Bilateral inguinal hernia in children. Symptoms of inguinal hernia in children, treatment methods and surgery to remove it

An inguinal hernia in a child is a congenital pathology in which the abdominal organs extend beyond the abdominal cavity in the groin area. In boys, this is most often the intestines; in girls, it is the ovaries and fallopian tubes.

Causes of development of inguinal hernia in childhood

During the intrauterine development of a child, the testicles form in the abdominal cavity and only then descend through the inguinal canal into the scrotum. If there is a developmental anomaly, this canal may not close completely and the communication between the abdominal cavity and the scrotum will remain, which leads to the appearance of a hernia defect.

It is this fact that explains that these hernias appear in boys much more often than in girls (80%-90% occur in males). In girls, the cause is a defect in the development and formation of the ligamentous apparatus of the uterus.

In a full-term pregnancy, in the absence of the above developmental pathologies, the formation of a congenital inguinal hernia is unlikely

Doctor Komarovsky's opinion

It is worth drawing the attention of parents to the fact that severe crying, frequent constipation, colds, which are accompanied by bouts of severe coughing, lead to an earlier manifestation of the disease and aggravate its course. It is also worth noting that even the maximum possible restriction of a child from all the above-mentioned problems will not save him from CONGENITAL pathology, which will manifest itself sooner or later anyway, and no one will be to blame in this situation - neither the doctor, nor the parents, nor the grandfather with grandmother.

Since every parent is interested in the full life of their child, when diagnosing a hernia defect, the child should not be limited in sports or other leisure activities associated with physical activity, but should consult a doctor for surgical treatment, which should be performed within a maximum of 6 months.

Diagnostics

All children of preschool age must undergo a mandatory examination by a number of specialists, the list of which must include a surgeon. During the examination, the surgeon pays attention to the groin area, palpates this area, and in boys, he must examine the scrotum for the presence of 2 testicles. During palpation, in the presence of a hernia, an enlarged inguinal ring or a hernia itself is palpated, which can descend into the scrotum.

The hernial tumor increases with a strong cough, when the child cries or tries to go to the toilet “for a long time.” Visually, this may look like asymmetry of the groin area or swelling. Additional research methods are usually not required, but ultrasound of the groin area and scrotum can be used. MRI or CT are used extremely rarely, only in exceptional cases.

Tactics for managing inguinal hernias in children

A diagnosed hernia in a child is a 100% indication for routine surgical treatment. This pathology must be operated on within 6 months after its diagnosis, regardless of the child’s age. All hernia defects of the anterior abdominal wall are treated exclusively surgically, both in children and adults. The use of traditional methods, special exercises, and wearing hernia bandages will, at best, slow down the increase in the size of the hernia defect, and at worst, it will lead to strangulation and, as a result, emergency hospitalization and surgery.

What will happen if left untreated?

In the absence of timely treatment for this pathology, the hernia defect will gradually increase in size, and this can take years (or months, weeks), but the larger the hernia defect, the greater the likelihood of its strangulation. A strangulated inguinal hernia requires emergency hospitalization in the surgical department, if the hernia is strangulated and less than an hour has passed, there is a possibility of spontaneous reduction into the abdominal cavity, against the background of conservative therapy, then the operation is performed as planned, if reduction has not occurred or the doctor has doubts about the viability of the strangulated organ - only emergency surgery is indicated. It is worth noting that a strangulated inguinal hernia in girls will in any case lead to emergency surgery.

Symptoms of a strangulated hernia

Sharp pain in the groin on the side of the hernia defect.
The hernial tumor becomes dense, the skin over it is hyperemic and swollen.
If before the strangulation it was possible to reduce it into the abdominal cavity, then after it it is fixed in the hernial orifice.
Body temperature may rise, nausea, vomiting, and loose stools may appear.

Operation

Surgical treatment is performed under general anesthesia. For an experienced surgeon, this operation does not cause any technical difficulties and rarely exceeds 30-40 minutes. In boys, due to anatomical features, and in particular the presence of the spermatic cord intimately connected with the hernial sac, requires careful processing of all elements in this area. After this stage, the surgical technique does not differ between girls and boys; the hernial sac is excised, bandaged and plunged into the abdominal cavity. Plastic surgery of the inguinal canal and layer-by-layer suturing of the postoperative wound are performed. An important point is that polypropylene mesh is not used in children.

In the modern world, endoscopic repairs of inguinal hernias are increasingly being performed, including in childhood, and they have a number of advantages over open operations:

Less surgical trauma.
Lower rate of relapses and postoperative complications.
Possibility of performing the operation simultaneously on both sides.
More pronounced cosmetic effect.

But unfortunately, not every medical center has the necessary medical equipment.

Postoperative period

After surgical treatment, the patient remains in a hospital setting for 2-3 days, then is discharged for outpatient treatment. In the area of the postoperative wound, as well as the scrotum, tissue swelling may appear, which gradually decreases over the course of 5-7 days.

Dressings are performed once every two days; it is forbidden to wet the wound; if the bandage is wet or dirty, it should be replaced. The sutures are removed on 7-8 days; most often in children they use a cosmetic suture with absorbable thread, therefore, there is no need to remove the sutures. On the first day, it is allowed to give water and unleavened broths to drink.

In the absence of postoperative complications, on the second day the child can be given his usual diet. In the first month, it is recommended to limit the child as much as possible from stressful situations that can lead to excessive crying; for older children, limit physical activity for one month.

An inguinal hernia is a condition in which the hernial sac protrudes through the peritoneum. Inside the sac are internal organs, so their location changes and their functions deteriorate.

Now let's look at this in more detail.

What is an “inguinal hernia”?

A hernia can occur in different areas; when localized in the groin, the bladder and intestines usually come out. This happens through the inguinal gap, which is located between the muscles and ligaments. In girls, the hernial sac may also include the ligament of the uterus, and in boys, the spermatic cord.

Pathology can be congenital or acquired. It often occurs in premature babies. The protrusion itself may be painless, but during physical activity pain is felt and symptoms of disturbances in the functioning of internal organs arise.

Complete removal of a hernia is only possible through surgery, which is recommended for children whose pathology is visible from birth. Often the disease is combined with others - hydrocele, hip dysplasia, spinal abnormalities. The problem occurs several times more often in boys than in girls. This is explained by the peculiarities of intrauterine development, during which a canal is formed for the descent of the testicles into the groin area. Normally, the hole should close; if this does not happen, an inguinal hernia occurs. Clinical manifestations are not always immediately noticeable and may appear throughout the child's life.

The danger of the disease is that during physical activity the hernia may be strangulated, after which the internal organs cannot be reset into the peritoneum on their own. This leads to their dysfunction and the appearance of additional symptoms.

What does an inguinal hernia look like in children with photos

The degree of protrusion during a hernia can vary. It is often invisible when lying down and appears only when the abdominal muscles tense, for example, when a child cries or laughs. In boys, the hernia looks like hydrocele, in girls it has a more characteristic appearance. Examples of inguinal hernia are shown in the photo below:

The first signs of an inguinal hernia

Congenital inguinal hernias are noticeable immediately after birth. The first sign is protrusion of the skin in the form of swelling. It is painless, has a round shape and can completely disappear when the child is calm. If the hernia is large, it is not difficult to notice it; if it is small, it will be detected a little later, when the child begins to become active or cry.

Hernias can be right-sided or left-sided. In some cases, pathological protrusion forms on both sides. In addition, oblique and straight formations are distinguished, and several types are distinguished, depending on the degree of mobility, which is important for the doctor.

Symptoms of inguinal hernia

The swelling itself is painless, however, during the movement of organs through the hernial gap and back, the child may experience discomfort. Some complain of nagging pain, others complain of a feeling of heaviness in the lower abdomen.

In boys, a hernia leads to stretching and asymmetry of the testicles. At the location of the hernia, the scrotum will be enlarged. In girls, a similar thing is observed with the labia - one of them will be clearly larger. The hernial protrusion does not always descend into the genitals, but may remain in the lower region of the peritoneum. In this case, the swollen ball will be visible much better. Most often, the protrusion occurs on the right side.

Organs trapped in the hernial sac can be compressed when moving. This leads to strangulation of the hernia and closure of organs on the outside of the peritoneum. This condition is accompanied by poor circulation, increased intra-abdominal pressure, flatulence, and pain.

When pinching occurs, the child begins to cry sharply, becomes restless and complains of pain. The bulging area cannot go back down and becomes hard, tight and painful. Almost always, the intestine gets into the hernial sac, so its strangulation leads to intestinal obstruction. As a result, the child develops bloating, an inflammatory process develops, and later necrosis of the organ walls. In the absence of urgent help, there is a possibility of perforation of the intestinal wall and the development of peritonitis.

The disruption of blood supply that occurs during strangulation is especially dangerous for girls. Insufficient nutrition of the tissues of the ovary and genital organs leads to the death of eggs and necrotic processes.

Causes and prevention of inguinal hernia

In children, inguinal hernias are predominantly a congenital feature. At the stage of fetal formation, the child has a vaginal process, which at the 12th week of development resembles a protrusion. After performing its functions, the appendage overgrows, and disruptions in this process lead to the formation of cracks and the appearance of a hernia after birth. Premature babies are more likely to develop a hernia because the area does not have time to heal. This appendix is the hernial sac into which the internal organs enter: in girls - the intestines, ovary and fallopian tube, in boys - the intestines, spermatic cords.

It is believed that the disease can be inherited. Approximately 11% of children with an inguinal hernia had a relative with a similar pathology.

It is widely believed that a hernia can be acquired if the child carries heavy loads or cries too much. In fact, this happens very rarely. Basically, acquired pathologies can occur in boys of school or puberty age who engage in intense physical activity and at the same time have congenital weakness of the abdominal wall.

Thus, an inguinal hernia forms even before the birth of a child, but the pathology can increase in size during intense physical activity, which is why many consider the hernia to be acquired.

Of the provoking factors that lead to protrusion of the hernial sac, doctors identify the following:

cystic formations in the ovaries or spermatic cords;
hip dysplasia;
problems with the spine;
obesity;
constipation;
coughing.

Prevention of hernia includes timely detection of pathology and regular visits to specialists to monitor the dynamics of hernia development. Children are advised to exclude the provoking factors described above, and then the number of protrusions and pinching will be significantly less.

To prevent acquired hernia, it is recommended to take care of the general health of the child. This includes moderate physical activity, which will help strengthen the abdominal muscles, treatment of constipation, as well as proper nutrition to normalize the functioning of the gastrointestinal tract.

Diagnostics

Typically, a hernia is diagnosed immediately after the baby is born. The pathological protrusion is noticed by the parents themselves or discovered by the doctor during a routine examination of the baby. To make an accurate diagnosis, the results of instrumental studies, visual examination and palpation, as well as anamnesis will be required.

To make it easier to identify a hernia, the child is asked to bend over, strain or cough. When the abdominal muscles tense, the protrusion becomes more noticeable. After this, the child is asked to take a horizontal position. With an uncomplicated hernia, the internal organs are easily reduced into place. If the intestine gets into the hernial sac, then as it moves from the peritoneum and back, characteristic rumbling sounds can be heard.

After a preliminary diagnosis, the doctor sends the child for an ultrasound. An ultrasound examination examines the pelvis, inguinal canals and peritoneum.

The specialist must also differentiate an inguinal hernia from other diseases that have a similar appearance (inguinal hernia, femoral hernia, spermatic cord cyst).

Treatment of inguinal hernia

Only unstrangulated hernias can be set back. If the organs are nevertheless pinched, the pathology can only be corrected by surgical intervention. The quality of the result depends on the degree of neglect of the process and the stage at which treatment begins. Conservative therapy is theoretically possible, but is not currently used. It involves constantly wearing bandages or compression garments, which will prevent the organs from protruding outward.

For young children, surgery is performed at the age of 6-12 months. The procedure involves cutting off the hernial sac and restoring the normal anatomy of the inguinal canal. This may also require strengthening the affected area with your own tissue.

Surgical treatment can be performed openly and using laparoscopy. The second technique is preferable, as it has fewer side effects and requires minimal tissue incisions. When performing the procedure, the surgeon must be careful not to damage the spermatic cords, otherwise this will disrupt reproductive function.

The operation is performed by a doctor in a hospital setting and if the outcome is successful, the child can be transferred to home treatment.

If a girl's hernia is strangulated, emergency surgical intervention is indicated, as there is a high probability of ovarian atrophy and impaired reproductive function. If a hernia is strangulated in boys, measures can be taken to independently reduce the organs:

take a warm bath;
take antispasmodics to relax muscles and widen the hernial gap;
position the child horizontally or lift his pelvis upward to make it easier for the organs to “return.”

The prognosis for a child with an inguinal hernia is, in most cases, favorable. For uncomplicated conditions, surgical treatment is very effective. Before surgical reduction of strangulated hernias, it is necessary to first ensure the viability of the organs. If their blood supply has been severely impaired and necrotic areas have appeared, the doctor performs a resection.

Complications

A complication is considered to be a pinched inguinal hernia and the consequences that this condition leads to. It is impossible to predict pinching in advance. It is a jamming of internal organs between the muscles of the peritoneum, so that they are sticking out. In this case, the muscles often spasm, which makes it impossible to return the contents of the peritoneum back. This often occurs when the intestinal loop is overcrowded, which gets into the hernial sac and falls out after physical exertion.

If a child is pinched, immediate surgical assistance is required. The process is acute and occurs suddenly. The child suddenly experiences severe pain in the groin, feels nausea and attacks. The area of the hernia that sticks out becomes hard and irreducible. The patient's health deteriorates sharply and quickly.

In addition to painful sensations, pinching is dangerous because it interferes with normal blood flow in organs that are outside the peritoneum. Within a few minutes, tissue appears in them, and after a few hours necrotic processes develop. In 10% of cases when pinched, doctors diagnose gangrene. Such conditions are life-threatening for the child and can be fatal if timely help is not provided.

If parents are offered to undergo surgery to remove a hernia while the child is still small, they should agree. As you get older, the likelihood of getting pinched will increase. In addition, the baby will have to limit himself in many ways in everyday life until he gets rid of the problem. An inguinal hernia does not go away on its own and in any case will have to be removed at some age.

Rehabilitation

After surgery, the child is recommended to rest for the first time so that the functioning of the internal organs is restored and returns to normal. After about a month, doctors say to do special physical therapy exercises to strengthen the muscles of the abdominal wall and accelerate tissue regeneration.

It is recommended to add breathing exercises to special physical exercises, which improves homeostasis and the child’s overall immunity. Already a month after surgery, the doctor may allow you to visit the pool or engage in active walking.

It is very useful to attend massage sessions. Their goal is not only to strengthen the abdominal muscles, but also to normalize intestinal motility. Massage movements are performed in the navel, groin, oblique abdominal muscles, and also on the back along the spine.

Sometimes doctors recommend taking mild laxatives to avoid straining and straining the surgical area during bowel movements. Duphalac is an absolutely safe drug for children of any age. Postoperative bandages can be used as an aid. They need to be purchased in specialized places, taking into account the individual sizes of the child.

An inguinal hernia in children is often congenital; a newborn develops a protrusion of the navel from the first days of life, and even then it is necessary to take therapeutic and preventive measures to quickly get rid of the defect and prevent progression. The disease is diagnosed less often in girls, and more often in premature infants, which is due to genetic predisposition.
Acquired hernias practically never occur in children under one year of age; they begin to form at an age when the body already experiences high physical stress. In the formation of protrusion in girls or boys under one year of age, the processus vaginalis takes part, which acts as a conductor of the gonads into the scrotum from the peritoneum. In a healthy child, it gradually becomes overgrown, but disruption of the normal process, which occurs in premature babies, creates favorable conditions for the appearance of a protrusion in the groin area, both in girls and boys.

In children under one year of age, this process simultaneously acts as a hernial sac, which contains the peritoneal organs: omentum, intestinal loop, fallopian tube or ovary in girls. In this case, the hernial orifice forms the ring of the groin canal.

Types of disease

Congenital pathology in the groin in children can be oblique or straight, as well as right-sided or left-sided. An oblique hernia in a child under one year of age passes through the internal ring of the inguinal canal; straight hernias are relatively rare and pass through a muscular opening in the peritoneal wall in the projection of the inguinal ring. In boys under one year of age, a right-sided oblique hernia is more often diagnosed (60%), direct protrusions form with age. A severe clinical case of a hernia in a one-month-old baby is a bilateral hernia, which more often occurs in girls.

Only boys under one year old experience inguinal-scrotal hernias, when the testicle is compressed, which in the future can lead to male infertility. Inguinoscrotal hernia is divided into testicular and cordic (diagnosed in 90% of cases).

Causes

The direct causes of the defect in a premature baby lie in the underdevelopment of muscle tissue and incomplete closure of the abdominal opening. This disease does not occur among healthy boys and girls, therefore every child with a hernia up to one year old is examined by a pediatric surgeon to find the true cause. About 15% of newborns with hernias under one year of age had a genetic predisposition, so parents with an inguinal hernia should be prepared for the birth of a child with such a defect.

An inguinal hernia in children is not dangerous as long as it is controlled by parents and doctors, therefore, from birth it is necessary to take therapeutic measures to prevent complications, given that congenital protrusion does not always go away on its own. The anatomical features of a child’s body may not allow self-healing even if all the rules are followed.

Pathology of muscle tissue in premature babies leads to complications if the doctor’s recommendations are not followed. The cause of the complication is the child’s tension during screaming, crying, or incorrect body position during sleep. In case of complications, it is necessary to undergo surgery, but in 95% of cases it is possible to get rid of the defect without surgery.

Clinic and diagnostics

A hernia in the groin area looks the same in girls and boys: a bulge appears on one or both sides in the form of a lump, which reaches up to 5 cm (it can increase during tension). When you put the child on his back, the protrusion disappears, but in a standing position or while crying, it sticks out as much as possible. When pressing on inguinal hernias in children, the protrusion also disappears, which does not happen in the case of pinched organs in the hernial sac.

How does an inguinal hernia manifest in a child?

The protrusion is painless, rarely accompanied by aching pain in the lower abdomen, which can be the reason for the child’s constant crying and even greater protrusion of the hernia.
The hernia has an oval shape; with an inguinal-scrotal hernia, the defect descends and compresses the scrotum, which leads to asymmetry of one of the halves. In girls, a prolapsed hernia can lead to enlargement of the labia.
Symptoms of complicated protrusion change: severe pain, enlargement of the defect, and impossibility of reduction. Pinching of organs in the hernial sac leads to poor circulation and ischemic changes occur. With such manifestations, it is necessary to urgently undergo surgery and then the inguinal hernia in children will be completely eliminated.

Accompanying symptoms of complicated pathology are: intestinal obstruction, preceded by constant constipation, vomiting, and bloating.

Important! Premature girls have a high risk of egg death due to ovarian necrosis during pinching, therefore the complication may serve as a factor in reproductive dysfunction in the future.

What to do if you have a hernia?

Conservative treatment of inguinal protrusion for up to a year includes wearing a support bandage, bandages; surgery should be done immediately in case of infringement. As planned, the operation is carried out up to six months and consists of cutting off the hernial sac to restore the normal anatomical structure of the inguinal canal and peritoneal organs. During surgery, the doctor may install a mesh or strengthen the inguinal canal with nearby tissue.

Operating on children requires special care; the surgeon must exclude accidental injury to the spermatic cord in boys, otherwise reproductive function will be impaired. After opening access to the pathological area, the viability of the organs located in the hernial sac is assessed. In case of tissue necrosis, the surgeon performs resection of part of the intestine or omentum.

After the operation, it is recommended to do gymnastics, massage treatments, and swim with the child in the pool to prevent relapse. A recurrence of the disease can occur in an adult, but after surgery with mesh installation this happens extremely rarely.

How treat inguinal hernia in children and in what cases can you do without surgery? Today we will talk about what modern treatment of inguinal hernia in a child completely eliminates the problem and does not have a negative impact on the functioning of adjacent organs.
An inguinal hernia is a tumor that occurs in the groin area. If the formation has spread to the scrotum, the hernia becomes inguinal-scrotal. This tumor (hernial sac) contains the ovary, omental strand, intestinal loop, and other organs. If you press on the hernial sac, you can hear some kind of rumbling, then the formation disappears, and reduction occurs.
Often in children an indirect inguinal hernia is diagnosed. The disease occurs in the same way as a cyst of the spermatic cord or communicating ovarian hydrocele. The vaginal process of the peritoneum (wide, not closed) acts as a hernial sac, which connects the abdominal cavity and the scrotum. From the abdominal cavity, through a process, everything is discharged into the inguinal canal. Inguinal hernia in children- a fairly common disease nowadays and in most cases it is indicated surgery to remove hernial sac to avoid destruction of the structure of the inguinal canal under the pressure of a hernia that grows with age.

For a child, an inguinal hernia is a serious illness that must be treated. The use of traditional medicine recipes in most cases aggravates the problem. In babies, hernias are predominantly congenital, caused by weak muscle tissue on the front of the peritoneum. Doctors notice them immediately after the baby is born. Sometimes muscle weakness is caused by the baby’s prematurity; not all of its organs are sufficiently developed.

If an inguinal hernia is detected in a child You should immediately consult your pediatrician. After the examination, he will explain how to deal with the disease in a particular case.
An inguinal hernia is repaired using operations, which is performed on a small patient no earlier than six months. When exactly is decided by the pediatric surgeon.

But if a child’s inguinal hernia is strangulated, then it should be repaired immediately. If this is difficult to perform, urgent surgical intervention is indicated (within 6 hours from the moment of injury).

Herniotomy is performed on the baby on the day he goes to the hospital. During the operation, the surgeon removes (sutured) the hernial sac, realigns the displaced organs, returning the inguinal canal to its normal structure. The spermatic cord and vas deferens are partially connected to the hernial sac; it is necessary to operate on a male patient very carefully.

An umbilical hernia is almost never strangulated; it is often possible to do without surgical intervention. Girls are operated on if the umbilical ring is dilated. Bloodless operations, without incisions, are now becoming popular. Children tolerate them well, do not feel severe pain and do not encounter complications. Mom during surgery next to her child. The body recovers quickly, and after a couple of hours you can return home.

It is important to keep in mind that inguinal hernia in children is a very dangerous disease and if you detect obvious symptoms of an inguinal hernia in your child, you should seek qualified help from a pediatric surgeon as soon as possible. Only a specialist should decide what treatment the baby needs. In some cases, it is enough to perform a reduction (at an early stage of hernia formation). But in most cases, surgery is indicated to restore the anatomy of the abdominal canal as quickly as possible and remove the hernial sac.

Now you know how much inguinal hernia in children is dangerous and what treatment necessary when this disease is detected in a child. If you have an inguinal hernia in your child, immediately contact a qualified doctor and under no circumstances self-medicate - any non-traditional folk remedies can only aggravate the situation and cause serious harm to the child’s health.

Next article.

An inguinal hernia in a child is a defect of the abdominal wall, located in the groin area and characterized by protrusion of internal organs outward through the formation of an oval protrusion. Due to an increase in intra-abdominal pressure and expansion of the inguinal canal, all organs located in the peritoneum and adipose tissue can protrude outward, thereby causing discomfort and pain in the groin.

An inguinal hernia can be either congenital or acquired. The hereditary predisposition to the formation of this formation is due to the fact that the low strength of the connective tissue that forms the muscle-tendon canal is not able to restrain intra-abdominal pressure. An acquired hernia, on the contrary, develops due to heavy lifting, systematic constipation, impaired urination and chronic cough.

The main factors contributing to the development of an inguinal hernia include:

Genetic, age and sex predisposition. The fact is that if close relatives have a history of pathology, then the likelihood of its occurrence in a male infant increases several times. The same risk is observed in older people, because over time the tone of the abdominal muscles decreases significantly.
Obesity or excessive asthenia;
More than 3 births;
When systematically performing heavy physical labor.

Even after surgery, the risk of relapse of the pathology tends to 100%, unless the patient changes his type of work (as for adults). Diseases accompanied by a constant cough can also provoke the development of an inguinal hernia. For example, chronic obstructive pulmonary disease, bronchitis, etc.

Classification

According to the clinical classification, protrusions are divided into:

Direct. Refers to purchased. Their main characteristic is the formation of a protrusion of the peritoneum directly through the inguinal canal, while bending around the spermatic cord.
Oblique. They can be either congenital or acquired. Their main characteristic is that the contents of the hernial sac penetrate the inguinal canal through the internal ring and pass close to the spermatic cord.

Inguinal hernia is much less common in pediatric patients than in adults.. Despite this, every parent should remember that if any strange changes appear on the child’s body, it is necessary to seek medical help.

Symptoms and signs

Patient complaints directly depend on which organs are pinched during the formation of a hernia, on the size of the sac and the development of any complications. As a rule, the main sign of pathology is the presence of a protrusion and its pain.

The collected complaints determine the features of an individual approach to the further algorithm for performing an inguinal hernia operation in a child or adult. During an objective examination of the patient, attention is paid to:

the size of the spherical formation in the groin area;
determining the intensity of pain during palpation of the abdominal cavity and protrusion;
the presence of frequent two-stage urination, which is a sign of involvement of the bladder inside the hernial formation.

In some situations, the hernia can be reduced on its own, especially when patients lie on their back. If it is impossible to reduce the hernial contents into the peritoneal cavity, it is customary to speak of its irreducible type.

Diagnostics

In most cases, diagnosing a hernia in the groin does not create any difficulties: a visible protrusion can be easily detected during a physical examination.

With the development of a large hernial formation in males, as a rule, one half of the scrotum enlarges, its skin stretches, and the penis deviates in the opposite direction.

If you do not seek help in a timely manner, the hernial sac can grow to gigantic proportions. and completely hide the penis in folds of skin.

During palpation, the specialist evaluates the shape and volume of the hernial sac with the patient lying and standing. There are two options for its location:

oblique hernia - the protrusion has an oblong shape and is located in the area of the inguinal canal (along its course), in some situations it can move into the scrotum;
direct hernia is a formation that has a round or oval shape and is located in the middle part of the inguinal ligament.

If the protrusion is located above the projection site of the external opening of the inguinal canal, then it is necessary to carry out differential diagnosis with peri-inguinal and interstitial hernia. If there are two protrusions, the development of a combined hernia can be suspected.

Where the danger lurks

pinching of the hernial sac;
development of intestinal obstruction;
the occurrence of an inflammatory process between the layers of the peritoneum (peritonitis);
bleeding;
spread of inflammation to the scrotum area;
development of an unreducible hernia.

Conservative treatment

At the moment, the bandage is a scourge among patients and parents of children who have suffered from this pathology. The fact is that this device helps to reduce the load on the groin area and reduce the pressure in the hernial sac. The use of a bandage can have a therapeutic effect only with a reducible hernia in the initial stages of the disease.

The use of this type of canning therapy in children can lead to the development of the following consequences:

expansion of the area of the hernial protrusion due to tissue scarring;
compression of the contents of the hernial sac;
development of atrophy in the area of the fascial edges;
compression of the spermatic cord.

Treatment of inguinal hernia in children without surgery is possible, but indications for its implementation should be justified exclusively by a specialist based on medical history and diagnostics. Movement is life. Every parent should remember this statement and, in order to prevent the development of an inguinal hernia in children with a predisposition to this disease, instill a love of sports from childhood. Thanks to systematic exercises, the abdominal muscles will become stronger and the risk of hernia will decrease.

Methods of surgical treatment

Currently, the three most common techniques are used for the surgical treatment of inguinal hernia in children. These include:

Tension method. When using this method, the removal of the hernial sac occurs through the use of patient tissue. The edges of the formed defect are subsequently tightened with a suture. Today, this technique is used less frequently due to the high risk of relapse and difficult recovery period.
Tension-free hernioplasty. Elimination of a hernia defect is carried out through the use of a special synthetic mesh, which plays the role of a kind of frame and barrier that prevents the re-formation of a hernia.
Laparoscopy. This is the most gentle surgical intervention. Through several small incisions, trocars, an endoscope and the necessary instruments are inserted into the abdominal cavity. Meshes are also installed using laparoscopy.

At the moment it is becoming more and more common same day surgery. Laparoscopic surgery for hernia formations in children is a treatment method with minimal tissue trauma and the shortest recovery period.

Is surgery necessary if the patient is diagnosed with an inguinal hernia? This is discussed in an interview with a practicing surgeon.

Ultrasonography

In pediatric patients, as a rule, ultrasound examination of the inguinal canals and scrotum is used for diagnosis. Thanks to ultrasound, the following features can be determined:

localization and size of hernial formation;
identification of internal organs involved in the pathological process;
condition of the walls and openings of the canal.

Also, thanks to ultrasound, it is possible to determine whether the ovaries and fallopian tubes are affected, and what part of the intestine is located in the hernial sac.