Hernias and Hydroceles

There are three points to remember if your child has been diagnosed with an inguinal hernia or a hydrocele: 
  • An inguinal hernia (or hydrocele) is a different problem in a child than it is in an adult.
  • Inguinal hernias and hydroceles are not caused by exercise, crying, or any other physical activity.
  • Inguinal hernias and hydroceles are not hereditary; they are basically developmental glitches.
Inguinal hernias form as a direct consequence of normal events in fetal development. At about 12 to 14 weeks of gestation, the gonads (testicles or ovaries) are formed near the kidneys. They gradually descend through the abdomen as the baby develops. If the baby is a boy, the testicles pass through an opening low in the abdomen and into the scrotum; if the baby is a girl, the gonads stop near this opening, and develop into ovaries.
 In about 5 % of children in the United States, this opening does not close properly. This happens more commonly in boys than in girls, and even more often in premature babies. (As a result, about 8 boys will develop inguinal hernias for every girl who does so, and 10-30% of premature infants will be found to have hernias.) The failure of this opening to close potentially allows the contents of the abdomen to travel down into the scrotum (in a boy) or the labia (in a girl). The contents of the abdomen include the intestines, the ovaries, and the clear fluid in which the intestines normally float. If the scrotum or labia are found to contain intestines or an ovary, this is termed an inguinal hernia. If they contain only fluid, this is a hydrocele. The difference between the two is usually just the size of the opening; the basic anatomy is the same in both cases.
Signs and symptoms
There are two periods of time when this condition is typically discovered: during the first year of life, and at 3 to 4 years of age, after the child has been upright and walking. It is unusual to find childhood inguinal hernias after the age of 10.
The primary sign to look for in children is a bulge in the groin extending toward the scrotum or labia. Your child may also complain of pain in that area. If there is firmness or tenderness in the bulge, it may be a sign that an abdominal organ has become trapped (or incarcerated); in this case, the child needs immediate medical attention. When abdominal organs get trapped in hernias, the blood supply to that organ may become choked off. This can result in the loss of an ovary or intestine.
Surgery is the only treatment option for hernias; they do not resolve on their own. 
Epigastric hernias
Epigastric hernias are also congenital conditions (the children are born with them).  These hernias occur as tiny defects in the upper anterior abdominal wall (in the midline, between the umbilicus and the sternum, or breastbone).  Often they are noticed because a little piece of intra-abdominal fat becomes trapped, or incarcerated, in the hernia.  This incarcerated tissue is palpable as a tiny knot just beneath the skin.  While epigastric hernias may be asymptomatic, they are often quite tender, and the child may complain of pain at the site.
Surgery is usually recommended when they are diagnosed, as they will not resolve on their own and may cause more problems as time progresses.
Umbilical hernias
Umbilical hernias form at the site where the umbilical cord passed through the abdominal wall of the developing baby.  Usually, the abdominal wall seals off this "passageway" after birth.  However, in some children this does not occur, and the opening in the abdominal wall persists as an umbilical hernia.
Umbilical hernias are more common in girls than in boys, and are often seen in infants.  They are usually obvious, noticed as protrusions at the umbilicus, which may bulge as the child strains or cries.  More rarely, the defect will be tiny and less visible; the child may be brought to the attention of a doctor because a little piece of trapped intra-abdominal tissue in the hernia is causing pain at the site.
Many of these hernias (unlike inguinal or epigastric hernias!) will close off as the child grows, so immediate surgery is not often recommended for infants with this condition.  However, if the initial hernia is unusually large, is causing the child discomfort, or if the child has reached the age of four or five years without closure, generally, surgery will be recommended. 
Can my child's hernia come back after surgery?
It is rare for any childhood hernias to recur. You do not need to restrict your child's activities or prevent him/her from participating in sports.  Children who are at higher risk for recurrence of inguinal hernias include those who need emergency hernia surgery, premature infants, and children who have increased pressure in the abdomen (such as children with ventriculo-peritoneal shunts or peritoneal dialysis).
 
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