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[Inguinal hernia in children: easily incarcerated]
Yvonne Wimper1,2, Eva Stortelder3, Sanne M B I Botden3
1Deventer Ziekenhuis, afd. Urologie, Deventer.
Insights
Undiagnosed inguinal hernias in children can lead to serious complications. Delayed diagnosis and treatment increase risks, highlighting the need for timely surgical repair in pediatric patients.
Area of Science:
- Pediatric Surgery
- Embryology
- Clinical Medicine
Background:
- Congenital inguinal hernias result from incomplete obliteration of the processus vaginalis during embryonic development.
- The hernia sac may contain abdominal contents like bowel or ovaries, posing risks to pediatric patients.
- Diagnosis relies on clinical history and physical examination, with guidelines recommending prompt surgical intervention.
Observation:
- Three pediatric cases illustrate severe complications arising from unrepaired inguinal hernias.
- A review of 243 surgically treated congenital inguinal hernias (Jan 2018-Aug 2019) revealed 13.6% presented with acute incarceration.
- An additional 6% of patients received incorrect advice, leading to delayed surgical referral.
Findings:
- Inadequate patient referral and delayed diagnosis are significant issues in managing pediatric inguinal hernias.
- A substantial percentage of children with inguinal hernias experience acute complications like incarceration.
- Misinformation from primary care physicians contributes to delayed treatment and potential adverse outcomes.
Implications:
- Timely surgical repair of pediatric inguinal hernias is crucial to prevent incarceration and associated complications.
- Improved diagnostic pathways and referral protocols are necessary to ensure prompt surgical consultation for affected children.
- Educating primary care physicians on the urgency of pediatric inguinal hernia management is vital to improve patient outcomes.
Abstract:
Inguinal hernia in children is caused by an incomplete obliteration of the vaginal process during the embryological development. The vaginal process can thus become a hernia sac that often contains bowel and in girls, an ovary. The diagnosis of inguinal hernia is made by history and physical examination. According to current guidelines surgical repair should be performed without delay to avoid incarceration, which gives a high risk of complications, including testicular atrophy and ischemia of vital organs. However, patients are regularly not referred adequately. We present three cases of children who developed complications of a non-repaired inguinal hernia. Additionally, the data of all children with a congenital inguinal hernia, surgically treated from January 2018 until August 2019 show that out of 243 children 13.6% presented acutely with an incarcerated inguinal hernia. Another 6% received a wrong advice from their primary care doctor and was not referred to a (pediatric) surgeon.
