My child has a lump in the groin. Is it a hernia?
In boys, the lump may be a a high testicle, a bowel hernia, abdominal fat lining (omentum) or a hydrocoele. Less commonly it is a lymph node.
In girls, a lump in the groin can be a bowel hernia, an ovary or a lymph node.
The difference between these lumps is quite important. Therefore, all groin lumps in children should be properly checked by a doctor.
Why did my son have a hernia?
During development in the womb, all children have a ring-shaped gap communicating between the abdomen and the groin.
In boys, the testicle tracks through this gap on its journey from the abdomen to the testicle sac (scrotum). If this gap doesn’t close by the time of birth it can allow a trickle of fluid (hydrocoele). Sometimes the gap is large enough to allow fat or bowel from the abdomen to follow the testicle into the scrotum (hernia).
Therefore, hernias are more common in boys because of the link to testicle development and descent. They are also more common in premature babies for the same reason.
Why does my daughter have a hernia?
Again, all children have a ring-shaped gap communicating between the abdomen and the groin. In most baby girls, this gap is closed at the time of birth. However, in some girls it remains open and becomes more obvious as the child grows.
The gap can allow a little trickle of fluid (canal of Nuck hydrocoele). The gap can allow fat or bowel from the abdomen to pop into the groin (hernia).
The ovary lies low in the abdomen and close to the ring-shaped gap. Sometimes, a hernia contains the ovary.
Does a bowel hernia need an operation?
Yes.
If the bowel is moving freely in and out of the groin, then the operation should happen as soon as is feasible.
- If the bowel or fat is stuck within the hernia, it becomes inflamed and tender. The operation should be done as an emergency. The operation is even more urgent if there are signs of bowel blockage.
Bowel blockage or obstruction is suspected when the hernia is tender. The child deteriorates from reduced feeding to vomiting, particularly green vomiting. This is an emergency. The child needs to be reviewed in A+E for stabilisation before emergent surgery.
Does an ovarian hernia need an operation?
Yes. The timing of this operation depends on the status of the ovary.
- If the ovary is moving freely and is not stuck within the hernia, inflamed or tender, then the operation should happen as soon as is feasible.
- If the ovary is stuck within the hernia, is inflammed or tender, then the operation should be done as an emergency procedure.
Are children’s hernias different to adult hernias?
Yes.
Most bowel hernias in children are properly called indirect inguinal hernias. They arise from variations in the development process. Adults tend to have direct inguinal hernias which arise from weakening of the abdominal wall.
This difference matters for two reasons.
- Firstly, the operation for children’s hernias involves closing off the ring-shaped gap. This is done with a strong stitch. No mesh is needed.
- Secondly, your surgeon should be specially trained to perform the operation in children. It can be done both keyhole (laparoscopic) and open, with good outcomes for both approaches.
The doctor thinks this lump is a femoral hernia.
This type of hernia is quite rare in children. Here is some more information on femoral hernias.
The doctor thinks this lump is a direct inguinal hernia.
This type of hernia is quite rare in children. Here is some more information on direct inguinal hernias.
