Hernias and hydroceles
When infants are in utero (before birth), there is a passageway between
the lining of the abdomen and a sac that is present in the groin area (inguinal
canal and scrotum). Usually, this passageway closes before birth. However, when
it stays open, anything that is contained in the abdominal cavity can now come
through the connection and into the sac.
When the sac contains only fluid, it is called a hydrocele . When the sac
contains any material other than fluid (such as bowel, fat, bladder) it is known
as a hernia . In both conditions, the defect is the same, namely, the persistent
communication between the abdomen and the groin/scrotal area. This is the reason
that the surgical correction of both of these conditions is essentially the
same.
How common is this condition?
Inguinal hernias occur in four percent of all children.
In premature infants, the incidence is much higher—approximately 30 percent.
Hydroceles occur in approximately 15 percent of all male infants. Most
of these conditions are noticed within the first
year of life. Hernias
and hydroceles are nine times more common in boys than in girls and
are most commonly (60 percent) found on the right side. However, they can occur on
either side or both sides.
Diagnosis
Fetal hydrocele can be diagnosed by ultrasound
(sonogram) examination prior to birth, generally within the third trimester.
Evaluation of the urinary system is part of the routine ultrasound examination
done by many obstetricians as part of their routine prenatal care.
The need for repair
In both conditions,
the opening can be large enough to allow a section of the bowel to come down
into the groin area and twist enough on itself such that it can't be pushed back
into the abdomen. This causes a blockage of the bowel with the possibility that
the twisted section can lose its blood supply and die.
When a child has a hernia that has not yet been surgically corrected, the
section of bowel that has become trapped in the sac bulges into the scrotum and
the groin becomes larger, redder, and/or tender to the touch. The child may also
become fussy or uncomfortable, vomit, and develop a distended abdomen. THIS A
SITUATION THAT REQUIRES IMMEDIATE ATTENTION.
Treatment for a hydrocele (or hernia)
The treatment for hydrocele/hernia is surgery. In some situations,
especially when the infant is under one year of age and the passageway is small,
the passageway may close without treatment. However, if the hydrocele gets
larger or, if in the course of a day, there are large variations in the
hydrocele's size, this suggests that the passageway is unlikely to close
spontaneously, and surgery should be considered sooner rather than later.
The surgery, which is not considered a dangerous
procedure, is performed on an outpatient basis; it is one of the most common
procedures performed by a pediatric urologist. The procedure takes about one to one and one-half hours, and the
child is under general anesthesia. A small incision is made in the groin area.
The passageway (the area of communication) is identified and tied off. Depending
on the size of the defect, it is uncommon for the hydrocele or hernia to return.
However, in cases of very large ones, the potential for recurrence is much
higher.
Long-term outlook
After the fetal hydrocele disappears on its own or is
surgically repaired, the long-term outlook for the child is very good as long as
there are no other associated abnormalities. Children should have no long-term
effects or complications as a result of this condition.
See information on this same
topic as written by physicians in Pediatric General Surgery.