Hernias

A hernia or “rupture” represents a defect within the muscle coating of the abdominal wall and most commonly presents itself as a painless lump or bulge. Commonly seen in adults, hernias are also frequently diagnosed in children. In fact, repair of hernias is the most common elective surgical procedure performed by pediatric surgeons in the United States. With the exception of umbilical hernias, all hernias require surgical repair or closure. This is to prevent the complication of incarceration and or strangulation. Incarceration occurs when a piece of an internal organ, usually the intestine, becomes trapped within the hernia sac. Following this, strangulation may occur in which the internal losses its blood supply. This can be life threatening. Fortunately, these complications are rarely seen in the U.S. as hernias are repaired prior to these events. Hernias which are painful, red, cannot be reduced or pushed back inside, or are associated with abdominal pain, fever or vomiting may be incarcerated. Strangulation can occur within hours. If your child has any of these symptoms, you must seek medical attention immediately by proceeding to the nearest emergency room or calling 911.

The most common site for hernias in children is the groin. These are referred to as inguinal hernias. They usually present as a painless lump or bulge in the groin or scrotum in boys. They are more common in premature babies and boys. They will not resolve spontaneously and always require repair. They most effective way to diagnose a hernia is on physical exam by a physician. Inguinal hernias may involve both sides, particularly if they present within the first year of life. Surgical closure of inguinal hernias is fairly simple and safe, does not involve placement of a mesh, is performed through a small incision and usually can be done as an outpatient. Premature babies may need to stay for one night after repair.

Hernias may also occur elsewhere, such as within the belly button or umbilicus. Umbilical hernias are not routinely repaired as they may resolve spontaneously in the first few years of life. Unlike other hernias, they also rarely are complicated by incarceration.

If you believe your child to have a hernia and would like to discuss treatment options with one of our physicians, please call (865) 546-2131 or ask your child’s doctor for a referral to our office.

Hydrocele

A hydrocele is a collection of sterile fluid surrounding but not involving one or both testicles. Hydroceles are common in newborns, especially those born prematurely. A simple hydrocele is basically an isolated sac of fluid and has no connection to the peritoneal cavity (the cavity in which the intestines and other organs reside). A simple hydrocele requires no treatment and will usually resolve within the first year of life. A “communicating” hydrocele does posses a communication with the peritoneal cavity and in this fashion is similar to a hernia (see picture). This type of hydrocele will not resolve spontaneously and will persist beyond the first year of life, usually changing in size during the course of a day. A communicating hydrocele does require outpatient surgery to remove the communication and drain the fluid as these will only increase in size and difficulty to treat.

Hydroceles may also be diagnosed with ultrasound which is painless and involves no radiation. If you believe your child has a hydrocele and would like to discuss treatment options with one of our physicians, please call (865)546-2131.