Disease Description (Causes and Symptoms)
- Definition summary: An inguinal hernia is a condition in which an abdominal organ (mainly the small intestine or part of the intestine) protrudes through the inguinal canal into the groin (inguinal region) or scrotum. In children, most are indirect inguinal hernias, caused by failure of the processus vaginalis (the sac-like structure leading to the scrotum), which is part of fetal development, to close.
- Causes/pathophysiology: If the passageway (processus vaginalis) formed as the testicles descend from the abdominal cavity into the scrotum during fetal development remains open, the intestine is pushed into it by intra-abdominal pressure. It occurs more frequently in premature infants.
- Main symptoms: A lump (swelling) in the groin or scrotum; a soft lump that can be pushed back in (reduced) when touched; enlargement when the child is fussy or crying. If the hernia becomes trapped (incarceration/strangulation), pain, persistent crying, vomiting, abdominal distension, redness and swelling of the scrotal skin, and systemic symptoms (fever, lethargy) may occur.
- Diagnosis: Mainly diagnosed through medical history and physical examination. The doctor checks whether a lump appears during situations that increase intra-abdominal pressure (crying, sneezing, etc.). When the diagnosis is uncertain or incarceration is suspected, ultrasound examination (abdominal/scrotal ultrasound) is used to assess the contents and blood flow.
Treatment Methods
- Principle: Surgical repair is the standard treatment for pediatric inguinal hernias. Early surgery is recommended because leaving the condition untreated carries a risk of incarceration (trapping of the intestine) and intestinal necrosis.
- Surgical method: In children, isolation and excision of the hernia sac and ligation of the base of the hernia sac (herniorrhaphy or herniotomy, high ligation) under general anesthesia, rather than local or regional anesthesia, is generally performed. The testicular blood vessels, spermatic cord, and vas deferens are usually preserved. If a bilateral hernia is suspected, simultaneous exploration and repair may be considered.
- Emergency treatment (in cases of incarceration): If incarceration or intestinal obstruction is suspected due to severe pain, vomiting, high fever, or a red, firm protruding mass that cannot be reduced, go to the emergency room immediately. A doctor may attempt gentle manual reduction under sedation and analgesia; if this fails or intestinal ischemia is suspected, immediate surgery is required. Patients and caregivers should be instructed not to force reduction at home.
- Medication/other: Pain medication before and after incarceration, and fluid and electrolyte correction (in cases of vomiting or dehydration). Antibiotics are used when intestinal injury or peritonitis is suspected.
- Postoperative care: Most patients are discharged after same-day or overnight hospitalization. Return immediately for wound care concerns, fever, excessive pain, or a wound abscess. Activity restrictions are generally minor, and patients can usually quickly return to normal activities (follow the treating physician's postoperative instructions).
- Prognosis: The prognosis is good with appropriate surgery. Complications (recurrence, wound infection, testicular damage/atrophy, vas deferens injury, etc.) are rare but possible.
Checklist Before the Outpatient Visit (Including Example Questions)
- Items and information to prepare:
- A list of currently taken medications (prescription drugs, OTC medications, and supplements)
- History of previous surgery and anesthesia, and allergies (including medications and anesthetics)
- When the symptoms began and how they have changed (when first noticed, persistent/intermittent nature, changes in size)
- Whether the hernia can be reduced (whether it can be pushed back in), and whether reduction was attempted at home and the result
- Whether there has recently been vomiting, fever, or changes in bowel movements
- Birth history (whether premature), and family history (history of hernia)
- Copies of previous test results, if available (such as abdominal/scrotal ultrasound results)
- Preparing a photo for the doctor showing the hernia protruding can help with diagnosis.
General Example Questions to Ask the Doctor
- "How long is it safe to wait in this condition? Is surgery urgent?"
- "What surgical method and type of anesthesia will be used? What are the risks?"
- "How likely are postoperative complications (recurrence, infection, effects on the testicle)?"
- "What should we be careful about before and after surgery (fasting, stopping medications, etc.)?"
Example Questions Tailored to the Condition
- "This child was premature (or a bilateral hernia is suspected). Do both sides need to be examined and repaired at the same time?"
- "If incarceration is suspected (ongoing vomiting or persistent pain), is there anything we can do at home? Should we go to the emergency room immediately?"