Congenital inguinal hernia

Congenital inguinal hernia is the protrusion of the nearby elements of internal organs into the inguinal canal area, which is an anomaly since birth. Most often, the intestinal loop and part of the omentum, or the testicle, the round uterine ligament, the area of the bladder, etc., can enter the inguinal sac. Such a pathology can occur independently, or in combination with other anomalies. For example, with such defects as hydrocele or pathology of the spermatic cord.

ICD Code 10

• K00-K93 Diseases of the digestive organs.
• K40-K46 Hernias.
• K40 Inguinal hernia.
• K40.0 Double-sided inguinal hernia with obstructions.
• K40.1 Double-sided inguinal hernia with gangrenous complication.
• K40.2 Two-sided inguinal hernia uncomplicated.
• K40.3 Unilateral or undiagnosed inguinal hernia with occlusion phenomena.
• K40.4 Unilateral or undiagnosed inguinal hernia with gangrenous complication.
• K40.9 Unilateral or undiagnosed inguinal hernia without complications.

Causes of congenital inguinal hernia and pathogenesis

Congenital inguinal hernia is formed due to the existence of the inguinal canal inside the human body. The canal originates in the middle of the abdominal cavity, passes through the anterior wall of the abdominal press, then lies inward and downward, forming a hole just above the scrotum in the male body, or above the labia in the female body.

This hole is considered a pathology. The inguinal canal is formed from muscles and ligaments. Under normal circumstances, a male spermatic cord passes through it, or a female round uterine ligament. However, in some cases a hernial sac may pass through this canal. What contributes to this:

• congenital weakness of the abdominal wall;
• tissue after the testicle has descended into the scrotum.

As is known, congenital inguinal hernia in boys is found approximately 20 times more often than in girls. This is due to the peculiarities of the anatomy of the male body. At the same time, the percentage of appearance of pathology in premature infants is much higher.

First, the vaginal peritoneal process is of great importance in the development of the hernia, which can be represented as a certain tubercle of the parietal region of the peritoneum (blind sac). This process together with the testicle should proceed to the scrotum, and all these actions take place during the growth of the fetus in the womb of the mother. These processes largely depend on the hormonal changes in the body, and if there are any disorders, then there may be an incontinence of the vaginal process and a delay in the testicle in the groin canal. As a consequence, the child develops a hernia, and at the same time, as a rule, a hydrocele or cystic formation of the spermatic cord appears.

Congenital inguinal hernia in girls is extremely rare. This can be explained by the fact that the girl's lumen of the inguinal canal is much narrower, and there is already a round uterine ligament in it. However, in rare cases, the vaginal process may not close, and the opening will remain free. This phenomenon is called the "formation of the Nukkieva canal" in it and the ovary can appear.

[1], [2], [3]

Symptoms of congenital inguinal hernia

The first signs of a hernia appear in children immediately after birth. At the same time, the main thing that you can pay attention to when examining a child is an incomprehensible protruding tubercle in the groin area, which looks like an oblong swelling that passes along the inguinal canal. The hernia has a soft and elastic consistency, is painless and almost does not give the baby uncomfortable sensations.

In the state of rest and in the supine position, protrusion "hides", creating the appearance of a lack of pathology. In such a situation, the disease can be recognized by sealing the spermatic cord, which can be seen during a thorough examination. This symptom is called a "symptom of a silk glove".

However, when the child takes an upright position, or strains, laughs, cries, the inguinal hernia becomes much more noticeable.

In the girl, protrusion can have the appearance of unilateral or bilateral puffiness on the labia majora.

Injury of the inguinal hernia can reveal itself by the following symptoms:

• it becomes difficult to feel the hernia (the child cries and cries);
• hernia does not lend itself to self-correction;
• the child has nausea (burps), then vomiting, increased gas formation and constipation.

Object of infringement at boys usually becomes a loop of an intestine, and at girls - an appendage.

Effects

Complications of congenital inguinal hernia can be observed as follows:

• infringement is the most common consequence, which can be eliminated only surgically;
• necrosis of organs in the restrained hernial sac - intestinal loops, segments of the omentum, epididymis or tube of the uterus;
• peritonitis - an inflammatory reaction that affects the entire abdominal cavity (can also occur as a result of infringement);
• acute attack of appendicitis - an inflammatory reaction in the appendix, which arises from the compression of the vessels of the appendix in the inguinal ring;
• Symptomatic effects of inguinal hernia can be disorders of the digestive process, disruption of the intestine, flatulence, etc.

The most formidable complication is the infringement of a hernia - this situation requires urgent medical care, with hospitalization in a hospital and urgent surgical intervention.

[4], [5], [6]

Diagnosis of congenital inguinal hernia

Diagnostic procedures with congenital hernia begin with an examination of the child's surgeon. The doctor will assess the problem from the outside, palpate in different positions of the child.

When palpation determines the nature of the internal composition of the hernial protrusion:

• the intestinal loop has an elastic and elastic consistency, and during rattling, rumbling can be heard;
• the gland site is softer, lobate structure;
• In the hernial sac, the testes on the contrary are the most dense.

The doctor determines the possibility of repositioning the hernia with a finger. When listening to the bulging zone containing the intestinal loop, peristaltic movements can be felt.

The type of content can be clarified with the help of X-ray of the gastrointestinal tract, as well as ultrasonography of the hernia.

Instrumental diagnostics can also include the following types of research:

• ultrasound examination of the scrotum, which allows you to determine the contents of the bag (fluid or intestinal tract). Additionally, using ultrasound, it is possible to distinguish a hernia from a hydrocele;
• Diaphanoscopy is the procedure for scrotal grafting - a simple and affordable method of diagnosis. If the contents of the bag are liquid, then the rays penetrate through it without problems. A denser structure will not miss the rays, and the light will look bleak and uneven.

In addition, before starting treatment, the doctor will prescribe general clinical tests:

• analysis of blood and urine;
• biochemistry of blood;
• blood for hepatitis, AIDS, syphilis;
• blood coagulability analysis.

Differential diagnosis is carried out mainly with hydrocele or an increase in inguinal lymph nodes.

With the hydrocele, there is a pronounced increase in the swollen part of the scrotum. The cough impulse is not confirmed. The scrotum increases in the afternoon, and at night (during the rest period) its volumes are normalized.

Enlargement of lymph nodes is accompanied by their compaction, while the temperature rises. Over the affected lymph nodes skin turns red, it becomes hot to the touch.

[7], [8], [9], [10], [11], [12]

Treatment of congenital inguinal hernia

The doctor during the examination must necessarily decide whether to carry out the hernia treatment at the child immediately, or postpone for several years. Optimum operation should be carried out at the age of 6 to 8 months, or after 5 years.

Treatment of a hernia is mandatory, as this disease does not pass independently. That is why conservative and alternative treatment of hernia is a senseless waste of time and money - the only radical way to get rid of pathology is surgery.

A hundred years ago, doctors confidently stated that they had found a conservative way to treat a hernia of the groin. They provided specially designed medications, which were supposed to be introduced into the hernial sac, which caused the collapse of its walls and scarring. This method was not easy to use, expensive and time-consuming. However, later the doctors were forced to abandon this procedure, since numerous side effects of this conservative method were found:

• development of inflammation after injection;
• the appearance of cicatricial changes also in the spermatic cord;
• the possibility of simultaneous damage to the nearest vessels.

After a series of unsuccessful attempts, the specialists were forced to admit that the only successful procedure for the removal of the inguinal hernia would be an operation.

The only method of conservative therapy, which is still used today, is the use of a bandage.

Indications for wearing a bandage are:

• the impossibility of performing an operation at a given time;
• re-emergence of a hernia after surgery;
• the presence of contraindications to the operation (for example, poor blood coagulation).

The bandage does not cure a hernia radically, but only serves to prevent its further growth and infringement.

Operation with a congenital inguinal hernia in a child is most often done in this way:

• general anesthesia is performed;
• an incision is made in the groin in the groin ring area, where the hernial sac is lowered;
• the doctor carries out the separation of the sac and testicles, since they are, as a rule, glued to each other;
• then the surgeon makes an incision in the hernial sac and examines it, making sure that it is empty;
• after that the bag is cut off, the outgoing part of it is bandaged;
• The doctor sutures the wound - the operation has come to an end.

If there are no individual difficulties, the operation does not last long - about half an hour.

Operation in childhood has its own characteristics, which the surgeon always takes into account:

• the child's inguinal ring, as a rule, is not yet fully formed, so over the years it may decrease in diameter. For this reason, the doctor only cuts off the pouch in the child, without performing the procedure of strengthening the inguinal ring. In this regard, the operation is faster and easier;
• The operation in childhood is always done under general anesthesia;
• a child can be operated on by making a very small incision - no more than 10-15 mm;
• in girls, the operation is even easier. As a rule, it takes only up to 15 minutes.

Prevention

It is quite difficult to designate any preventive measures to prevent congenital inguinal hernias, since it is not known exactly what exactly and at what point of the intrauterine development causes weakening of the connective tissue. Moreover, approximately in 18% of cases the congenital hernia is caused by genetic predisposition, that is, family heredity.

A woman during pregnancy is recommended to eat fully, avoid the use of any medication without a doctor's recommendation, exclude all bad habits that can adversely affect the healthy development of the fetus (alcohol, smoking, drugs). It is recommended to walk more in the fresh air, to eat more vegetables and fruits, not to overdo it and not to be nervous.

Forecast

Postoperative period the child spends in a hospital under the supervision of a surgeon. The doctor examines and dresses the wound every day.

As a rule, there is no need to remove stitches: children usually get self-absorbing cosmetic sutures, which in most cases do not leave scars at all.

Completely the child is restored in 3-6 months after an operative intervention.

It must be understood that congenital inguinal hernia can not disappear by itself. The appearance of a hernia occurs because of the vaginal abdominal process, which does not overgrow and turns into a stitch. Without an operation, he will not disappear anywhere on his own and will not resolve.

[13], [14]