Tag Archives: Umbilical hernia

Hernia in Children

Definition:
Hernia in children is a medical condition in which a tissue or structure or part of an organ is protruded through a weakness or hole in other body muscular tissue or membrane. A soft bulge is seen underneath the skin where the hernia has occurred.

In children, a hernia usually occurs in one of two places:

1.around the belly-button
2.in the groin area

A hernia that occurs in the belly-button area is called an umbilical hernia. A hernia that occurs in the groin area is called an inguinal hernia.

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Hernias in children mostly occur in the umbilical region. A weak abdominal wall in the children can be a reason for development of umbilical hernias. Hernias are present during the first year of child and may keep on coming and going at any age.

The disease condition is common among all the age groups. Boys are more prone to this disease than girls. Approximately 1 out of 50 boys are affected.

Symptoms:
Hernias usually occur in newborns, but may not be noticeable for several weeks or months after birth.

Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable.

*Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If your physician pushes gently on this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen.

*Umbilical hernias appear as a bulge or swelling in the belly-button area. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If your physician pushes gently on this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen.

A hernia usually causes a visible lump or swelling, which appears intermittently as the herniating tissue slips back into place and then protrudes again (umbilical hernias are more constant).

Crying, straining, coughing or anything else that increases pressure within the abdomen can make the hernia more obvious, as this forces out the contents.

If the hernia is not reducible, then the loop of intestine may be caught in the weakened area of abdominal muscle. Symptoms that may be seen when this happens include the following:

*a full, round abdomen
*vomiting
*pain or fussiness
*redness or discoloration
*fever

Symptoms of a hernia may resemble other conditions or medical problems. Please consult your child’s physician for a diagnosis.

Causes:

A hernia can develop in the first few months after the baby is born because of a weakness in the muscles of the abdomen. Inguinal and umbilical hernias happen for slightly different reasons.

Inguinal Hernia...click & see
As a male fetus 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 this area does not close off 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 an inguinal canal, so they can develop hernias in this area as well.(

Femoral hernias are more common in women, usually elderly and frail (although they can happen in children).)

Umbilical Herniaclick & see
When the fetus is growing and developing during pregnancy, there is a small opening in the abdominal muscles so that the umbilical cord can pass through, connecting the mother to the baby.

After birth, the opening in the abdominal muscles closes as the baby matures. Sometimes, these muscles do not meet and grow together completely, and there is still a small opening present. A loop of intestine can move into the opening between abdominal muscles and cause a hernia.
Risk Factors:
Hernias occur more often in children who have one or more of the following risk factors:

*a parent or sibling who had a hernia as an infant
*cystic fibrosis
*developmental dysplasia of the hip
*undescended testes
*abnormalities of the urethra

Inguinal hernias occur:
*in about one to three percent of all children.
*more often in premature infants.
*in boys much more frequently than in girls.
*more often in the right groin area than the left, but can also occur on both sides.

Umbilical hernias occur:
*in about 10 percent of all children.
*more often in African-American children.
*more often in girls than in boys.
*more often in premature infants

Why is a hernia a concern?
Hernias are usually painless. However, if the contents become trapped, the blood supply to the tissues may become restricted causing pain. This pain may be intermittent, but if the hernia is stuck permanently – known as an irreducible, strangulated or incarcerated hernia – the pain becomes constant and there’s a risk of damage to the trapped intestines or surrounding tissues. In this case the child may vomit and appear unwell.

Occasionally, the loop of intestine that protrudes through a hernia may become stuck, and is no longer reducible. This means that the intestinal loop cannot be gently pushed back into the abdominal cavity. When this happens, that section of intestine may lose its blood supply. A good blood supply is necessary for the intestine to be healthy and function properly.

Diagnosis:
Hernias can be diagnosed by a physical examination by your pediatrician. Your child will be examined to determine if the hernia is reducible (can be pushed back into the abdominal cavity) or not. Doctor may order abdominal x-rays or ultrasound to examine the intestine more closely, especially if the hernia is no longer reducible.

Treatment:-
Specific treatment will be determined by your pediatrician based on the following:

*your child’s age, overall health, and medical history
*the type of hernia
*whether the hernia is reducible (can be pushed back into the abdominal cavity) or not
*your child’s tolerance for specific medications, procedures, or therapies
*your opinion or preference

Inguinal hernia:……………..

An operation is necessary to treat an inguinal hernia. It will be surgically repaired fairly soon after it is discovered, since the intestine can become stuck in the inguinal canal. When this happens, the blood supply to the intestine can be cut off, and the intestine can become damaged. Inguinal hernia surgery is usually performed before this damage can occur.

During a hernia operation, your child will be placed under anesthesia. A small incision is made in the area of the hernia. The loop of intestine is placed back into the abdominal cavity. The muscles are then stitched together. Sometimes, a piece of meshed material is used to help strengthen the area where the muscles are repaired.

A hernia operation is usually a fairly simple procedure. Children who have an inguinal hernia surgically repaired can often go home the same day they have the operation.

Umbilical hernia:
By 1 year of age, many umbilical hernias will have closed on their own without needing surgery. Nearly all umbilical hernias will have closed without surgery by age 5.

Placing a coin or strap over the hernia will not fix it.

There are many opinions about when a surgical repair of an umbilical hernia is necessary. In general, if the hernia becomes bigger with age, is not reducible, or is still present after 3, your physician may suggest that the hernia be repaired surgically. Always consult your child’s physician to determine what is best for your child.

During a hernia operation, your child will be placed under anesthesia. A small incision is made in the umbilicus (belly button). The loop of intestine is placed back into the abdominal cavity. The muscles are then stitched together. Sometimes a piece of meshed material is used to help strengthen the area where the muscles are repaired.

A hernia operation is usually a fairly simple procedure. Children who have an umbilical hernia surgically repaired may also be able to go home the same day they have the operation.

Prognosis:-
Once the hernia is closed, either spontaneously or by surgery, it is unlikely that it will reoccur. The chance for re-occurrence  of the hernia may be increased if the intestine was damaged.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

Femoral Hernia


http://www.childrenshospital.org/az/Site1018/mainpageS1018P0.html
http://www.bbc.co.uk/health/physical_health/conditions/hernia2.shtml

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Belly Bulges

A protruding belly button is commoner in boys and may run in families   Everyone would love an eight pack abdomen, but for some it may remain just a dream. Their abdominal wall has unsightly bulges and protuberances, which may be a well rounded paunch or even hernia.

Some children have a protruding navel or belly button, which is noticed soon after the remnant of the umbilical cord falls off. When the baby cries or strains, the tummy bulges at the umbilicus. The swelling is called an umbilical hernia. It is commoner in boys. It may run in families and be associated with other diseases like thyroid deficiency or inborn errors of metabolism.

CLICK & SEE THE PICTURES

The foetus receives its nutrition through umbilical blood vessels that are attached to the navel. The abdominal muscles also fuse at that point. There is an area of weakness there which can cause a defect in the abdominal wall muscles. The intestines may protrude through this. Usually, the intestines can be pushed back when the child is quiet and lying down.

By the age of three or four years, the abdominal musculature develops and the hernia disappears on its own. It usually does not cause any symptoms till that time. If the skin over the hernia changes colour, or if the child starts to cry incessantly, consult a doctor. It may mean the intestine has got trapped in the hernia and its blood supply is being compromised, strangling the bowel.

Strapping the bulging belly button with plaster, tying it with a bandage or fixing a coin over it won’t help. On the contrary, it may be harmful as a piece of intestine may get caught in the bandage and stop the blood supply. This then becomes a medical emergency. If the hernia persists after the age of three, it needs to be surgically repaired.

Hernias can also suddenly appear near the umbilicus in adults. This “paraumbilical hernia” is situated just above the navel and occurs through a weakness in the abdominal wall muscles. It may be due to pregnancy, obesity or poor abdominal muscle tone. It may also appear if fluid accumulates in the abdomen as a result of kidney or liver disease. The hernia may contain fat or intestines.

Paraumbilical hernias that appear during pregnancy may disappear on their own. In others, they need to be surgically corrected, even if they are painless. Bits of bowel or other intestinal content can suddenly become trapped in them, precipitating an emergency. There is a band of fibrous tissue connecting and holding together the musculature of the two halves of the abdomen. If this is weak and separates out, it may cause a condition called “divarication of the rectus abdominus”. It is common in obesity. The affected area is usually long and stretches over the abdomen from the umbilicus to the rib cage. As the defect is large, the intestine does not become trapped inside. If there is no umbilical hernia, it can be left alone. Surgical repair is a variation of a “tummy tuck” and is done purely for cosmetic reasons.

If there is a small defect in the linea alba (fibrous structure running down the midline of the abdomen), a ping-pong ball sized bulge can occur at the spot. This is called an “epigastric hernia”. It needs to corrected.

About 75 per cent of hernias occur lower down in the groin area and are called “inguinal hernias”. They are commoner in men. They can extend from the lower part of the abdomen to the scrotum in men and to the labia in women. They are caused by a congenital defect in the abdominal wall. Some men push the contents of the hernia back into the abdomen and then use a “surgical truss” to hold it there.

The surgical treatment of hernias has changed over the years. Traditional techniques involved opening the abdomen and suturing the muscle layers. Hospital stays were prolonged and recovery slow. Now, laparoscopic repairs can be done, reducing the hospital stay to two or three days. Fine sterile surgical mesh can be used to cover the defect. The hernia is then less likely to recur as there is no tension on the layers of the abdominal muscles.

Some hernias can’t be prevented. Congenital abdominal wall defects are less likely to manifest as hernias if

• The BMI (body weight divided by height in metre squared) is 23

• Core strengthening exercises (oblique sit ups, plank position) are done daily

• Lifting heavy weights is avoided

• Weight-lifting exercises are done after proper training and conditioning.

Source: The Telegraph (Kolkata, India)

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