Inguinal Hernia

What is an inguinal hernia?

A hernia is present when an opening is present in the abdominal wall through which a sac protrudes from the abdominal cavity through the abdominal wall. In pediatric patients it is generally a congenital abnormality and not something which develops after birth.

In adults, these may occur from progressive weakness of the abdominal wall, but this is rarely true in infants, children or teenagers. A hernia will be apparent if there is a soft bulge in either the inguinal area (the crease between the abdomen and the top of the leg) or in the scrotum.

A hernia that occurs in the groin area is called an inguinal area. Part of the abdominal contents, such as intestines, can be pushed through this opening. Inguinal hernias occur in 2 percent of all children but are more common in boys than girls. They may occur on either side, but they are more frequent on the right side.

Illustration of inguinal hernia into the canal and into the scrotum

What causes an inguinal hernia?

The testicles develop in boys in the back of the abdomen just below the kidney. During development of the fetus, the testicle descends from this location into the scrotum pulling a sac-like extension of the lining of its abdomen with it (inguinal hernia into scrotum). This sac surrounds the testicle into adult life, but the connection to the abdomen generally entirely resolves. If this does not occur a hernia will result with the sac extending from the abdomen through the abdominal wall and into the inguinal canal (inguinal hernia into canal), where it ends in the groin or it can persist going all the way into the scrotum and the sac surrounding the testicle.

Inguinal hernias are apparent only when there are contents from the abdominal cavity within the sac. In infants and children the sac may not be apparent if contents from the abdominal cavity have not escaped from the abdomen into the sac because the opening in the abdominal wall is too narrow to allow this to occur.

With development, the abdominal wall becomes stronger and can push contents through the opening into the sac often dilating this opening. Some factors place children at higher risk for inguinal hernias such as:

Although girls do not have testicles, they do have an inguinal canal, so they can develop hernias as well. It is often the tube and ovary that fall into the hernia sac.

Occasionally, in both boys and girls, the loop of intestine that protrudes through a hernia may become stuck and cannot return to the abdominal cavity. If the intestinal loop cannot be gently pushed back into the abdominal cavity, that section of intestine may lose its blood supply. A good blood supply is necessary for the intestine to be healthy and function properly.

What are the symptoms of an inguinal hernia?

Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries and may get smaller or go away when the baby relaxes. If your physician pushes gently on this bulge when the child is calm and lying down, it will usually get smaller as the contents of the sac go back into the abdomen.

If the hernia is not reducible, then the loop of intestine may be too swollen to return through the opening in the abdominal wall and requires urgent surgery.

How are inguinal hernias diagnosed?

Inguinal hernias can be diagnosed by a physical examination by your child’s physician. Your child will be examined to determine if the hernia is reducible (can be pushed back into the abdominal cavity) or not. Your child’s physician may order abdominal x-rays or an ultrasound to examine the intestine more closely, especially if the hernia is no longer reducible.

What are the treatment options for inguinal hernias?

Specific treatment will be determined by your child’s physician based on the following:

  • your child’s age, overall health, and medical history
  • the type of hernia
  • whether the hernia is reducible (can be pushed back into the abdominal cavity) or not
  • your child’s tolerance for specific medications, procedures or therapies

An operation is necessary to treat an inguinal hernia. It will be surgically repaired fairly soon after it is discovered, since the intestine can become stuck in the inguinal canal. When this happens, the blood supply to the intestine can be cut off, and the intestine can become damaged. Inguinal hernia surgery is usually performed before this damage can occur.

During a hernia operation, your child will be placed under anesthesia. A small incision is made in the area of the hernia. The loop of intestine is placed back into the abdominal cavity. The muscles are then stitched together. Sometimes, a piece of meshed material is used to help strengthen the area where the muscles are repaired, but this is rare, even in adolescents.

A hernia operation is usually a fairly simple procedure. Children who have an inguinal hernia surgically repaired can often go home the same day they have the operation.

Once the hernia is closed, either spontaneously or by surgery, it is unlikely it will reoccur.