During the embryonic period, there is a “peritoneal sphincter” in the groin that helps to fix the testicles descending into the scrotum or the round ligament of the uterus. In some children, this sheath is incompletely closed after birth, causing the small intestine, omentum, and fallopian tubes in the abdominal cavity to enter this sheath, which becomes a hernia, and if only abdominal fluid enters the scrotum, which is scrotal edema. The general incidence of hernia is 1-4%, 10 times higher in boys than in girls, and even higher in premature infants, and may occur on both sides. Pediatric inguinal hernia first affects the patient’s digestive system, resulting in symptoms such as lower abdominal cramping, abdominal flatulence, abdominal pain, constipation, poor absorption, easy fatigue, and decreased physical fitness. Also, because the inguinal region is adjacent to the genitourinary system, the normal development of the reproductive system can be affected by the extrusion of the hernia. The intestinal canal or large omentum inside the hernia sac is easily squeezed or collided to cause inflammatory swelling, resulting in difficulty in hernia retrieval, leading to hernia impaction, causing severe abdominal pain and serious complications such as intestinal obstruction and intestinal necrosis, which may be life-threatening if not treated in time. Therefore, pediatric hernia should be treated early and thoroughly.
Symptoms of the disease
1. Pediatric hernia may occur days, months or years after birth.
Usually, when a child cries, exercises vigorously, or has dry stools, there will be a protruding mass in the groin, sometimes extending to the scrotum or labia; it will disappear on its own when lying down or when pressed by hand.
3. Once the hernia mass becomes ingrown (the hernia mass cannot be retracted), abdominal pain, nausea, vomiting, fever, anorexia or crying, and irritability may occur.
4.In the early stage of the onset of pediatric hernia, the swelling may disappear when the toddler lies flat and quiet; as the intra-abdominal pressure continues to increase, the swelling may descend into the scrotum. At this time, if the factor of increased intra-abdominal pressure can be lifted and the child is allowed to lie flat or the swelling can be gently pushed in the direction of the abdominal cavity, the swelling can return to the abdominal cavity through that channel when the testicle descends and the swelling disappears; this condition is called reversible hernia.
If the swelling cannot be returned to the abdominal cavity, there will be increased abdominal pain and crying, followed by symptoms of intestinal obstruction such as vomiting, abdominal distension and poor defecation, etc. An oval-shaped swelling with hard texture and obvious pain to the touch can be seen in the groin or scrotum; the skin can be red and swollen if it is embedded for a long time, and serious complications such as ischemic necrosis of the intestinal canal may occur if the intestinal canal cannot be returned for a long time.
Causes of the disease
In boys, the testes descend through the inguinal canal to the scrotum just before birth, and the peritoneum then moves down to form the sphincter. If the sphincter is not atretic after birth, or if it is not fully atretic, but instead becomes a larger cavity, the abdominal contents will protrude to the body surface from here, and a hernia will form. Because the right testicle descends slightly later than the left and the atresia of the sphincter is also later, there are more inguinal hernias on the right side. Of course, girls can also form hernias due to weakness of the abdominal wall, but the incidence is relatively low.
Disease examination
Inguinal hernias are most common in young children under one year of age. If an attack occurs, there is a bulging mass in the groin that is easily detected with a little vigilance. Children with the following symptoms should be taken seriously.
1. unexplained crying and fussiness should be considered as a possibility of pediatric hernia with intussusception;
2. violent vomiting and fever; consider the possibility of pediatric hernia with intussusception;
3.Intestinal obstruction; it is necessary to consider the possibility of pediatric hernia with intussusception;
4.Bloody stool is found; it is necessary to consider the possibility of pediatric hernia with intussusception.
It is important to carefully investigate the presence of inguinal hernia; of course, it is also necessary to ask the physician to check whether there are other diseases.
Complications
A hernia first affects the digestive system of the patient, resulting in symptoms such as lower abdominal cramping, abdominal flatulence, abdominal pain, constipation, poor nutrient absorption, fatigue and decreased physical fitness. Since the inguinal region is adjacent to the genitourinary system, elderly patients are prone to bladder or prostate diseases such as frequent urination, urgent urination and increased nocturia; children may be affected by the normal development of testicles due to the extrusion of the hernia; and middle-aged and young patients are prone to sexual dysfunction. The intestinal canal or omentum inside the hernia sac is prone to inflammatory swelling caused by extrusion or collision, resulting in difficulty in hernia retrieval and dangerous conditions such as intestinal obstruction, intestinal necrosis, and severe abdominal pain.
Disease prevention
1. Since hernias can occur in infancy, the child’s groin or scrotum should be observed frequently during this period to see if it is swollen or if there is a lump that appears from time to time, and to consult the doctor when in doubt.
2. Although more boys suffer from hernia, hernia can also occur in girls. It is important to be more alert to hernias in girls because often the ovaries and fallopian tubes enter the hernia sac.
3. Don’t wrap the child’s abdomen too tightly during infancy to avoid increasing intra-abdominal pressure. Don’t let the child stand too early to prevent the intestinal canal from falling down and forming an inguinal hernia.
4.Eat foods that are easy to digest and contain a lot of fiber to keep the stools open. If your child has dry stools, take laxative measures and don’t let him/her forcefully relieve the stool.
5.Don’t let your child cough loudly. Children suffering from cough should take appropriate cough suppressants under the guidance of a doctor. Avoid the child crying loudly to prevent the abdominal pressure from rising.
Disease treatment
1.Since the possibility of spontaneous healing of pediatric hernia is low, early surgery is generally recommended for more reliable results. Surgery is generally safer after the age of half a year. The time of surgery is not limited by age in case of frequent intussusception.
2. The incision of hernia surgery is small, mostly minimally invasive, with short anesthesia time and no long-term adverse effects on the child.
The previous method of hernia belt compression therapy has been basically abandoned because of inaccurate efficacy and long-term compression of the spermatic cord, which can easily lead to damage to the spermatic cord and vas deferens. As for the hernia bursa injection drug treatment is very harmful and should be eliminated.