Title: Groin (inguinal) hernias in children

What is a groin (inguinal) hernia? — A groin hernia (also called an “inguinal hernia”) is a bulge in the part of the body where the thigh meets the trunk (figure 1). 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 vagina.

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.

Groin hernias can be dangerous if a piece of intestine gets trapped in the hernia and can’t slide back into the belly. Doctors call this an “incarcerated” hernia. When this happens, the intestine does not get enough blood, so it can become swollen and damaged.

What are the symptoms of a groin hernia in children? — 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 fussy and not eat well.

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:

●Swollen belly
●The bulging area turns red or blue
Should I see a doctor or nurse? — Yes. If your child has bulge in the groin that comes and goes, see your child’s doctor or nurse. Groin hernias in children almost always need to be treated.

If your child has a bulge in the groin that does not go away, see your doctor or nurse right away. This is an emergency!

Will my child need tests? — That depends on whether you have a boy or a girl.

In boys, tests are not usually needed. Doctors 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, the doctor will usually do an ultrasound to see if the ovary is trapped in the hernia.

How are hernias treated? — 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. A special doctor called a “surgeon” will do the surgery on your child.

Surgeons can repair groin hernias with surgery in 1 of 2 ways. Your child’s doctor will decide which way is best for your child. The 2 types of surgery are:

●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 sews the muscle layer together so that nothing can bulge through.
●Laparoscopic surgery – During laparoscopic surgery, the surgeon 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 muscle layer with stitches.
If the intestines get trapped, the doctor will first try to “reduce” the hernia, which means gently pushing it back into the belly. If this works, a surgeon will do surgery to fix the hernia within a few days. If the doctor is not able to reduce the hernia, emergency surgery might be needed.

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