What is it about ?
A hernia is a piece of tissue that comes out of the body cavity in which it is normally located. This is the case, for example, when a piece of fat or intestinal tissue comes out through an opening in the wall of the belly.
The phenomenon occurs regularly in children, where it almost always concerns a congenital anomaly. In children, hernias can form in the upper abdomen, groin, thigh and around the navel. Hernias are generally not dangerous. However, if a piece of tissue gets stuck in the hernia and blocks the blood supply, the tissue can necrode (die). This is called a strangulation or a strangulated hernia.
The abdominal (belly) hernias appear on the midline that runs from the navel to the breastbone, where the large muscles of the abdominal wall meet. There is then an opening between the muscles of the belly, so that fat bulges outwards and causes palpable swelling.
A hernia may appear just above the navel following a bulging of fat tissue, which it is often impossible to push back inside. This hernia is not dangerous, but it will not heal on its own.
The true umbilical hernia (navel hernia) is the most common hernia in children. It usually heals spontaneously. The smaller the hernia, the longer you can wait and the greater the chance that the orifice will close on its own. Complications are not common in umbilical hernias.
The inguinal hernias (groin hernias) are characterized by a passage between the stomach cavity and the groin. This passage is normal during the developmental phase of the fetus (eg for the descent of the testicles), but usually closes around the time of birth. Otherwise, a piece of intestine or peritoneum or an ovary may become trapped in the groin canal. It can be painful, and the hernia is strangled in about a quarter of children.
In boys, this passage can also cause fluid to accumulate up to the testicle, this phenomenon being known ashydrocele. This hernia usually causes few symptoms and heals on its own.
What is their frequency?
In children, hernias are frequent and generally harmless.
About 10% of newborns have a herniated navel, and this percentage is even higher in premature babies.
Groin hernias affect 2 to 3% of children, their frequency being higher in boys and in the right groin. 1 in 10 children have a hernia on both groins. Strangulated groin hernias most commonly affect babies under 12 months of age.
1 in 10 boys develop hydrocele, which may vary in severity and size.
How to recognize them?
A hernia creates a lump (swelling) in an unusual place. This bump may be present continuously or disappear and then return. Its volume may vary over time and may, for example, increase when the child cries or stretches.
It often happens that a hernia is not accompanied by any complaints and the risk of strangulation is very low. Sometimes the hernia is painful and warrants treatment.
How is the diagnosis made?
The doctor listens to the parents’ story, asks questions, and tries to feel the lump during a physical examination. He then examines whether it is possible to push the lump back inside. This maneuver can cause pain in the case of a strangulated hernia.
Sometimes the doctor needs to assess the size of the opening causing the hernia, eg. in the case of a hernia of the navel. To do this, he tries to push his index finger into the hole.
To confirm a hydrocele, the doctor will expose the testicle to direct light: since the lump is made up exclusively of water, the testicle will let light pass through.
What can your doctor do?
Hernias are not always responsible for symptoms. Some hernias still need to be treated surgically. This is for example the case with hernias located above the navel and in the groin. The intervention is then generally carried out in day hospitalization and the hernia rarely returns after treatment.
Other hernias, such as navel hernias, should only be operated on if there is pain or strangulation or when they persist after the age of 4 and specific treatment is requested.
If a strangulated groin hernia is involved, the strangled tissue must be released before necrosis. Sometimes the doctor can free it by hand, but in other cases urgent surgery is necessary.
A hydrocele only undergoes surgical treatment when there is a significant accumulation of fluid and considerable discomfort in daily life, when the hydrocele first develops after infancy or when ‘it occurs in a child over 4 years old.
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