, or if they become trapped or block the intestines. Surgery, often outpatient, is used for inguinal hernias to prevent incarceration.

DOs and DON’Ts in Managing Hernias:
  • DO watch your child’s hernia to make sure that it gets smaller in the first 2 or 3 years of life.
  • DO give your child pain medicine that your health care provider prescribes after surgery.
  • DO protect your child after surgery from respiratory infections that might cause coughing and sneezing. These could strain the stitches. Frequent hand washing is the best way to prevent these infections.
  • DO learn the symptoms of inguinal hernia incarceration. Delayed treatment can cause serious problems.
  • DO keep the incision clean and dry until it heals. You may need to limit your child’s activity for a while.
  • DON’T forget follow-up health care provider appointments.
FOR MORE INFORMATION

Contact the following source:

  • The American Academy of Pediatrics
    Tel: (847) 434-4000
    Website: http://www.aap.org
  • American Gastroenterological Association
    Tel: (301) 654-2055
    Website: http://www.gastro.org
  • American College of Gastroenterology
    Tel: (703) 820-7400
    Website: http://www.acg.gi.org

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

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