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Child surgery
Inguinal Hernias
▪ They are commonly seen in approximately 3–5 % of full-term infants. ▪ Male>>>>female, 5: ▪ Girls – more bilateral inguinal hernias ▪ More common on the right side o Indirect inguinal hernia in which the hernia enters through the internal inguinal ring (caused by failure of embryonic closure of the processus vaginalis). o Direct inguinal hernia where the hernia contents pass through a weak spot in the back wall of the inguinal canal which is formed by the transversalis fascia. ▪ Inguinal hernia also occurs more commonly in patients with chromosomal disorders Inguinal hernia
Reducible Irreducible Obstructed inguinal hernia: irreducible, blood supply is intact
Incarcerated Inguinal hernia: adhesions develop between the wall of hernial sac and the intestines preventing it from being reduced. (immediate surgery is needed) Strangulated inguinal hernia: obstructed compromised blood supply, which lead to ischemia Amyand’s hernia: appendix as content Littre’s hernia: Meckel’s diverticulum. Busse’s hernia: testicle is within the hernia sac. Richter’s hernia: a hernia in which only one side of the wall of the bowel is trapped into the hernial sac Sliding hernia: occurs when the herniated organ forms part of the hernia sac. The colon and the urinary bladder are the commonest to be involved in a sliding hernia. Pantaloon hernia (saddle bag hernia): This is a combined direct and indirect inguinal hernia, when the hernial sac protrudes on either side of the inferior epigastric vessels. Maydl’s hernia: This is seen when two adjacent loops of small intestines are within a hernial sac with a tight neck. The intervening portion of bowel within the abdomen is deprived of its blood supply and eventually becomes necrotic. Complications of inguinal hernia repair include: Wound infection Hematoma Scrotal edema Ascent of testis Testicular atrophy Recurrence
Umbilical hernia
● Results from imperfect closure or weakness of the umbilical ring
● contains a few lymphatics, loose areolar tissue, and occasionally a lymph node called Cloquet’s node ● Femoral hernias are rare in the paediatric age group. They form about 0.4– 1.1 % of all groin hernias. ● Coopers’ hernia: a femoral hernia with two sacs, the first being in the femoral canal and the second passing through a defect in the superficial fascia
Lumbar Hernia
● Petit’s hernia: A hernia through Petit’s triangle (inferior lumbar triangle). ● Grynfeltts hernia: A hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle).
Hydroceles
● A hydrocele is a collection of fluid in the scrotum around the testicle ● A narrow spermatic cord felt above the swelling. − It transilluminates. − It does not empty on squeezing ● Surgery is indicated: − If the hydrocele has not disappeared by age 1 year. ● Hydroceles need to be treated surgically when they develop as a complication of ventriculoperitoneal shunts.
Hydrocele of the cord is due to obliteration of the proximal and distal processus, with retention of a fluid-filled sac along the spermatic cord. On examination, a smooth sausage-link mobile mass is palpable in the inguinal canal. Undescended Testes (Cryptorchidism) Undescended testes are relatively common conditions affecting about 3 % of full-term infants and 30 % of premature infant boys are born with at least one undescended testis. cryptorchid testes descend by the first year of life (the majority within 3 months) Mostly bilateral, for unilateral - left is more commonly affected Undescended testes are associated with: − Reduced fertility. − Increased risk of testicular germ cell tumors. − Psychological problems at the time of puberty. − testicular torsion and infarction. − associated with inguinal hernias. − To reduce these risks, undescended testes are usually brought into the scrotum in infancy.
− Cryptorcidism occurs at a much higher rate in those with Down’s syndrome, Prader–Willi syndrome, and Noonan syndrome. − Spigelian hernia The primary management of cryptorchidism is surgery (orchidopexy). Prognosis: Fertility, Testicular Cancer
