Hernias - Paediatrics

Hernias

Inguinal Hernia

·        4:1 male to female.  1% of boys

·        Virtually all indirect. A widely patent proximal process vaginalis allows bowel (and ovary in girls) to enter the inguinal canal 

·         Presentation: intermittent swelling overlying the external inguinal ring that has been noticed by a parent

·        50% right, 25% left, 25% bilateral

·        Do not resolve spontaneously

·        If < 1 more likely to present with strangulation

·        Incarcerated (bowel loop stuck through): 

o   Peak incidence in first year – main cause of obstruction. High index of suspicion in any child with abdominal distress 

o   If neglected will strangulate – testes will die first due to ¯venous return

·        Management:  Should be repaired ASAP. 

o   98% of acute or strangulated hernias can be reduced by taxis: manipulating it back in. Then fix electively (ie within a week) 

o   If signs of ischaemic gut or peritonitis ® surgery

·        Complications: 

o   Girls: fallopian tube and ovaries may be within the hernia. May tort. Care with surgery. Can completely close the internal ring.

o   Boys: damage to vas or testicular atrophy if surgery while acute

Umbilical hernia

·        Rarely cause problems, even if large

·        Repair at age 3 if haven‟t resolved by then

Congenital Diaphragmatic Hernia

·        1:5,000 live births.  1:2,000 total births (Þ lots of still births) 

·        Diaphragm should close just before mid gut comes back from umbilicus. In this case, returning gut enters chest. Compromises ipsilateral lung development (more common on left) ® mediastinal shift and lung hypoplasia 

·        Symptoms:

o   Early respiratory distress/cyanosis

o   Scaphoid abdomen

o   Bowel sounds in chest

o   Dextrocardia (diaphragmatic hernia most common cause) 

·        Treatment: don‟t bag the child ® bagging also blows up stomach and guts ® compromises lung expansion further. Ventilate. Surgery 

·        Complications: pulmonary hypertension in severe cases

·        Overall survival of 40 – 60%