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What is a hydrocele / hernia?
Inguinal hernia and hydrocele are common surgical problems that can occur at any age. A hernia is suspected when a child has a “bulge” in the groin or in boys only, the scrotum. Inguinal hernias are much more common in boys. A hernia is the descent of abdominal contents into the groin or scrotum. In boys, the contents may include the intestines. In girls, the contents may include the intestines, fallopian tubes, and ovaries. A hydrocele is a collection of fluid in the scrotum around the testicle.
A passage between the abdomen and the groin called the tunica vaginalis normally closes during the last trimester of pregnancy. Normally this natural opening obliterates, but W when this passage does not close, a hernia or hydrocele can results. A hernia or communicating hydrocele always means that the passage is open and that surgery is needed to close the passage.
Small scrotal hydroceles are common seen shortly afterat birth. and if confined to fluid around the tesicle is referred to as This is due to the trauma of the delivery. This type is called a non-communicating hydrocele. Most non-cimmunicating hydroceles resolve and will resolve on itstheir own. If however, they persist beyond 18 months repair is generally indicated.
What are the symptoms?
When a hydrocele is present, a nontender mass or bulge is seen in the groin or scrotum. A hernia will change in size, becoming larger when a baby is crying or if older, when the child is up walking. The bulge will decrease in size when the child is sleeping or quiet. A hydrocele or hernia is in general not painful, however, some infants do experience pain. They exhibit this by excessive irritability, crying, and pulling the legs up to the abdomen.
A hydrocele does not pose a serious risk, but it can develop into a hernia. In hernia, as long as the abdominal contents can be eased back into the abdomen, the child is not at risk. If, however, the abdominal contents become stuck and cannot be reduced (pushed back) into the abdomen, it is termed an incarcerated hernia. If your child develops vomiting, extreme tenderness of the area, a black and blue appearance to the groin or scrotum, fever, or diarrhea, the hernia may have become incarcerated. This can result in a bowel obstruction or damage to the contents in the hernia.
What is an incarcerated inguinal hernia?
If the bulge can be gently pressed back into the abdomen, the hernia is termed reducible. If it cannot be pressed back into the abdomen, the hernia is known as incarcerated (irreducible). When a hernia becomes incarcerated, infants or children will show signs of irritability and may vomit. They may also have loss of appetite, abnormal bowel patterns, and / or tenderness of the groin area and swelling of the abdomen.
With a prolonged period of incarceration, the blood supply to the intestine could be cut off, causing it to die. This is referred to as a strangulated hernia — a life-threatening situation that requires immediate surgical attention. If you suspect your child has an incarcerated hernia call your doctor immediately or proceed to the emergency room.
Observation will be the treatment for a non-communicating hydrocele. If hernia or communicating is present, surgery will be needed. In general, if a hernia is suspected or confirmed on examination, prompt repair is recommended. Depending on the age of your child, your surgeon may also recommend the insertion of a small camera through the hernia sac into the abdomen to look at the other side. This minimally invasive technique permits detection of a hernia on the opposite side, occurring in upto 20% of cases, and repair during the same anesthetic rather than at some later date.
As noted above, any hydrocele that persists beyond the age of eighteen months should be repaired.
In teenagers, especially males, your surgeon may recommend not only closure of the hernia but reinforcement of the repair with a plastic patch to reduce the risk of recurrent hernia. This is how most hernias are repaired in adults.
In infants and young children, an anesthetic can be instilled into the caudal space (tailbone) for post-operative pain relief. This avoids the risk of narcotics in young children. In older children or adolescents, local is injected into the incision by the surgeon at the time of wound closure. Your anesthesiologist and surgeon will discuss these options with you.
After surgery care
After surgical repair of a hernia / hydrocele, a special dressing will be placed over the incision. This may be a clear painted on sealant or some fabric strips, called steri-strips. These will gradually work their way loose and peel off. The area should be kept as clean and dry as possible with frequent diaper changes. If BM gets on the wound, clean it as well as you can with a warm wet washcloth. The strips or glue may be removed in seven to ten days. Your child should avoid tub baths or swimming for 7 days post-operatively. Your child may return to school as early as the next day if feeling well. Sports and other recreational activities can be begin as early as one week after surgery , but this should be discussed with your surgeon prior to starting.
Additionally, please follow these limitations:
- No tub baths until 5 days post-op
- No straddle toys or playing in sandboxes for 4 weeks
- No gym, sports, lifting more that the weight of a gallon of milk for 4 weeks
- May return to school 2-3 days post-operatively or when no longer taking narcotics for pain control.
When to call the doctor
Call your doctor if your child is excessively irritable, seems to be in pain, vomits, has fever or diarrhea. These symptoms should be reported immediately.
Source: Cincinnati Children’s Hospital Medical Center