Types of Hernia

TYPES  OF  HERNIA

 Inguinal Hernia:

 It is the most common hernia seen in infants and children. It occurs in the groin region. It may be unilateral or bilateral, more frequent in boys (90%) than girls (10%). It is more common in premature than term infants.

Pathophysiology:

As the male foetus grows and matures during pregnancy, the testicles develop in the abdomen and then move down into the scrotum, through an area called the inguinal canal.

Shortly after the baby 👶 is born, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If the closure does not occur completely, a loop of intestine can move into the inguinal canal, through the weakened area of the lower abdominal wall, causing a hernia. Although girls do not have testicles, they do have inguinal canal, so they can develop hernias in this area as well.

This hernia may be reducible or irreducible. If the hernia is reducible, the contents of the hernia sac can be replaced into the abdominal cavity by manipulation. In an reducible hernia, the contents of the hernia sac cannot be reduced or replaced into the abdominal cavity.

Indirect Inguinal Hernia:

 It occurs due to weakness of the abdominal wall. The hernial sac protrudes through internal inguinal ring into the inguinal canal and often descend into the scrotum. Herniotomy should be done to manage the problem and to prevent obstruction and strangulation.

Direct Inguinal Hernia:

It develops when the hernial sac protrudes through abdominal wall in the region of Hesselbach's triangle,a region bounded by the rectus abdominus muscle , inguinal ligament and inferior epigastric vessels. It is rare in children. Repair of the posterior wall of the inguinal canal is required to managed this problem. Repair is a difficult procedure.

Clinical Features:

• Vomiting that contains bile
• Cramping pain
• Abdominal distension
• Fever 🤒
• Infant👶 becomes irritable and restless
• Obstruction to venous return from the incarcerated intestine and resulting oedema leads to strangulation which causes gangrene

Diagnostic Evaluation:

1. Hernia in the inguinal area can be diagnosed by physical examination of the child. The child is examined to determine if the hernia is reducible or not
2. An abdominal x-ray or ultrasound may be done to examine the intestine closely

Management:

Specific treatment for hernia depends on the child's age , overall health and type of hernia- whether it is reducible or irreducible.Two types of surgeries are done to repair hernia:

• Open inguinal hernia repair(Herniorrhaphy, Hernioplasty)
• Laproscopic repair

In case of uncomplicated hernia, an elective inguinal herniorrhaphy is done soon after the condition is diagnosed, so as to reduce the risk of incarceration. If repair of reducible , uncomplicated hernia is postponed, then parents are taught the method of reducing the hernia.

 

  In case of incarcerated hernia, reasonable attempts are made to reduce it. Reduction may be successful if the infant can be helped to relax by giving warm bath or allowing to suck a pacifier. Compression is then exerted on the hernia. If non-operative reduction is successful, elective surgery can be done in 2-3 days, after the inflammation has subsided. If non-operative reduction is successful, an irreducible incarcerated hernia requires immediate surgery. Hernia repair is done using a small incision directly over the weakened area. The intestine is then returned to the abdominal cavity, hernia sac is excised and muscles are closed tightly over the area.

Hiatal Hernia:

Hiatal hernia (or) partial thoracic stomach is the herniation of cardiac end of the stomach through the esophageal hiatus of the diaphragm. The infant is presented with regurgitation (or) vomiting, dehydration and aspiration pneumonia. Failure to thrive and anemia are usually found.

Diagnosis: Barium - meal study

Surgical Management: Nissen type of fundoplication

Surgery is indicated for persistent vomiting, esophagitis, hematemesis, melena, frequent aspiration and impending stricture.

Conservative measures: Propped -up position, thickened feed and antacids.