[am730] Childhood Hernias – Dr. Leo Sze-wai, Paediatric Surgeon

Don't assume that inguinal hernias, commonly known as groins hernias, are exclusive to adults. They are also very common in young children, often appearing after crying spells as a bulge or abdominal pain in the abdomen. This is because organs like the intestines protrude through a gap. In severe cases, it can lead to acute complications such as intestinal obstruction. Therefore, parents must not neglect this condition and should seek medical attention as soon as possible if they suspect it.

International data indicate that the incidence of inguinal hernia in full-term infants is approximately 3% to 5%, whilst the incidence in preterm infants is around 30 per cent higher;Other studies indicate that inguinal hernia is one of the most common causes of children requiring surgery for acute abdominal pain, demonstrating that it is the most common surgical condition in infants and young children; clinically, it is relatively more common in boys.

In children, hernias are most often indirect hernias. This is because the groin, the area where the abdomen meets the thigh, has a diagonal passage near the abdomen. If this passage does not close normally during development, a gap forms in the groin, connecting to the abdomen. Organs within the abdominal cavity, such as the small intestine, ovaries, or peritoneum, can then protrude through this gap, or even descend into the scrotum in boys or the perineum in girls, causing abnormal swelling.

Certain situations can trigger hernias, such as prolonged crying, coughing, or straining during bowel movements and other forceful abdominal actions. This increases abdominal pressure, forcing internal organs to protrude, creating a lump of varying size in the groin. This can cause discomfort and a pulling sensation for the infant. However, when the pressure is released, such as by relaxing or lying flat, the bulge will disappear. When the abdomen is strained again, the lump may reappear, but this doesn't necessarily happen every time the child cries, making it difficult to detect at times. Furthermore, young children are unable to clearly articulate their discomfort, so parents need to observe them carefully.

Doctors can generally determine if a toddler has a hernia through clinical examination, case history enquiry, palpation, and ultrasound scans. Treatment involves surgery under general anaesthesia, including traditional open surgery or minimally invasive laparoscopy, to stitch up the hernia opening in the groin, thereby preventing the recurrence of symptoms and complications.

Inguinal hernias require surgery to resolve.

Hernias generally do not heal naturally. In fact, with current medical technology, performing hernia surgery on babies is not a major issue. If the condition is left untreated and leads to complications such as intestinal obstruction or intestinal necrosis, it would be even more dangerous for the child.

Parents are reminded that infantile hernias do not heal on their own. If the protruding intestine becomes compressed in the groin, restricting blood flow, it can easily lead to acute complications such as intestinal obstruction or even ischaemic necrosis. Symptoms may include severe pain, vomiting, abdominal distension, and difficulty passing stools. If parents suspect their child has a hernia, they can take a photo of the abdominal bulge on their mobile phone to show the doctor during a consultation, which will aid diagnosis.

by Tsuen Wan Adventist Hospital, Hong KongPaediatricsConsultant PhysicianLiu Sze-wai