Hernias in infants, children, and
adolescents
Also known as…inguinal hernia, groin hernias
What is a
hernia?
A hernia is a weakness, hole or opening in the abdominal wall that does not belong
there. Most hernias in children are the result of normal developmental processes that did
not quite finish properly. They are more common in boys, but occur in girls as well.
During normal development in the womb, there is an opening in the lower part of the
abdominal wall of every fetus. In boys, this opening is associated with the movement of
the testicle down into the scrotum. A similar opening is present in girls. The opening has
usually closed off prior to birth, but may persist, resulting in an inguinal hernia. The
persistence of this opening is more common in infants born prematurely. The abnormal,
persistent opening may be large and obvious or very small, only allowing fluid to move
through it. Sometimes the size of the opening allows things to become stuck in it. When
something is stuck (incarcerated) in the hernia opening, treatment is needed urgently. In
boys, a piece of intestine is most likely to become stuck, while in girls, the ovary is
most likely to become stuck. Unless something is stuck in the hernia sac, hernias cause
little in the way of symptoms.
Diagnosis and Treatment of
Hernias
Hernias are diagnosed by observation and examination. You may have seen or felt the hernia
bulge in the groin or down in the scrotum of your child. Older children may have noticed
the bulge or swelling themselves. You may have seen fluid around the testicle increase or
decrease. Your pediatrician or family physician may have discovered the hernia during an
examination. We will usually be able to confirm the presence of the hernia by examining
your child in our office. Sometimes the hernia will not bulge out during our examination
and we may rely on your description or your doctor’s to make the diagnosis. Tests
such as x-rays, ultrasounds, CAT scans and MRIs are rarely helpful in making the diagnosis
and planning the treatment.
An operation is performed to correct inguinal
hernias in both boys and girls. A small incision is made in the lower part of the
abdominal wall, just above the groin on the side of the hernia. The hernia sac is tied off
at its origin. Incisions are closed with dissolving sutures. Surgery is performed as an
outpatient, where your child comes to the hospital on the day of surgery, and is sent home
later that day. Small premature infants or children with special medical needs may stay
overnight. A hernia is sometimes present on the opposite side as well (rarely). There are
some circumstances where we may recommend hernia repairs on both sides. Physicians in the
Division of Pediatric Surgery at the Penn State Children’s Hospital treat infants,
children, and adolescents with inguinal hernias. We have a team of surgeons,
anesthesiologists, nurses and child life specialists dedicated to providing both you and
your child with the best operative experience possible. We believe it is important to
reduce pre-operative anxiety and to control post-operative pain and discomfort.
Glossary of Terms
Inguinal region:
region of the body where lower abdomen meets upper thigh (the groin).
Incarcerated: organs such as bowel
or ovary stuck in a hernia.
Strangulated: incarcerated organ
with compromised blood supply.
Reduce (the hernia): push the
contents of the hernia back where they belong.
Hernia sac: portion of the abdominal
lining (thin membrane) that protrudes through the hernia defect.
Hydrocele: a
simple sac of fluid that surrounds the testicle. Many baby boys have this. Usually goes
away on its own. Operation recommended only if it persists.
Communicating hydrocele: small
opening connects abdominal sac and the fluid-filled sac in the scrotum. Essentially a
small hernia opening. Repair is recommended.
Femoral hernia: unusual form of
inguinal hernia that protrudes into the upper thigh.
Indirect inguinal hernia: anatomic
description of the most common hernias found in children.
Direct inguinal hernia: anatomic
description of "muscle/tissue weakness hernia" that is often seen in older
individuals. Requires repair of the weakness of the abdominal wall.
Physician's Who Treat Hernias
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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