Inguinal hernias (groin hernias) occur in about 2% of children, more in boys than girls. Unlike adults who develop hernias, children are born with them. The most common is the inguinal, or groin, hernia. It may present as a bulge to either side of the pubic bone when the child cries or strains, or as fluid appearing next to a boy’s testicle after birth. The opening from the abdomen into the groin allows intestine (or an ovary in a girl) to get into the hernia and possibly get stuck (an “incarcerated hernia”, which may progress to a “strangulated hernia”). These hernias should be repaired soon after diagnosis, as long as the baby or child is in good health. If the hernia does become incarcerated, emergency surgery may be necessary.
Umbilical hernias, openings in the wall of the abdomen at the “belly-button”, are very common. Most are small and will close off by themselves by the time the child is 3 or 4 years of age. Tape, coins, or belly-binders do not help the hernia close and may irritate the skin. Only those hernias that are very large, with an opening bigger than the diameter of an adult’s thumb, or those that do not close by age 5 years, need surgical repair. They rarely get intestine stuck in them. An experienced pediatric surgeon will repair the hernia in a way that the healed belly-button looks as normal as possible.
Epigastric hernias are seen as small lumps in the midline of the upper abdomen (epigastrium), anywhere between the umbilicus (belly-button) and the breast-bone. They represent fat protruding from inside the abdomen through small defects in the thick covering (fascia) between the two big abdominal muscles and are noticeable when the child stands up or cries. Protruding fat can get stuck in the hernia – a very painful event. They do not close by themselves and require a simple surgical procedure.
Femoral hernias are rare in children. They present in the upper thigh, right below the groin crease, and may be mistaken for inguinal hernias. They can become incarcerated, and should be closed when recognized. Like femoral hernias in adults, they require a more complicated type of repair, with permanent sutures.
Almost all of the above hernias in children can be repaired as ambulatory (same-day) procedures, in a hospital or ambulatory surgery center.