By Dr Anand Sinha
Inguinal hernia means protrusion of the intestines though a weakness in the groin. It is the commonest surgical problem in children with an incidence as high as 1-5 per cent in the general population.
What causes inguinal hernia in infants?
During the early part of a baby’s development in the mother’s uterus, the testicles and ovaries are formed high up in the tummy just below the kidney. As the baby develops, the gonads descend to reach the lower part of the tummy and induce an opening in the tummy wall. In girls, the ovaries stay back in the tummy but in boys, the testes come out of this opening and come to lie within the scrotum. The openings get closed before the baby is born. In some children this opening persists after the child is born and whenever the baby strains, the intestines protrude as a swelling in the groin.
Hernias are more common in boys as in females, as the ovaries don’t exit this opening. Hernias are far more common in prematurely born babies as they get lesser time for the openings to close. Hernias in infants differ from those in adults. In adults there is no patent opening, but a generalised weakness of the tummy wall which causes intestines to bulge out. Hence the treatment also differs in children and adults.
How does one recognise hernia?
Hernia appears as a soft swelling in the groin between the lower belly and the thighs. In boys, it can reach the scrotum. The swelling increases when the child cries or strains while passing urine or stool. When the child is calm, the swelling reduces as the intestines go back into the tummy.
How does one confirm the diagnosis of hernia?
Hernia is essentially a clinical diagnosis. A doctor will recognise a hernia as soon as they see one. Occasionally, the swelling may not be evident when one reports to the doctor’s office. It is a wise idea to take a photograph when the swelling is evident and share it with the doctor. An ultrasound may be done but is not essential to confirm the diagnosis.
How does the hernia affect a child?
Hernia itself does not cause any major discomfort. But occasionally intestines can protrude from the narrow opening but fail to go back. This is called an irreducible or strangulated hernia. The blood supply to the intestines gets constricted at the opening and it becomes a surgical emergency. So, it is prudent to get the hernia corrected before any such episode happens.
What is the treatment of hernia?
Inguinal hernia in infants is repaired by paediatric surgeons. A minor surgical procedure is performed under anaesthesia and the opening is closed with a stitch permanently. It is a very safe day-care procedure and can be done via a tiny groin incision or with laparoscopy. Once corrected, hernias have no lasting implications and the child can lead a normal healthy life.
(The writer is Senior Consultant, Paediatric Surgery, Fortis Memorial Research Institute, Gurugram.)