inguinal hernia in newborns

The protrusion of internal organs in newborns is a pathology that occurs in 10% of children. Let's consider the features of the disease, causes, methods of diagnosis and treatment of inguinal hernia in newborns.

Premature babies, patients with various congenital anomalies, and connective tissue pathologies are predisposed to the development of inguinal hernias. The disease occurs more often in boys than in girls. It can be combined with other abdominal wall lesions, orthopedic diseases, developmental defects of the nervous system, and spinal cord defects.

This pathology in infants is congenital. Its main causes are weakness of the connective tissue of the peritoneum and underdevelopment of the abdominal walls. Hernia in girls is associated with improper fixation of the ovaries and the round ligament of the uterus, and in boys - with a delay in the descent of the testicles into the scrotum.

Inguinal hernias are classified according to location:

• Inguinal - located near the external opening of the inguinal canal.
• Inguinoscrotal - located near the testicle and affects the scrotum.
• Cordial - located near the spermatic cord, does not reach the level of the testicles, but descends into the scrotum.

Characteristics of the location of the hernial sac:

• Direct - the organs exit through the weakened peritoneum, but do not affect the internal opening of the inguinal canal.
• Oblique - passes near the spermatic cord, through the inguinal canal.
• Combined – there may be more than two pathologies on one side that are not related to each other.

Oblique protrusion is more common in newborns, as the other two are acquired. The pathology has a number of features, which complicates its diagnosis and treatment. Symptoms do not appear immediately, this is due to the fact that the child spends the first months of life in a horizontal position. The defect is not a harmless phenomenon, as it can cause serious complications and life-threatening consequences. Therefore, timely diagnosis and treatment are the key to the normal development of the baby.

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Causes of inguinal hernia in newborns

20% of cases of protrusion of organs in the groin in children are associated with a hereditary predisposition. If there is a family history, then the disease is associated with a congenital defect of connective tissue.

The main causes of inguinal hernia in newborns:

• Overweight baby
• Difficulty urinating
• Physical overexertion (prolonged crying and screaming, which is not acceptable in the first months of life)
• Traumas and pathologies of the abdominal wall
• Postoperative scars

The etiology of the defect is associated with the vaginal process, a formation that forms from the 10th to 12th week of fetal development in its abdominal cavity. Its task is to lower the embryo's genitals into place. The pathology has a hernial orifice, which is formed with the help of the external ring of the inguinal canal. The hernial sac is a vaginal process, on the back wall of which is located the spermatic cord in boys, the omentum, the round ligament of the uterus and the intestines in girls.

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Pathogenesis

The mechanism of inguinal hernia development in infant boys and girls has its own peculiarities. Thus, in girls, the fallopian tube and ovaries get into the hernial sac, and in boys, intestinal loops. Inguinal protrusion is more common in boys, this is due to the fact that as they descend, the testicles can pull part of the peritoneum. Because of this, a displacement occurs, as a result of which a pocket is formed. In girls, the disorder occurs due to the congenital weakness of the fixing apparatus that holds the round ligament of the uterus.

Congenital hernia:

• Boys - the embryo's testicle is formed not in the scrotum, but in the abdomen, but by the fifth month it descends to the inguinal canal, and by the ninth month to the scrotum. Passing through the inguinal canal, the testicle pulls the vaginal process, that is, a small pocket. It is this process that is the protrusion that must heal and close. If this does not happen, a hernia appears, since the connection between the peritoneum and the inguinal canal of the scrotum is preserved. Some organs and intestinal loops can descend into the hernial orifice.
• Girls - the embryo's uterus is located above its normal anatomical position. As the fetus grows, the uterus descends and can pull the peritoneum along with it, forming a fold. It protrudes and can penetrate the inguinal duct.

The acquired form of the disease is rare and most often occurs due to excessive physical exertion. Its development is facilitated by the weakness of the muscle tissues of the anterior abdominal wall.

Symptoms of inguinal hernia in newborns

Regardless of the cause of the hernial protrusion, the signs of the disorder are typical - a bulge in the groin area, which increases with physical exertion, crying, screaming, straining and other conditions that cause an increase in intra-abdominal pressure. The symptoms of an inguinal hernia in newborns are completely consistent with those described above. The hernia is quite elastic with a soft consistency, and when pressed, it is easily reduced into the abdominal cavity. If it is not complicated, then the reduction does not cause pain or discomfort to the child.

The most common symptoms of hernial pathology in infants:

• Pain and discomfort during palpation, the child begins to be capricious and cry.
• When changing body position, the protrusion changes size, but is easily corrected.
• Nausea, vomiting and flatulence.

Depending on the sex of the child, the defect may shift, boys may experience swelling of the testicle, and girls may experience enlargement of the labia. The main reason why parents do not immediately seek medical help is the lack of complaints about discomfort from the child. Ignoring the external signs of the disease leads to serious complications and infringement.

First signs

Symptoms of abdominal muscle defects do not appear immediately, which significantly complicates the diagnostic process. The first signs are associated with gastrointestinal disorders, vomiting, nausea, and flatulence. A small swelling is found in the groin area, which increases with the child's restless behavior, but disappears at rest.

Signs of the disease:

• Bulge in the groin area

It has a round shape, painless on palpation. The round shape indicates that the hernia has not yet descended to the scrotum, the oval shape is an inguinal-scrotal pathology. The protrusion of the hernial sac increases with abdominal straining.

• Scrotal enlargement

This symptom indicates an inguinoscrotal defect, which occurs only in boys.

• Enlargement of one of the labia

This symptom occurs in girls and indicates that the hernia has descended towards the labia majora.

• Reduction of the defect

The pathology is clearly visible in a standing position, but in a horizontal position it can be easily and painlessly corrected.

As a rule, the disease does not cause painful sensations, but if pinching occurs, then pain and other pathological symptoms increase.

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Inguinoscrotal hernia in newborns

If the abdominal organs and tissues extend beyond the abdominal wall, this indicates a hernial defect in the groin; if the contents descend into the scrotum, this is a complete or inguinal-scrotal hernia. This pathology is common in newborns, which is associated with the anatomical features of the child's body. No reliable cause for this problem has been identified. But a decrease in tone in the inguinal rings is accompanied by organ prolapse and occurs due to the action of many factors.

Inguinal-scrotal hernia in children occurs due to a violation of embryogenesis. This occurs during the period of descent of the testicles into the scrotum, one testicle does not descend completely and pulls the tissues of the peritoneum. The disease is almost asymptomatic, its main symptom is a protrusion on one side in the groin area. If there is strangulation, that is, the initial pathology is complicated, then the skin over the tumor is hyperemic, sharp pains appear.

There are no limits to the enlargement of the scrotum, that is, the disease does not go away on its own, but rather progresses and the tumor increases in size. The signs of the disease depend on the organs that have entered the hernial sac. Most often, this is the small intestine or the greater omentum. If the greater omentum enters the sac, pain appears in the groin area. If the intestine is strangulated, in addition to pain, symptoms of intestinal insufficiency appear, that is, constipation, bloating, vomiting.

Diagnosis is based on external examination and instrumental research methods. Treatment is carried out both by conservative methods and surgically. If there is no strangulation, the child undergoes surgery followed by wearing a bandage.

Consequences

An inguinal hernia, like any other disease in newborns, threatens serious problems. The consequences depend on timely medical attention. If the pathology is detected late, it can lead to strangulation. The strangulated protrusion compresses important blood vessels and part of the organ. This complication is dangerous to ignore. The baby suffers from painful sensations, fever, constipation, bloating, vomiting appear.

The infringement does not fit into the abdominal cavity and causes pain when lightly pressed. Without treatment, the discomfort subsides for a while, but then the pain returns with renewed vigor. Such symptoms indicate that part of the organ has died, local blood circulation is impaired, and the nerve endings are not functioning. If necrotic tissue is not removed at this stage, this may further lead to inflammation, perforation of the intestinal walls, and the penetration of opportunistic microflora into the abdominal cavity. Against this background, the infant develops peritonitis, which is life-threatening.

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Complications

The most dangerous problem that can be encountered with untimely treatment of a hernia in a child is strangulation and serious disruptions in the functioning of internal organs, which subsequently affects the growth and development of the baby. The complication is characterized by compression of the organ and disruption of its blood supply. The hernia cannot be reduced, the tumor becomes hard and causes sharp pain when palpated. This complication is treated surgically with a subsequent course of recovery.

This defect can lead to serious consequences in girls. If there is a strangulation, it entails the death of the ovary in infancy. As a result, there is a hormonal imbalance, which affects the general health of the child and physical development in general.

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Diagnosis of inguinal hernia in newborns

Various methods are used to detect a defect in the abdominal muscles. Diagnosis of inguinal hernia in newborns is based on the complaints of the child and his parents, as well as on the symptoms characteristic of the disease. The doctor conducts a visual examination of the patient, auscultation and palpation. During the examination, the surgeon can detect a unilateral or bilateral protrusion.

When palpated, the baby does not feel pain, and the hernia itself has an elastic, soft consistency. The tumor can be round or oval, the latter indicates an inguinal-scrotal lesion. In girls, the hernia descends to the labia, deforming them. To diagnose the disease, blood and urine tests are taken from the child. In order to determine the composition of the hernial sac, an ultrasound examination is performed.

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Tests

Various methods are used to detect protrusions of organs in the groin. Tests are included in the mandatory diagnostic composition. They are necessary to obtain information about the condition of the child's body and when scheduling surgical treatment.

Basic tests for inguinal hernia in infants:

• General blood and urine analysis
• ECG and fluorography
• Analysis for hepatitis B and C
• Wasserman reaction (test for syphilis)
• Determination of blood group and Rh factor
• Coagulogram

Based on these analyses, the doctor creates a treatment plan, selects medications and the type of surgical intervention.

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Instrumental diagnostics

When diagnosing inguinal protrusion of abdominal organs, instrumental methods are very important. Instrumental diagnostics gives a complete picture of the patient's condition.

The following procedures are highly informative:

• Ultrasound of the abdomen – determines the condition of the internal organs and the composition of the hernial sac.
• Contrast radiography of the abdominal cavity - the patient is given a barium solution to drink, after which a series of radiographic images are taken. This allows changes in the location of the intestine to be determined and intestinal obstruction to be detected.
• CT scan is necessary to determine the size of the pathology and the nature of the contents of the hernial sac.

It is necessary to conduct instrumental diagnostics at the first signs of the disease. This will allow avoiding surgical intervention and treating the defect with conservative therapy.

Differential diagnostics

In some cases, the symptoms of a hernia are so vague that it can be confused with other diseases. Differential diagnostics are necessary to distinguish organ prolapse from other pathologies. The doctor's task is to distinguish an oblique hernia from a direct one based on their relation to the scrotum, shape and localization. By inserting a finger into the inguinal canal, the pulsation of the inferior epigastric artery is determined outside the pathology in the direct form and cunni from it in the oblique form.

The main difference between a femoral hernia and an inguinal hernia is that the former is located under the inguinal ligament, while the latter is above it. The disease must be differentiated from lipoma, tumors and inflammatory processes in the lymph nodes, with hydrocele of the testicle, spermatic cord and abscess.

In its consistency, a lipoma is similar to a hernia, but it lies lateral to the subcutaneous inguinal ring or originates from the subcutaneous adipose tissue.

• Hydrocele of the testicular membranes does not retract into the abdominal cavity, has clear boundaries and does not increase with straining.
• Enlarged lymph nodes are clearly separated from the external opening of the inguinal canal and have a dense consistency. The pathology does not change its size when straining.
• The acute form of inguinal lymphadenitis is characterized by redness of the skin over the nodes, their soreness, and swelling.
• Hydrocele of the spermatic cord can affect the inguinal canal, resembling a protrusion in its symptoms. However, it does not change size when straining and does not press into the abdominal cavity.
• An abscess is characterized by a lateral location relative to the external opening of the inguinal canal, and is painful to palpation. It does not change size when straining, and has a dull sound when percussed.

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Treatment of inguinal hernia in newborns

Many methods are used to eliminate the defect of the abdominal muscles. Treatment of inguinal hernia in newborns is based on the results of diagnostics. There are two treatment options - surgical and conservative. When choosing a type of therapy, the doctor is guided by the presence of complications, concomitant diseases and other characteristics of the child's body.

To completely eliminate the hernial protrusion, only surgery is used, which consists of the following manipulations:

• Opening access to the inguinal canal.
• Working with the hernial sac (dissection from tissue and removal).
• Suturing the inguinal opening when it is widened or destroyed.
• Reconstructive plastic surgery of the inguinal canal.

Each of the above stages requires control over the localization of the formation and the anatomical features of the patient. Since there is a risk of developing serious complications and relapses of the disease. If there is strangulation, then laparotomy is performed.

Conservative treatment is based on wearing special bandages. This method is used only if there are appropriate indications:

• Large postoperative hernias, for which repeated surgery is impossible or there is a risk of inflammation and suppuration.
• Recurrence of the disease after a previous operation.
• The presence of contraindications to surgical treatment.

But do not forget that the bandage is a method of temporary relief of the patient's condition. It prevents the hernia from increasing and reduces the risk of its strangulation. After the bandage is stopped, the symptoms of the disease return.

Medicines

Treatment of groin protrusion in infants is a complex process. Medicines are used both in conservative therapy and for recovery of the body after surgery. Medicines are also necessary in preparation for surgery. Correctly selected medications facilitate the recovery period and contribute to the fact that the hernial orifice closes on its own.

After the operation, the child is prescribed special nutritional mixtures that speed up recovery and strengthen the body. In addition to medications, the child is prescribed to wear a bandage, which prevents the organs from falling out into the hernial opening. A combination of vitamin therapy, immunostimulants and physiotherapy procedures minimizes relapses of the disease.

Folk remedies

In the treatment of any disease, both classical and non-traditional methods are used. Traditional treatment involves the use of herbal components that are safe for the body, have a minimum of contraindications and side effects.

• You can make an ointment from nettle, sour cream and cabbage to eliminate painful sensations. Grind nettle leaves and mix them with heavy cream. Apply a layer of the product to the body, put a cabbage leaf on top and fix it with a bandage. It is better to use the product before going to bed at night, the course of treatment is 3-4 weeks.
• Grind the flowers of the horsetail, pour boiling water over them and let it brew for 1-2 hours. The product must be filtered and used as a compress on the affected area.
• Soak a piece of bandage or a piece of gauze in sauerkraut brine and apply to the sore spot. The compress should be changed every 20-30 minutes for 2 hours. Instead of brine, you can use sauerkraut leaves.
• Wash the affected area of the body daily with cold water and vinegar 1:1. After that, apply a compress of oak bark infusion to the body for 30-40 minutes. This treatment can be used in combination with classical therapy.
• Prepare an infusion of cornflower flowers, pour 150 g of the plant with 500 ml of boiling water. The solution should be infused for 24 hours. The remedy is taken 100 g 3-5 times a day before meals.

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Herbal treatment

Traditional methods of treatment help to eliminate the signs of the disease and speed up the recovery process. Herbal treatment can only be carried out after a doctor's consultation, since not all plants are equally useful for a child's body.

Let's look at several recipes for herbal therapy for inguinal hernia:

• Pour 500 ml of boiling water over a tablespoon of meadow clover and leave for 1-2 hours in a closed container. After cooling, strain the decoction and take 1/3 cup during the day before each meal.
• Grind gooseberry leaves, pour 4 spoons of the product with 500 ml of boiling water and leave for 1-2 hours. The finished decoction must be filtered and taken 1/3 cup before meals.
• Apply a fern leaf or a compress of crushed nettle leaves to the inguinal hernia at night. It is recommended to use this medicine for 1-2 months in combination with wearing a special bandage during the day.

Homeopathy

Homeopathic remedies are more related to alternative medicine methods, since not all doctors approve the use of such drugs. Homeopathy can be used only after permission from a doctor, who selects a medicine individually for each patient.

Let's look at popular homeopathic remedies for eliminating abdominal muscle defects in the groin:

• Alumina – helps with constipation due to intestinal disorders.
• Calcarea carbonica is the mainstay of treatment for congenital hernias. It is usually prescribed to patients who are overweight and have a feeling of heat and pressure in the affected area.
• Cantharis – used for pathologies arising from chronic urinary retention, i.e. prostate enlargement and ureter narrowing. Relieves burning pain in the groin, frequent urge to urinate.
• Lycopodium – prescribed for right-sided hernia. The patient complains of weakness of the abdominal wall muscles, flatulence, vomiting.
• Nux vomica – used to treat protrusion, which is accompanied by chronic constipation and painful sensations in the rectum. The remedy is also effective for digestive disorders.
• Phosphorus - the drug is prescribed for hernia, which arose due to chronic inflammatory diseases of the bronchi. Severe cough has a pathological effect on the condition of the muscles, which provokes the appearance of a lumen in the aponeurosis, through which the intestinal loop falls out.

Surgical treatment

The main method of eliminating a hernia in the groin is surgery. Surgical treatment allows you to restore the anatomical position of the organs and their normal functioning. The goal of the operation is plastic surgery of the inguinal canal. The treatment procedure consists of the following stages:

1. Formation of access to the operating area. An oblique incision is made in the groin above and parallel to the inguinal ligament. The doctor dissects the aponeurosis of the oblique abdominal muscle, separates its upper flap from the internal transverse, lower and oblique muscles and from the spermatic cord, opening the groove of the inguinal ligament up to the pubic tubercle.
2. At this stage, the hernial sac is isolated and removed.
3. Suturing the inguinal ring to normal dimensions.
4. Reconstructive plastic surgery of the inguinal canal.

When choosing a plastic surgery method, the doctor takes into account the fact that the main cause of the pathology is the weakness of the posterior wall of the inguinal canal. Direct and complex forms of protrusion are restored by strengthening the canal wall with narrowing of the deep ring to normal dimensions. For this, one of the following methods can be used:

• Bobrov-Girard method – based on strengthening the anterior wall of the inguinal canal. The edges of the transverse and oblique abdominal muscles are sewn to the inguinal ligament above the spermatic cord.
• The Spasokukotsky method is a modification of the above-described method. Its main difference is that in addition to the muscles, the upper flap of the aponeurosis of the external oblique muscle is also sewn to the canal.
• Bassini's method - after removal of the hernial sac, the strengthening of the posterior wall of the inguinal canal begins. The surgeon moves the spermatic cord to the side and sutures the lower edge of the transverse and internal oblique muscles with the transverse fascia of the peritoneum to the inguinal ligament. The spermatic cord is placed on the new muscular wall.
• Laparoscopic hernioplasty – the doctor makes a tongue-shaped incision in the peritoneum facing the inguinal ligament. If the hernia is oblique or large, it is cut off at the neck, Cooper's and inguinal ligaments, and the pubic tubercle are isolated. After this, a synthetic mesh is applied to the affected area and sutured. The peritoneal flap is returned to its place and fixed with staples and sutures.

Prevention

It is easier to prevent any disease than to treat it. Prevention of inguinal hernia in newborns is based on proper care of the child. Massage has a positive effect, which can be done independently or by contacting a professional massage therapist. Physical therapy to strengthen the abdominal muscles helps to avoid hernial protrusion.

Preventive exercises:

• Take the baby by the arm and leg, carefully turn him over onto his left and right side.
• Place your child on the fitball and, holding him by the chest, roll him on the ball on his stomach and back.
• Take the baby by the arms, spread them apart and pull the baby's body towards you. In this position, the baby should raise the upper part of the body and head.
• Place the baby on his back and with warm hands stroke his tummy clockwise, that is, along the intestines. The navel should be in the center of the palm.
• Place your hands at the level of the oblique abdominal muscles, that is, on the sides, and with gentle movements massage from the back to the navel and back.
• Perform light pinching around the navel in a clockwise direction. This helps to strengthen the muscular frame.

Please note that your hands should be warm during the massage so that the child feels comfortable. It is better to perform the procedures 30 minutes before meals or 1-2 hours after meals. Such simple gymnastics will help strengthen the abdominal muscles.

Particular attention should be paid to the infant's diet. It is necessary to choose food that does not cause flatulence, colic or constipation, as this can provoke a hernia and negatively affect the treatment of an existing one. More often lay the child on his stomach, monitor the regularity of the stool and do not allow bloating or constipation. Try not to allow the baby to scream or cry loudly, as increased pressure in the abdominal cavity can provoke the organs to protrude into the groin.

Forecast

The outcome of pathological protrusion of organs in the groin in children depends on early diagnosis and selected treatment methods. As a rule, the disease is treated surgically, since the use of only conservative therapy can lead to relapses and strangulation of the hernia, which significantly worsens the treatment outcome.

The prognosis worsens with surgical intervention on the trapped inguinal protrusion. With this variant of the disease, the recovery period takes a long time, accompanied by various complications that negatively affect the growth and development of the child's body.

An inguinal hernia in newborns that remains without surgical intervention is even more dangerous. Therefore, at the first signs of the disease, parents should take the child to the doctor and undergo all necessary examinations. This will reduce the risk that is present during emergency interventions. You should not delay visiting a doctor and having surgery, as this worsens the prognosis for recovery.

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ICD-10 code

In the process of diagnosing various diseases in pediatric patients, the International Classification of Diseases, 10th revision, is used, as is the case when determining the disease in adults.

ICD 10 code for inguinal hernia:

• K00-K93 Diseases of the digestive system
  • K40-K46 Hernias
    • K40 Inguinal hernia (Abdominal hernias)
    • K40.0 Bilateral inguinal hernia with obstruction without gangrene (Intestinal obstruction)
    • K40.1 Bilateral inguinal hernia with gangrene
    • K40.2 Bilateral inguinal hernia without obstruction or gangrene
    • K40.3 Unilateral or unspecified inguinal hernia with obstruction without gangrene (Intestinal obstruction)
    • K40.4 Unilateral or unspecified inguinal hernia with gangrene
    • K40.9 Unilateral or unspecified inguinal hernia without obstruction or gangrene (Inguinal hernia)