Pediatric inguinal hernia is the most common disease in pediatric surgeon. In Taiwan, according to the investigation of school age children, the incidence is 3%. The male to female ration is 4:1. The prevalence is higher in prematurity, and can be bilateral.
The abdominal cavity and scrotum are connected in fetus. Under general condition, the connection is closed spontaneously before birth. If it did not close, the intestine in the abdominal cavity could slide in to her or his scrotum or inguinal area, which is the hernia.
Most of the pediatric inguinal hernias are congenital. It is because of processus vaginalis, so called hernia sac, between abdomen and scrotum, could not be closed during development. It causes the intestine in the abdomen to slide in the scrotum, especially when crying, defecation and other situations when abdominal pressure elevated. Some people call this situation “intestine drop”. The hernia sac of female is from abdominal cavity to labium major.
Hernia could develop several days, months, or years after birth. It looks like a painless mass, appearing in the inguinal area or scrotum. It occurred when a child crying or coughing, noted as a bulging mass in the inguinal area. It slides back to abdominal cavity when lying on bed or resting. Some times the intestine could not slide back after entering scrotum. In the more serious condition, the intestine is resulted in strangulation and could be life threatening. The speechless newborn or infant often are noted with irritable crying or vomiting. Children who can speak will complain about abdominal pain.
The differential diagnosis could be made by using flashlight. If it is translucent, the mass is hydrocele. If the hernia is palpated like air inside, it is better to visit a doctor to make sure the cause.
Surgery is the best solution for pediatric hernia. Other medication or hernia band is confirmed ineffective. The operation is safe and short. If there is hernia, the treatment should be early to prevent incarceration, which could cause the operation more difficult and risky. The incarceration of hernia mostly occurs in small child, and small child often could not describe their discomfort, and that often delays diagnosis. Therefore, the inguinal hernia should be repair.
With the improvement of pediatric surgeon, even the smallest child could receive operation. If parents find their child with unexplainable crying, they should unwrap the diaper to check. Thus early diagnosis could result in early treatment.
中國醫藥大學附設醫院
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