An inguinal hernia usually shows up as a bulge in the lower abdomen, also called the groin, or in the scrotum.
Before birth, a male baby’s testicles grow inside his abdomen, and then travel to the scrotum.
To get to the scrotum, the testicles must pass through two openings, called the internal and external inguinal rings,
and a passage between them, called the inguinal canal, formed by abdominal wall muscles.
As the testicles enter the scrotum, tissue lining the abdominal wall comes with them, forming a sac.
Normally, the opening of the sac into the inguinal canal closes within six months after birth.
Sometimes, for unknown reasons, the opening of the sac does not close.
As a result, the open tissue sac may fill with fluid that normally stays inside the abdomen.
The fluid-filled sac surrounding the testicle is called a hydrocele.
A small piece of the baby’s intestine or some fatty tissue from the abdomen may also slide into the sac, resulting in an inguinal hernia.
Usually, a doctor will be able to gently reduce, or push, the intestine back into the abdomen.
However, the intestine may become trapped, or incarcerated, inside the tissue sac. This will appear as a hard and tender bulge and is an emergency.
After about six hours, the intestine inside an incarcerated hernia may lose its blood supply and die.
This is called a strangulated hernia, and is an emergency that requires an immediate medical attention and surgery to repair it.
Hydroceles and inguinal hernias require an operation to tie off and remove the tissue sac to prevent future herniation and possible injury to the small intestine.
To begin, the surgeon will make a small incision near the hernia.
Next, the surgeon will carefully separate the tissue sac away from the cord structures, including small blood vessels and the vas deferens, that are attached to the testicle.
The surgeon will then open the sac to look for any herniated contents inside.
Usually, the sac is empty. However, if herniated contents are present, they will be moved back into the abdomen.
Sometimes, in children younger than two years of age, the surgeon will insert an instrument called a laparoscope through the open tissue sac.
The laparoscope contains a camera that will allow the surgeon to look at the internal ring on the other side and see if there’s a hernia on that side.
If the other internal ring is open and there is a hernia, the surgeon will need to make a similar repair on that side.
After checking the other side for a hernia, the surgeon will tie off the empty tissue sac with a suture.
The remainder of the sac will be removed.
Finally, the surgeon will close the incision with dissolvable sutures, skin glue, or closure-tape dressing.
The baby may receive an injection of anesthesia in the skin near the incision to help control pain that happens after the procedure.
To find out more about the repair of a pediatric inguinal hernia, talk to your healthcare provider.