Inguinal and umbilical hernias in children Flashcards
What is the processus vaginalis
It is an outpouching of peritoneum attached to testicle/round ligament. It trails behind as it descends retroperitoneally into scrotum/labium majora
Explain the clinical picture of an inguinal hernia in terms of
- History
- Examination
History:
- Intermittent visible swelling in the inguinoscrotal/inguino-labial region
- Swelling after crying or straining and resolves during sleep
Exam:
- Palpable swelling
What is the treatment for an uncomplicated hernia
What is the treatment for an uncomplicated hernia
Not an emergency - elective operation
Surgery is always needed
Explain the operation to treat an uncomplicated hernia
Explain the operation to treat an uncomplicated hernia
- Inguinal incision in the region of the external meatus
- Mobilise hernial sac: Cord structures separated, sac clamped, transsected and ligated
- Reconstruction of inguinal canal as in adults: Rarely necessary in children
What are the consequences of an incarcerated inguinal hernia
The bowel becomes swollen, oedematous, engorged and trapped outside the abdominal cavity.
Common cause of bowel obstruction in babies and children
Explain the clinical presentation of an incarcerated hernia
- History
- Exam
History:
- Painful swelling in the inguinal region (uncomplicated hernias are not painful)
Exam:
- Tender firm mass in inguinal canal or scrotum
- Child may be fussy, unwilling to feed, crying
- Overlying skin oedematous, erythematous, discoloured
- Signs of bowel obstruction
How is an incarcerated hernia treated
An attempt at reduction should be made - converts emergency into elective
Sedate the child and then put in Trendelenburg position on mothers lap
- If position os not successful in 2 hours child should be referred for emergency surgery
What are the clinical signs of a strangulated inguinal hernia
Same as incarcerated +
- Tachycardia
- Leucocytosis
- Tender distended abdomen
- CRP levels elevated
How is a strangulated hernia treated
Resus - Drip, NG tube
Refer for emergency operation
Operation:
- Inguinal incosion as for elective
- Hernial sac opened: bowel evaluated
- If necrotic, resection and primary anastomosis
What is an inguinal hydrocele
Painless non-reducible swelling of the scrotum or inguino-scrotal region
Sonar helpful in differentiating between hydrocele and hernia
Can close spontaneously therefor only if hydrocele persists beyond 1-2years of age is operative resection indicated
What are the indications for an umbilical hernia operation
Hernia not closed by age of 5
In rare event oif incarceration of contents
Very large defect: >2cm
What is the treatment for femoral hernias
Often missed on physical exam - High risk of incarceration and strangulation
Surgery asap
