Inguinal hernias include inguinal hernia and direct hernia, and all pediatric inguinal hernias seen clinically are inguinal hernia, so pediatric inguinal hernia is inguinal hernia that occurs in children. The vast majority are male, and the incidence in females is less than 5%. The right side is more frequent than the left side.
Etiology
1, the peritoneal sheath is not closed: during embryonic development the peritoneal sheath descends with the testes and should be occluded and atrophied into fibrous cords before birth. If the peritoneal sheath protrusion remains open or partially open after birth, it creates the possibility for the occurrence of hernia.
2. Increased intra-abdominal pressure: violent crying, prolonged coughing, difficulty in urination and defecation in children are precipitating factors for hernias.
Pathology
1, The inguinal canal in children is short, the deep ring leads almost vertically to the superficial ring, and the abdominal pressure is directed to the abdominal wall without buffer.
2. The hernia sac is located on the anterior medial side of the spermatic cord, and the vas deferens is located on the posterior medial side of the hernia sac.
3, The contents of the hernia sac are mainly the small intestine, sometimes the cecum or appendix; in girls, it may be the ovary or fallopian tube.
Diagnosis
(A) Clinical manifestations
1. Repeatable masses in the inguinal region: small masses are only located in the superficial ring of the inguinal canal, while large ones may protrude into the scrotum; they appear when standing, crying or moving, and disappear when quiet or lying down. The mass is soft and the upper boundary is unclear. The mass disappears when pressed and a “gurgling” sound can be heard at the same time.
2. The unilateral hernia is locally elevated at the superficial ring on the affected side, with thickening of the spermatic cord and a “silky abrasive sensation” when sliding on the spermatic cord.
3. The superficial ring mouth is loose, with a sense of impact, and the swelling does not appear when the superficial ring mass is pressed and cries, but reappears when it is removed.
(II) Differential diagnosis
1, syringomyelia: this disease mass is clearly bounded, cystic can move up and down with the testis, the mass can not be returned. Traffic sphincter mass can disappear, but the process is slow and there is no “gurgling” sound when it is returned.
2.Cryptorchidism: The scrotum on the affected side is poorly developed and empty, and the testicle cannot be retrieved; the mass is hard, and there is swelling and pain when pressed.
3. Inguinal lymphadenopathy: It is mainly distinguished from incarcerated hernia. The swelling is clearly bounded, red, swollen, hot and painful, and the mass is located in the outer part of the superficial ring.
Treatment
1. High ligation of the hernia sac should be performed once the diagnosis of inguinal hernia is clear, which can be performed laparoscopically or through a small incision in the inguinal canal.
2. For those who suffer from chronic cough, constipation and difficulty in urination, the primary disease should be treated first and then operated at an appropriate time. Surgery should be withheld for those suffering from serious diseases such as congenital heart disease, tuberculosis, malnutrition and premature babies.