Hernia in newborns and infants

Hernia in newborns and infants is a pathology that requires close attention from parents and doctors. We will tell you more about what kind of hernias such small children have and how to treat them in this article.

How does a hernia form

Any hernia is an anomaly in which the internal organs "look" outward, leaving their physiological place. Organs or parts of them pass through an opening, slit, which is normal or defective, and the integrity of the skin or other membranes is not compromised. Protrusion is possible in the space between the muscles if it was formed under the influence of certain factors, under the skin (with an external hernia) or into the internal cavities (with an internal hernia disease).

This formation appears when nature is disturbed by the provided balance between the internal pressure and the resistance of the shell. The structure of any hernia is approximately the same, it includes the hernial sac (stretched shell), the hernial gate - the hole through which the exit and the hernial contents (what is inside the bag) occurred.

The danger of a hernia lies not even in the fact that it has appeared and has a place to be, but in the fact that at any time, under the influence of certain factors or for no obvious reason, it can be strangled. This condition occurs when the hernial orifice is narrow, and the contents of the sac tend to change in volume (for example, the bowel loop as the contents of an umbilical or inguinal hernia can be filled with feces).

The consequences of such a condition are always negative - it is necrosis of a clamped organ or a certain part of it, a condition that threatens the patient's life. In an infant who cannot yet complain of certain symptoms, it can be difficult to identify a hernia at times. It all depends on the attention of the parents and their awareness of where hernias appear and how they look.

Types of hernias in infants

All hernias are divided into congenital and acquired. By the nature of the course of pathology, diseases associated with such formations are divided into complicated and uncomplicated ones. In addition, the international classification provides for the division into primary and recurrent hernias. There are also incisional hernias.

According to the ability to mobility, these formations can be adjusted and not. About a quarter of all diagnoses are internal formations, more than 75% are allocated to external ones. Among children of the first year of life, the following types of hernias are most common:

Diaphragmatic hernia

With such a pathology, part of the internal organs, which should be located in the abdominal cavity, rise up into the chest.

Causes. Diaphragmatic hernias in children of the first year of life are always congenital. The reasons why such a hernia forms at some point in fetal development in a child have not been fully investigated by scientists, but doctors are inclined to believe that the matter is in insufficient elasticity of connective tissue, impaired metabolism in the expectant mother, as well as genetic "failure" ...

Symptoms Symptoms are manifested by severe difficulty breathing in a child, a special shape of the abdomen in the form of a boat. They are immediately noticed by doctors in the hospital. In rare cases, the disease is revealed only after a day or two. The modern level of diagnostics allows you to see such a hernia even on an ultrasound scan during pregnancy.

Treatment. Treatment is always only surgical, and now there is even an opportunity to carry out a correction even before the birth of a child. But such an intervention is associated with rather high risks for the fetus and its mother, and therefore the operation is sometimes postponed until the postpartum period. The baby is sent for urgent surgery immediately from the delivery room. It takes place in two stages - first, a “patch” is made on the hole in the diaphragm from its own piece of skin. And after a while, this patch is removed. If the hernia is not bilateral, then the forecasts are quite optimistic: in 80% of cases, doctors manage to save the life and health of the child. In the case of bilateral hernia of the diaphragm, death is most likely.

Hernia of the white line of the abdomen in a child

These formations, passing in the center of the abdomen perpendicular to the bosom, can be small and large enough - up to 10 centimeters in diameter. The exit of the internal organs occurs between the weak muscle lines of the midline.

Causes. Such hernias can be acquired, but they are always based on congenital abnormalities of the connective tissue, which can disperse, forming rather large "pockets" due to screaming, coughing, constipation, when the baby strongly strains the peritoneum. The weakness of the connective tissue is due to some unfavorable intrauterine factors, such as malnutrition, oxygen, metabolic disorders, and genetic disorders.

Symptoms Such a hernia is unstable in size, and this is its main distinguishing feature. With any movement of the muscles of the tummy, it will visually decrease and then increase. After eating, the child behaves more restlessly than before eating, he is tormented by belching, constipation. In its development, a hernia of the white line goes through several stages: first, a gap appears, which will soon become a hernial gate, after a while you can notice a protrusion of the hernial sac. In the supine position, the hernia becomes more noticeable. And only when the bag is fully formed, symptoms appear.

Treatment. A small hernia does not always need treatment; medicine knows many cases when it goes through the stage of independent reverse development as the child grows. But this process should not be allowed to take its course. Doctors such simple hernias are set manually through the skin, after which the bulge is fixed with an adhesive plaster. The child is assigned a massage. If conservative treatment does not work, the hernia grows in size and there is a very real risk of pinching it, usually a decision is made about surgery, since today this is the only alternative. Surgeons adjust it and suture the pathological opening or fix it with a mesh implant.

Inguinal hernia

This type of childhood hernia disease always has a congenital factor. During the period of intrauterine development, the testes in boys form in the abdomen, and therefore descend through the inguinal canal downward. If by the time of birth, the "tail" from the peritoneum, which is lowered together with the testicles, does not overgrow, and the inguinal canal continues to communicate directly with the abdominal cavity, a hernia in the groin may develop.

In girls, such pathologies occur several times less often, and they are associated with a similar non-closure of the "pocket" (processus vaginalis), which is formed when the formed uterus descends at the 5th month of the mother's pregnancy, from above to the pelvic area.

Causes. The likelihood of developing an inguinal hernia is influenced by the condition of the child's abdominal muscles. In some, it appears at birth, and in some it is found only after a few months. A strong cry, constipation, and bloating contribute to its protrusion.

Symptoms Usually, a non-restrained inguinal hernia does not cause any trouble for a child. It does not hurt, it does not itch. In a state of rest and sleep, it becomes visually indistinguishable. In boys, the formation often appears on the testicles. A scrotal hernia can be both unilateral and bilateral. But in girls, the hernial sac usually protrudes on both sides, while looking for it should be on the labia.

Treatment. An inguinal hernia does not disappear on its own, as sometimes a median hernia of the white line or an umbilical hernia does. An operation is always needed to heal. During surgery, the doctor completely excises the hernial sac, preserving its contents as much as possible. This measure is determined by the state of the organs that were included in it. If there was no infringement, there was no necrosis, then the doctor sets the organs to their places and sutures the hole, which has become the entrance gate for the internal organs.

If necessary, plastic restoration of the damaged or enlarged inguinal canal is also done, it is brought to its normal size in order to prevent secondary prolapse of the abdominal organs. Operations are performed both by abdominal and laparoscopic methods.

Children's surgeon Alexander Ivanovich Sumin will tell you about the danger of an inguinal hernia in the next video.

Umbilical hernia

This is the most common hernia in newborns and children under one year old. It is not directly related to congenital developmental pathologies, unless, after trying, you can find several reasons for the weakness of the connective tissue, which, however, are characteristic of all hernial diseases. However, such a hernia is not an obligatory companion of gross defects in fetal development.

The umbilical cord, which becomes unnecessary at birth, is cut off. The umbilical ring remains. It in a baby should be overgrown with the same connective tissue with which many babies have such problems. Usually this process is completed by the end of the neonatal period. If the process is slowed down or does not go at all, then a hernial sac is formed from a weak peritoneum, in which the intestinal loops, part of the omentum and other internal organs protrude through the umbilical ring.

Causes. The appearance of a hernia provokes a strong load on the abdominal muscles. If a child cries for a long time, coughs, suffers from severe periodic constipation and bloating, his chances of getting an umbilical hernia are very high. In premature babies, the incidence of pathology is higher than in full-term babies.

Sometimes a hernia does not appear in the first months of life, but closer to a year. In this case, doctors consider as one of the reasons for the early setting of the baby on its legs or hanging in jumpers and moving in a walker. Until the peritoneum is ready for the vertical load, the child should crawl - this is a more natural way for him to move. The reason for the appearance of a hernia may be in an incorrectly or poorly tied navel in the maternity hospital, as well as in an infection brought in at the same time.

Symptoms It is not difficult to determine an umbilical hernia in a child - a swelling appears in the region of the umbilical ring, which has a bluish color if intestinal loops are clamped, or reddish if an omentum or part of the liver gets into the hernial sac. The hernia looks like a small (1-5 cm in diameter) rounded nodule with smooth or irregular edges. It bulges out in a child when he cries, pushes during bowel movements or coughs. In a calm state, lying on the back, this nodule is invisible. When you lightly press the knot with your finger, it easily adjusts back. It is already possible to examine a month-old baby at home on your own; it is advisable to monitor the condition of the navel very carefully at least up to a year.

Treatment. In the vast majority of babies, an umbilical hernia heals by itself as the abdominal muscles grow and strengthen. Often, pediatric surgeons set it down, fix it with a plaster and show parents how to change this plaster from time to time. Additionally, a massage is prescribed, which is designed to strengthen the press. They try not to prescribe operative treatment up to 5 years without urgent need. This need arises only when infringement occurs, but this, fortunately, is quite rare.

When carrying out planned operations for children after 6 years old, standard hernia repair schemes are used. Today children undergo both conventional and laser surgeries. After removing the hernial sac, the surgeon can do a plastic surgery of the navel so that the child grows up and does not hesitate to expose the belly (this is especially true for girls).

You can also listen to helpful tips from a professional doctor in the video below.

Cerebral hernia

Most often we are talking about a spinal hernia, which is considered the rarest and most severe in the treatment of pathologies of this kind. It is usually recorded in newborns and infants with musculoskeletal disorders. Almost always, a congenital cerebral hernia leads to disability. The hernia is congenital, but not inherited. This is a sign of abnormalities in the formation and development of the fetus during pregnancy.

Causes. Experts are sure that there is a direct link between a lack of folic acid in the mother's body and such a diagnosis in a newborn baby. About a third of cases are due to infectious causes associated with a severe infection that a pregnant woman had in the first trimester.

Symptoms It is not difficult to recognize such a hernia, despite the fact that not all varieties of the disease have an external protrusion. Symptoms are noticeable even in the hospital, less often - they become obvious already at the first visit to the pediatrician. The child may have paralyzed limbs, he does not control bowel movements and urination, he has multiple dysfunctions from various internal organs. Often, such a hernia accompanies cerebral hydrocephalus.

Treatment. It is impossible to cure such a hernia completely, and even more so at home. Spinal hernial pathology is very difficult to treat in general. If the pathology in the fetus is found on a routine ultrasound scan during the mother's pregnancy, it is possible to operate on the child right in the womb. Using high-precision equipment, surgeons penetrate the baby's spine and close the defect - a gap in the spine. The spinal cord returns to its place. Not all clinics in Russia today can afford to perform such operations, but this area is developing, and soon it will be able to eliminate the need for a pregnant woman to raise funds and go to Israel for such an operation. After a baby with such a hernia is born, he needs a neurosurgical operation for several days. Otherwise, disability is inevitable.

What should parents do?

If a hernia is found in a child, one should remain calm and be able to reasonably assess the situation. Most hernias, with the exception of spinal hernias, are successfully treated, and some in children of the first year of life go away on their own by one and a half years.

If we are talking about common abdominal hernias (inguinal, umbilical, midline of the abdomen, femoral), then it is important to ensure that the child does not cry for a long time, as this provokes an increase in the size of the hernia. It is important to avoid respiratory diseases that come with severe coughing. Regular massage, light gymnastics, and wearing a special orthopedic brace will definitely benefit your baby. But it is not necessary to overfeed a baby with a hernia, so as not to cause indigestion or constipation in him.

You should remember as much as possible the signs of a hernia infringement, because this can happen at any time:

strong pain;
vomiting, nausea;
blanching of the skin;
the hernia looks swollen, tense, it stops adjusting.

At the first similar symptoms, parents should urgently take the child to a surgical hospital or call an ambulance that will do it.

What cannot be done?

You can not try to set a hernia to a child on your own and treat him with folk remedies instead of visiting a surgeon.This can lead to infringement with the development of very negative consequences.