Inguinal hernia in newborns

The emergence of internal organs in newborns is a pathology that occurs in 10% of children. Consider the features of the disease, the causes, methods of diagnosis and treatment of inguinal hernia in newborns.

To the appearance of inguinal hernia predisposed preterm infants, patients with various congenital anomalies, pathologies of connective tissue. The disease often occurs in boys than in girls. It can be combined with other lesions of the abdominal wall, orthopedic diseases, malformations of the nervous system and spinal defects.

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

Inguinal hernia is classified according to localization:

• Inguinal - is located near the external opening of the inguinal canal.
• Pahovo-scrotal - is located near the testicle and affects the scrotum.
• Kanatik - located near the spermatic cord, does not reach the level of the testes, but descends into the scrotum.

Characteristics of the location of the hernial sac:

• Direct - the organs come out through a weakened peritoneum, but do not affect the internal opening of the inguinal canal.
• Kosaya - passes near the spermatic cord, through the inguinal canal.
• Combined - on one side there can be more than two pathologies that are not related.

In newborn children, oblique protrusion is more common, since the other two are acquired. Pathology has a number of features that make it difficult to diagnose and treat it. Symptoms do not appear immediately, this is due to the fact that the first months of life the child spends horizontally. A defect is not a harmless phenomenon, as it can cause serious complications and life-threatening consequences. Therefore, timely diagnosis and treatment is the guarantee of normal development of the baby.

[1], [2], [3]

Causes of inguinal hernia in newborns

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

The main causes of inguinal hernia in newborns:

• Excess weight of the baby
• Obstructed urination
• Physical overstrain (prolonged crying and crying, which is not permissible in the first months of life)
• Injuries and pathologies of the abdominal wall
• Postoperative Scars

The etiology of the defect is associated with the vaginal process - this formation, which is formed from the 10-12 weeks of development of the fetus in its abdominal cavity. Its task is to lower the genitals of the embryo to its place. The pathology has hernial gates, which are formed by the outer ring of the inguinal canal. The hernial sac is a vaginal process, on the back wall of which is a seed cord in boys, an omentum, a round uterine ligament and guts in girls.

[4], [5], [6], [7]

Pathogenesis

The mechanism of inguinal hernia development in boys and girls has its own peculiarities. So, in girls in the hernial sac gets the fallopian tube and the ovaries, and in boys - the bowel loops. Inguinal protrusion is more common in boys, this is due to the fact that as the lowering, the testicles can pull a part of the peritoneum. Because of this, there is a displacement, as a result of which a pocket is formed. In girls, the disorder occurs because of the inherent weakness of the fixation device that holds the round ligament of the uterus.

Congenital hernia:

• Boys - in the embryo the 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 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 a protrusion that must be closed and closed. If this does not occur, a hernia appears, as the communication between the peritoneum and the inguinal canal of the scrotum is maintained. In the hernial gates, some organs and loops of the intestine can be lowered.
• Girls - in the embryo the uterus is located above its normal anatomical position. As the fetus grows, the uterus descends and can pull the peritoneum, forming a fold. It protrudes and can penetrate the inguinal duct.

Acquired form of the disease is rare and often due to excessive physical exertion. Its development is facilitated by the weakness of the muscular tissues of the anterior abdominal wall.

Symptoms of inguinal hernia in newborns

Regardless of the cause of the hernial protrusion, signs of a disorder are typical - this is a bulging in the groin area, which increases with physical exertion, crying, screaming, straining and other conditions that cause an increase in intra-abdominal pressure. Symptoms of inguinal hernia in newborns fully correspond to the above. The hernia is quite elastic with a soft consistency, when pressed, it easily fits into the abdominal cavity. If it is not complicated, then the correction does not cause the child painful sensations or discomfort.

The most common symptoms of hernia pathology in infants:

• Soreness and discomfort in palpation, the child begins to be capricious and cry.
• When you change the position of the body, the protrusion changes its dimensions, but it easily fits.
• Nausea, vomiting and flatulence.

Depending on the sex of the child, the defect may shift, the boys have swelling of the testicle, and in girls - an increase in the labia. The main reason why parents do not immediately seek medical help is the absence of complaints about discomfort on the part of the child. Ignoring the external signs of the disease leads to serious complications and infringement.

First signs

The symptomatology of a defect in the muscles of the abdominal cavity does not appear immediately, which greatly complicates the process of diagnosis. The first signs are associated with abnormalities of the digestive tract, vomiting, nausea, flatulence. In the groin area there is a small swelling, which increases with restless behavior of the child, but disappears at rest.

Signs of the disease:

• Stem protrusion in the groin area

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

• Increased scrotum

This symptom indicates an inguinal and scrotal defect, which occurs only in boys.

• Enlargement of one of the labia

This sign is found in girls and indicates the lowering of the hernia to the large labia.

• Defect correction

Pathology is clearly seen in standing position, but in horizontal it can be easily and painlessly corrected.

As a rule, the ailment does not deliver painful sensations, but if there is infringement, then pain and other pathological symptoms increase.

[8], [9]

Inguinal-scrotal hernia in newborns

If the organs and tissues of the abdominal cavity go beyond the abdominal wall, then this indicates a hernial defect in the groin, if the contents falls into the scrotum, then this is a complete or inguinal and scrotal hernia. In newborns, this pathology is common, which is associated with the anatomical features of the child's body. A reliable reason for the appearance of this problem has not been identified. But a decrease in the tone in the groin ring, accompanied by loss of organs and arises due to the action of many factors.

The inguinal and scrotal hernia in children appears due to a violation of embryogenesis. This occurs during the period of lowering the testicles into the scrotum, one testicle does not fully lower and pulls the peritoneal tissue behind it. The disease is practically asymptomatic, its main symptom is a protrusion from one side in the groin area. If there is an infringement, that is, the initial pathology is complicated, then the skin over the tumor is hyperemic, there are sharp pains.

There are no limits to scrotum enlargement, that is, the disease does not pass by itself, but on the contrary it progresses and the tumor increases in size. The signs of the disease depend on the organs that got into the hernial sac. Most often it is a small intestine or a large omentum. If a large omentum gets into the bag, then there are pains in the groin area. When the intestine is infringed, in addition to pain, symptoms of intestinal insufficiency appear, that is constipation, bloating, vomiting.

Diagnosis is based on external examination and instrumental methods of investigation. Treatment is carried out both conservatively and operatively. In the absence of infringement, the child is operated on with the subsequent wearing of the bandage.

Effects

Inguinal hernia, like any other diseases in newborns, threatens serious problems. The consequences depend on the timely application of medical care. If the pathology is identified late, it can lead to infringement. Injured protrusion constricts important blood vessels and part of the organ. This complication is dangerous to ignore. The kid suffers from painful sensations, there is a fever, constipation, bloating, vomiting.

The infringement does not fit into the abdominal cavity and, with slight pressure, causes painful sensations. In the absence of treatment, the discomfort subsides for a while, but then the pain returns with renewed vigor. This symptomatology indicates that a part of the organ has died, local blood circulation is broken, nerve endings do not function. If at this stage, not to remove necrotic tissue, then in the future it can lead to inflammation, perforation of intestinal walls and penetration of conditionally pathogenic microflora into the abdominal cavity. Against this background, the baby begins peritonitis, which is life-threatening.

[10], [11]

Complications

The most dangerous problem that can be encountered in the untimely treatment of a hernia in a child is infringement and serious violations in the work of internal organs, which further affects the growth and development of the baby. Complication is characterized by squeezing the organ and violating its blood supply. The hernia does not lend itself to correction, the tumor becomes hard and causes sharp pains during palpation. This complication is treated surgically followed by a recovery course.

This defect can lead to serious consequences for girls. If there was an infringement, this entails the death of the ovary even in infancy. As a result - hormonal imbalance, which affects the overall health of the child and physical development as a whole.

[12], [13], [14]

Diagnosis of inguinal hernia in newborns

Various methods are used to detect a defect in the muscles of the abdominal cavity. Diagnosis of inguinal hernia in newborns is based on complaints of the child and his parents, as well as on the symptomatology characteristic for the ailment. The doctor performs a visual examination of the patient, auscultation and palpation. During the examination, the surgeon can detect a one- or two-sided protrusion.

At palpation the kid does not feel pain, and the hernia itself has an elastic, soft consistency. The tumor can have a round or oval shape, the latter indicating an inguinal and scrotal lesion. In girls, the hernia descends to the labia, deforming them. To diagnose the disease, the child takes blood and urine tests. In order to determine the composition of the hernial sac an ultrasound is performed.

[15], [16], [17],

Analyzes

To identify the protrusion of organs in the groin, a variety of methods are used. Analyzes are included in the mandatory diagnostic composition. They are necessary for obtaining information about the state of the child's organism and when staging for surgical treatment.

The main tests for inguinal hernia in infants:

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

Based on these analyzes, the doctor makes a treatment plan, selects medications and the type of surgery.

[18], [19], [20], [21], [22], [23]

Instrumental diagnostics

When diagnosing an inguinal protrusion of the abdominal cavity organs, instrumental methods are very important. Instrumental diagnosis provides a complete picture of the condition of the patient's body.

A good informativeness is possessed by such procedures:

• 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 and then a series of radiographic images is taken. This allows you to determine changes in the location of the intestine and reveal intestinal obstruction.
• CT is necessary to determine the size of the pathology and the nature of the contents of the hernial sac.

To conduct instrumental diagnostics is necessary at the first signs of the disease. This will avoid surgical intervention and cure the defect with the help of conservative therapy.

Differential diagnostics

In some cases, the symptoms of hernia are so blurred that it can be confused with other diseases. Differential diagnosis is necessary to distinguish between organ prolapse and other pathologies. The doctor's task is to distinguish an oblique hernia from a straight line in relation to the scrotum, form and localization. With the introduction of a finger into the inguinal canal, pulsation of the lower epigastric artery outside the pathology is determined with a straight shape and a knee from it with the oblique.

The main difference between the femoral hernia and the inguinal hernia is that the first is under the inguinal ligament, and the second is above it. The disease must be distinguished from the lipoma, tumors and inflammatory processes in the lymph nodes, from the dropsy of the testicles, the spermatic cord and the abscess.

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

• The dropsy of the testicle shells does not fit into the abdominal cavity, has clear boundaries and does not increase with straining.
• The enlarged lymph nodes are clearly separated from the outer opening of the inguinal canal, and have a dense consistence. Pathology does not change its size when straining.
• The acute form of inguinal lymphadenitis is characterized by reddening of the skin above the nodes, their soreness, swelling.
• A dropsy of the spermatic cord can affect the inguinal canal, resembling a symptomatic protrusion. But it does not change the size when straining and does not interfere with the abdominal cavity.
• The bleeding abscess is characterized by lateral placement relative to the external opening of the inguinal canal, painful on palpation. It does not change the size when straining, it has a blunt sound with percussion.

[24], [25], [26], [27], [28], [29]

Treatment of inguinal hernia in newborns

To eliminate the defect in the muscles of the abdominal cavity a variety of methods are used. Treatment of inguinal hernia in newborns is based on the results of diagnosis. There are two options for treatment - surgical and conservative. Choosing the type of therapy, the doctor is guided by the presence of complications, concomitant diseases and other features of the child's body.

To completely eliminate the hernial protrusion, only the operation is used, which consists of such manipulations:

• Opening access to the inguinal canal.
• Work with a hernial sac (excretion from tissues and removal).
• Sewing the inguinal opening when it is enlarged or destroyed.
• Restorative plasty of the inguinal canal.

Each of the above steps requires control over the localization of education and the anatomical features of the patient. Since there is a risk of serious complications and relapses of the disease. If there is an infringement, then a laparotomy is performed.

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

• Large postoperative hernias, reoperation of which is impossible or there is a risk of inflammatory and suppuration.
• Recurrence of the disease after a previous operation.
• 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 an increase in hernia and reduces the risk of her infringement. After the wearing of the bandage is discontinued, the signs of illness return.

Medications

Treatment of bulging organs in the groin in infants is a complex process. Medications are used in both conservative therapy and recovery of the body after surgery. Medicines are also needed when preparing for surgery. Correctly selected medications facilitate the recovery period and contribute to the fact that the hernial gates close themselves.

After surgery, the baby is prescribed special nutrition mixtures that accelerate recovery and strengthen the body. In addition to drugs, the baby is prescribed wearing a bandage, which prevents the loss of organs in the hernial opening. Combination of vitamin therapy, immunostimulants and physiotherapy procedures minimize relapse of the disease.

Alternative treatment

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

• From nettle, sour cream and cabbage, you can prepare an ointment to eliminate painful sensations. Chop the leaves of nettle and mix them with fatty sour cream. Apply the layer of the product to the body, from above place the cabbage leaf and fix it with a bandage. It is better to apply the drug before going to bed at night, the course of treatment is 3-4 weeks.
• Chop the flowers of field horsetail, pour boiling water 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 gauze flap with pickled cabbage brine and attach to a sore spot. The compress should be changed every 20-30 minutes for 2 hours. Instead of a pickle, you can use the leaves of sour cabbage.
• Daily wash the affected area of the body with cold water and vinegar 1: 1. After that, the body should apply a compress from the bark of the oak bark for 30-40 minutes. Such treatment can be used in combination with classical therapy.
• Prepare infusion of flowers of cornflowers, 150 g of the plant, pour 500 ml of boiling water. The solution should be infused within 24 hours. The drug is taken 100 g 3-5 times a day before meals.

[30], [31]

Herbal Treatment

Alternative therapies help to eliminate signs of the disease and accelerate the process of recovery. Treatment with herbs can be done only after a medical consultation, since not all plants are equally useful for a child's body.

Consider several recipes for herbal inguinal hernia therapy:

• A tablespoon of clover clover, pour 500 ml of boiling water and insist for 1-2 hours in a sealed container. After cooling, the broth should be filtered and taken by 1/3 cup during the day before each meal.
• Grind the leaves of gooseberries, 4 tablespoons of the agent, pour 500 ml of steep boiling water and insist for 1-2 hours. A ready-made broth should be filtered and taken 1/3 cup before meals.
• At night, attach to the inguinal hernia a fern leaf or a compress of crushed nettle leaves. Such a medicine is recommended to use 1-2 months in combination with wearing a special bandage during the day.

Homeopathy

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

Consider the popular homeopathic remedies for the elimination of a defect in the muscles of the abdominal cavity in the groin:

• Alumina - helps with constipation due to bowel disturbances.
• Calcarea carbonica is the main drug in the treatment of congenital hernias. As a rule, it is prescribed for patients with excess weight, sensation of heat and pressure in the area of the lesion.
• Cantharis - used in pathologies that arise due to chronic urinary retention, that is, with proliferation of the prostate and narrowing of the ureter. Relieves burning pain in the groin, frequent urge to urinate.
• Lycopodium - appoint with right-sided hernia. The patient complains of the weakness of the muscles of the abdominal wall, flatulence, vomiting.
• Nux vomica - used to treat protrusion, which is accompanied by chronic constipation and painful sensations in the rectum. The drug is effective in digestive disorders.
• Phosphorus - the drug is prescribed for hernia, which was due to chronic inflammatory bronchitis. A strong cough pathologically affects the condition of the muscles, which provokes the appearance in the aponeurosis of the lumen through which the intestinal loop falls.

Operative treatment

The main method of eliminating a hernia in the groin is an operation. Operative treatment allows restoring anatomical position of organs and their normal functioning. The purpose of the operation is the plasty of the inguinal canal. The treatment procedure consists of the following stages:

1. Formation of access to the operating area. In the groin, an oblique incision is made above and parallel to the inguinal ligament. The doctor dissects the aponeurosis of the oblique abdominal muscle, separates its upper flap from the inner transverse, lower and oblique muscles and from the spermatic cord, opening the groove of the inguinal ligament up to the lumbar lobe.
2. At this stage, the hernial sac is excreted and removed.
3. Sewing the inguinal ring to normal size.
4. Restorative plasty of the inguinal canal.

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

• The Bobrov-Girard method is based on the strengthening of the anterior wall of the groin canal. To the inguinal ligament over the spermatic cord, the edges of the transverse and oblique muscles of the abdomen are sewn.
• The method of Spasokukotsky is a modification of the method described above. 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.
• Method Bassini - after removal of the hernial sac, strengthening of the posterior wall of the inguinal canal begins. The surgeon pushes the spermatic cord aside 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 laid on a new muscular wall.
• Laparoscopic hernioplasty - the doctor makes a lingual incision of the peritoneum, facing the inguinal ligament. If the hernia is oblique or large in size, then it is cut off at the cervix, the Cooper and the papular ligament are isolated, the lumpum is tubercle. After this, a synthetic mesh is placed on the damage site and sewed together. The peritoneal flap is returned to its place and fixed with the help of brackets and seams.

Prevention

Any disease is easier to prevent than treat. Prevention of inguinal hernia in newborns is based on proper care of the child. A positive effect is the massage, which you can do yourself or call a professional masseur. Therapeutic exercises for strengthening the abdominal muscles, allows to avoid hernia protrusion.

Preventative exercises:

• Take the child by the handle and leg, gently turn it over the left and right side.
• Put the child on the fitball and, holding his chest, roll on the ball on his stomach and back.
• Take the baby by the arms, spread them apart and pull the child's body toward you. In this position, the toddler should lift the upper body and head.
• Put the baby on the back and warm hands clockwise, that is, along the bowels stroke his tummy. The navel should be in the center of the palm.
• Place your arms at the level of the oblique abdominal muscles, that is, on each side and gently massage from back to navel and back.
• Perform a slight tingling around the navel in a clockwise direction. This helps to strengthen the muscular framework.

Please note that the hands during the massage should be warm, so that the child feels comfortable. Perform procedures better 30 minutes before meals or 1-2 hours after eating. Such a simple gymnastics will help strengthen the muscles of the abdominal cavity.

Particular attention should be paid to the ration of the baby. It is necessary to choose a diet that does not cause flatulence, colic or constipation, as this can provoke a hernia and adversely affect the treatment of an existing one. Often lay the baby on the stomach, watch for the regularity of the stool and avoid swelling or constipation. Try not to allow the baby to cry and cry, because the increased pressure in the abdominal cavity can trigger the passage of organs into the groin.

Forecast

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

The prognosis worsens during surgery on the pinched inguinal protrusion. With this version of the course of the disease, the recovery period takes a long time, accompanied by various complications that adversely affect the growth and development of the child's body.

Inguinal hernia in newborns, left without surgery, is even more dangerous. Therefore, at the first signs of illness, parents should take the child to a doctor and undergo all necessary examinations. This will reduce the risk that is present in emergency interventions. To delay with a visit to the doctor and the operation is not necessary, since this worsens the prognosis for recovery.

[32]

ICD-10 code

In the process of diagnosing various diseases in pediatric patients, the international classification of diseases of the 10th revision is used, as in the definition of an ailment in adults.

Code for μB 10 inguinal hernia:

• K00-K93 Diseases of the digestive system
  • K40-K46 Hernia
    • K40 Inguinal hernia (abdominal hernia)
    • K40.0 Double-sided inguinal hernia with obstruction without gangrene (Intestinal obstruction)
    • K40.1 Double-sided inguinal hernia with gangrene
    • K40.2 Double-sided 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 (Herniated hernia)