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Inguinal Hernia in Children

By William J. Cochran, MD, Associate, Department of Pediatrics GI and Nutrition;Clinical Professor, Department of Pediatrics, Geisinger Clinic, Danville, PA;Temple University School of Medicine

(For adults, see Inguinal Hernia.)

A hernia is a protrusion of a piece of the intestine through an abnormal opening in the abdominal wall. An inguinal hernia occurs in the groin (the inguinal area).

  • A piece of intestine protrudes through a hole in the groin.

  • Typically, children develop a painless bulge in the groin or scrotum.

  • The diagnosis is based on an examination and imaging tests.

  • Usually, the hernia is repaired surgically.

A hernia in the groin is called an inguinal hernia (see Figure: What Is an Inguinal Hernia?). Inguinal hernias are more common among boys, particularly those who are premature. The right side is affected most commonly, and about 10% of inguinal hernias occur on both sides of the groin. An inguinal hernia extends into the groin and can extend into the scrotum. With an inguinal hernia, the opening in the abdominal wall can be present from birth or develop later in life.

What Is an Inguinal Hernia?

In an inguinal hernia, a loop of intestine pushes through an opening in the abdominal wall into the inguinal canal. The inguinal canal contains the spermatic cord, which consists of the vas deferens, blood vessels, nerves, and other structures. Before birth, the testes, which are formed in the abdomen, pass through the inguinal canal as they descend into the scrotum.

Symptoms

Inguinal hernias usually cause a painless bulge in the groin or scrotum.

Complications of inguinal hernia

Sometimes a portion of the intestine is trapped in the scrotum (called incarceration), and the bulge may become firm, tender, swollen, and red. If the intestine becomes trapped, the intestine’s blood supply can be cut off (called strangulation). Strangulated intestine may die (develop gangrene) within hours and this condition is an emergency.

Diagnosis

  • A doctor's examination

  • Sometimes imaging tests

Doctors base the diagnosis on an examination.

Sometimes the doctor does ultrasonography or computed tomography (CT) to help make the diagnosis.

Treatment

  • Surgical repair

Because inguinal hernias can become incarcerated, doctors usually advise surgery. Before surgery, doctors may try to push the intestine back into place by hand (called manual reduction). If the hernia is strangulated or incarcerated, surgery is done immediately.

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