Hernias and Hydroceles in Premature Infants

ER - Madison

4 min Average

Hernias and Hydroceles

What is a hernia?

A hernia is a protrusion of a loop of bowel from the abdomen into an area where it normally would not be. In babies the most common hernias are inguinal hernias and umbilical hernias. An inguinal hernia develops in the groin at the level of the skin crease between the leg and the abdomen. In a baby boy the bowel loop protrudes into the scrotum. An umbilical hernia develops after the cord comes off and is an outpouching where the cord used to be. Hernias are usually not present when the baby is born but develop later.

Why did my baby get a hernia?

A hernia develops when there is failure of certain openings to close during development. Normally the sides of these tissues come together and then seal over. If they don't seal, they can reopen and then fluid and loops of bowel can slide into the opening or sac. The closing process usually occurs in utero when the baby's tummy is flat and the intestines are small. When babies are born prematurely and they use their intestines earlier, there is more pressure and fullness to the tummy. This makes the risk for a hernia greater.

Hernias are more common in:

  • smaller babies
  • boy babies
  • babies who have had lung disease

What is done for a hernia?

Umbilical hernias will usually go away during the first year or two of life. They only need to be repaired surgically if they become very large or if a loop of bowel gets caught or trapped in the hernia (incarcerated). Inguinal hernias usually need to be repaired surgically. The timing of surgery varies. Tiny babies are more likely to have their hernias incarcerate, that is to have the loop of bowel get trapped in the hernia sac. But, tiny babies also have more delicate tissue and sometimes handle anesthesia less well. Therefore, the surgeon must weigh several factors in selecting the best time for repair. However, any time that the bowel appears to be trapped in the hernia, it is an emergency, and the hernia needs to be repaired right away.

Why is incarceration of a hernia so bad?

When a loop of bowel gets caught in the hernia, it swells. This cuts off the blood supply to that loop of bowel and the bowel loop can die and/or rupture. Also, in a boy baby, the swollen loop of bowel can cut off the blood supply to the testicle on the hernia side, causing injury or death to the testicle.

How will I know if the hernia is getting into trouble?

There are several signs of incarceration. Not all may be present. These include:

  • Cannot reduce the hernia, that is get the loop of bowel to go back into the tummy. This is the earliest and therefore the most important sign.
  • Inconsolable crying, pain
  • Soreness or tenderness over the hernia
  • Redness or bluish color in the groin or the scrotum
  • Vomiting

What is a hydrocele?

A hydrocele is a collection of fluid in the scrotal sac (by the testicle). If it is present at birth, usually it will go away slowly. The baby usually does not need surgery. If, however, the fluid collection increases, does not decrease in size or disappear in the first six months of life, or is accompanied by a hernia, it probably will need to be fixed by surgery.