hernia, inguinal

Most commonly, a hernia is a swelling that you or your doctor discover in your child's inguinal ("groin") area. They are much more common in boys than in girls, although inguinal hernias do occur in girls. A hernia usually pops up without warning and is noticed at bath or diaper change time, often when the child is crying. The area they first appear in lies just above the scrotum, on a line drawn from the scrotum up to the nipple on that side.

What has happened is that there was a weakness in the floor of the abdomen where the blood vessels, nerve and spermatic cord leading down to the testicle penetrate the wall of the abdominal cavity. Over time, as the baby cries and normally strains to push out his bowel movements, the pressure gradually works this weakness into an opening through the abdominal wall (first smaller and then larger) and ultimately through a sort of tunnel and down into the testicular sac (scrotum). When the hole is large enough, a short section of intestine can slide down into the tunnel and the scrotum. At that point it can be seen and felt.

A hallmark of hernias is that they come and go. By the time dad gets home for you to show him - hey! it's not there!?! Your doctor will trust your word for it, though, and after checking for it, will probably send you over to see a surgeon. Unless your child is very small, when we find hernias we schedule a repair. That's because rarely, a loop of bowel can get stuck in the canal, "strangulate,"and cause fairly serious problems. So when we find 'em, we generally fix 'em.

What all this means is that your child needs some very minor day surgery (home that afternoon) to correct the problem. Your child will be up and at 'em in a few days after that.

In little girls, sometimes an ovary can slip into a similar weakness in the same general area, and may slip all the way down into the labium majorum. The ovary also can get twisted and strangulated, so it gets fixed promptly as well.

Surgeons have long believed that if a male infant or child develops an inguinal hernia on one side of the body, the other side should be explored and repaired if an early defect is found. A large study in Japan reported in the Journal of Pediatric Surgery in July '98 refutes this idea. The low (11.7%) eventual incidence of subsequent hernia on the other side contrasted with the fairly significant risk of damage to reproductive structures on the side of exploration is high enough to lead the researchers to recommend: leave the apparently normal side alone.

By far the most common inguinal area swellings in either sex are not hernias, though, but just normal lymph nodes ("lymph glands" is the common but incorrect term). There is often a string of them on either side just above the inguinal crease between the abdomen and leg, somewhat to the outside of the area where hernias appear. Next well baby checkup, have your doctor show you where these are. And of course, any new swelling in this area that comes and goes or that lies just above the scrotum or labia needs to be seen by your doctor.

See hydrocoele. See painful testicle.

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