Hernias in children: Early identification, intervention prevents fatal complications

A groin hernia (also called an inguinal hernia) is a bulge in the part of the body where the thigh meets the trunk. In boys, the bulge can extend into the scrotum, the sac that holds the testicles. In girls, the bulge can extend into the outer lips of the genitals. Normally, organs in the belly are held in place by a wall of muscle. Groin hernias happen when a piece of intestine or other organ in the belly pushes out through that wall of muscle. Groin hernias are common in babies, because babies have a hole in the muscle wall that normally closes soon after birth. But if the hole does not close, or if the baby is born early, a hernia can happen. The main symptom of a groin hernia is a bulge in the groin that comes and goes. It often appears when the child has been crying or straining and then goes away when the child is resting. The child might also be irritable and not eat well. Groin hernias can be dangerous if a piece of intestine gets trapped in the hernia and can’t slide back into the belly. When this happens, the trapped portion of intestine does not get enough blood, so it can ‘die’ off and later perforate leading to causing a serious life threatening condition. If the intestine gets trapped, the bulge in the groin does not go away. In that case, the hernia might feel firm. Other symptoms of trapped intestines might include; excessive crying, vomiting, swollen belly, fever, failing to pass stool or even flatus, pain over the hernia area, and deterioration in the child’s general health status. In boys, tests are not usually needed. Clinicians can usually tell if a boy has a hernia by learning about his symptoms and doing an exam. In some cases, the doctor might also do an ultrasound to see if the bulge is a hernia or if there is another cause for the swelling. In girls, an ultrasound to see if the ovary is trapped in the hernia can be done. There are other forms of hernias which can happen in children, such as hernia of the umbilical region which also present with on and off bulging of the umbilicus. These hernias of the umbilicus can close on their own in very young babies if the hernia is small. Hernias of the umbilicus can develop similar complications too, if not corrected in time. Almost all children who have hernias need to have surgery. Doctors usually do surgery soon after the hernia is found to keep the intestines from getting trapped and prevent serious life threatening complications. Surgeons can repair groin hernias with surgery in 1 of 2 ways. The parent and doctor can decide which way is best for the child. The 2 types of surgery include; Open surgery – During an open surgery, the surgeon makes a small cut near the hernia. Then he or she gently pushes the bulging tissue back into place. Next, the surgeon closes the defect or passage which the contents of the abdomen were sliding into the groin. Laparoscopic surgery – During laparoscopic surgery, the surgeon usually makes a few cuts that are much smaller than the ones used in open surgery. Then he or she puts long thin tools into the area near the hernia. One of the tools has a camera on the end, which sends pictures to a TV screen. This tool is called a “laparoscope.” The surgeon can look at the picture on the screen to guide his or her movements. Then the surgeon uses the long tools to fix the defect where the abdominal content was sliding through. Laparoscopic surgeries are still limited country-wide, due to the less availability of the laparoscopic equipment, and also to a large extent due to limited number of personnel with skills to do laparoscopic surgeries. Surgery for hernia which hadn’t complicated can be a day care operation, with the patient returning home on the day of operation, and generally the patients have a hospital stay of less than 2 days. It is also important to know that hernias are managed by surgery, and no known medicine or other therapy will heal a hernia. Most patients who come to our emergency departments with life threatening complications have noticed the problem for years but ignored it since hernia rarely causes serious pain before it develops complications. Other patients come to hospital after trying different alternative sources of medicines, such as herbal and other traditional therapies. At Rwanda Military Hospital, we run outpatient clinics for such cases of hernia and other related general surgery cases every Monday and Wednesday of the week, where patients get to meet with specialist surgeons, and are scheduled for operations to prevent late potentially fatal complications of untreated hernia disease in these children.t. Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.

Health

Hernias in children: Early identification, intervention prevents fatal complications