Childhood Hernias

by Steve Holder on November 8, 2008

To many people, a hernia is something that primarily affects middle-aged and older men. But hernias can affect infants also. In fact, one type of hernia – the umbilical hernia – occurs in one out of five newborns. The childhood hernia types include:

Umbilical Hernia

A hernia is a condition in which a bodily organ protrudes through the tissue meant to surround it.  Abdominal hernias are the most familiar type.

In an umbilical hernia, a weakness in the abdominal wall near the belly button allows a small portion of the bowel to bulge out.  This can sometimes occur in newborns because during fetal development, the intestines actually develop outside the body in a sac in the umbilical cord.  Before birth, the internal organs retreat into the body and the opening in the abdomen closes.  When this opening is not fully closed, the organs can create a bulge in the abdomen at the weak point, especially when the infant cries, coughs or strains. This condition is not uncommon, but rarely serious, and almost always heals itself as the baby grows.

Inguinal Hernia

Boys are seven times more likely than girls to experience an inguinal hernia. An inguinal hernia occurs in the lower abdomen on ether the left or right side, and may be either direct or indirect. In a direct inguinal hernia, a small section of protruding intestine creates a bulge in the groin area.  In an indirect inguinal hernia, the bulge appears lower and closer to the genitals.

The indirect type occurs most often in boys because the internal organs protrude into a sac left over after the testes descend from the abdomen into the scrotum. In severe cases, the organs can descend along this path all the way into the scrotum. Though more common in boys, infant girls can also experience an indirect inguinal hernia resulting in a visible lump in the groin adjacent to the labia.

Inguinal hernias do not spontaneously heal and require surgical repair to prevent dangerous complications such as an incarcerated or strangulated bowel.  These are conditions in which the protruding bowel cannot be pushed back into the abdominal cavity, and the blood supply is pinched off by the abdominal wall – potentially resulting in gangrene. Surgical correction is usually uncomplicated and successful.

Diaphragmatic Hernia

The diaphragm is the internal muscle separating the abdominal space from the chest cavity. A diaphragmatic hernia is a birth defect in which a hole in the diaphragm allows the abdominal organs to enter the chest. This interferes with the normal fetal development of internal organs, and often results in a medical emergency at birth because the lungs are not functioning properly.

To correct this condition, the infant is first placed on a ventilator to aid breathing. In more severe cases, the infant may have to be placed on a heart-lung machine. When the baby’s condition is stabilized, surgery is performed to put all the organs in their proper places and close the hole in the diaphragm. Though everything is now where it belongs, the lungs are still underdeveloped and the baby will remain on a ventilator for some time after the operation.

Diaphragmatic hernias occur in approximately one out of every 3,000 births. The survival rate for this condition is approximately 80%.

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