Hernias in child

Question 1

When does a paediatric inguinal hernia usually develop?

Answer 1

When a patent processus vaginalis persists

Question 2

When do paediatric inguinal hernias usually present? When are they most risky?

Answer 2

Present in the first few months of life

• They are at risk of strangulation so the hernia should be repaired urgently
• Children over 1yr are at lower risk and surgery may be performed electively
• Day cases but neonated and preterm infants are kept overnight due to risk of post-op apnoea

Question 3

Which groups are inguinal hernias more common in ?

Answer 3

Preterm infants

Occur in up to 5% of boys

Question 4

Are paediatric inguinal hernias usually direct or indirect ?

Answer 4

Indirect is most common - they emerge from the deep inguinal ring through the inguinal canal

BUT in premature infants where the tissues are weak and friable, direct hernias are more likely than in older children

Question 5

What are the clinical features of an inguinal hernia?

Answer 5

• Lump in the groin
• May extend into the scrotum or labium
• Usually asymptomatic
• May be intermittent, visible during straining
• Sometimes lump or thickened cord structures can be palpated in the groin

Question 6

What are the complications of an inguinal hernia and what are the signs of these?

Answer 6

• Irreducible/incarcerated
• Pain
• Intestinal obstruction
• Damage to the testis/strangulation

In these cases the lump may be tender and the infant may be irritable and may vomit. Risk of incarceration is higher in infants than in older children.

Question 7

What is the management of a irreducible inguinal hernia?

Answer 7

Most hernias can be successfully reduced by ‘taxis’ (gentle compression in the line of the inguinal canal) with good analgesia.

Surgery can then be planned for a suitable time when any oedema has settled and the child is well

If reduction is impossible emergency surgery is required because of the risk of compromise of bowel or testis (in girls sometimes an ovary can become incarcerated within a hernia)

Question 8

What does surgical repair for inguinal hernias involve?

Answer 8

Surgery involves ligation and division of the processus vaginalis which has become the hernial sac (herniotomy, removal of the hernial sac - as opposed to herniorrhaphy in adults when the inguinal abdominal wall is also reinforced, usually with a mesh)

Beyond first 3 months of age this is safely done as a day case.