CHILDHOOD HERNIAS

INGUINAL HERNIA

Inguinal hernia is an extension of the processus vaginalis, which fails to close during foetal development. Through this opening abdominal content can herniate to varying extents into the inguinal canal and scrotal sac. The communicating type is the most common form and extends down into the scrotum; the noncommunicating
one is less common.

Clinical Features

A bulge presents at either the internal or the external rings, or scrotum for males and inguinolabial region for females, that increases in magnitude with straining.
There may be associated pain and discomfort, or it may present as an acute abdomen.
Examination findings reveal a reducible mass but cases of irreducible incarceration may occur. Trans-illumination test may be positive.

Investigations

  • Usually clinical, but ultrasound may assist in differentials.

Management

  • Inguinal hernias do not heal and must be corrected by elective herniorraphy for uncomplicated cases, to avoid complications.
  • Emergency surgery if complications like obstruction have set in.

ABDOMINAL HERNIA

This is a protrusion through the abdominal wall due to one of the following:

  • Omphalocele, which is due to the failure of development of the anterior abdominal wall at the area of insertion of the umbilicus, with the abdominal contents herniated out with only a peritoneal covering. There may be other associated anomalies. This is the most severe of these types of hernia.
  • Gastrochesis, which is a herniation of small bowel contents with no covering at all and is often paraumbilical. Unlike omphaloceles, this condition does not have many associated anomalies.
  • Umbilical hernia, which is a mild condition as a result of a defect in the linea alba. The herniated bowel has a covering of subcutaneous tissue and skin.

Clinical Features

There is protrusion of bowel contents through the abdominal wall to varying extents with or without other organs. Covering of the hernia varies and strangulation is a possibility.

Investigations

  • Usually a clinical diagnosis is sufficient for these conditions.
  • Ultrasound has a role in the antenatal period.

Management

  • Conservative management for small umbilical hernias with expectant observation. Suggest referral to higher centre if not sure of conservative management.
  • Surgical management best at specialized facility.
  • Surgery for omphalocoel and gastrochesis on first day if possible.
  • Surgery for strangulations or other surgical complications arising from the hernia.
  • Counselling and attending to associated conditions.