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Boston, MA 02115
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My Child Has:
Inguinal Hernia and Hydrocele
Programs that treat this condition
Andrology Program   General Surgery Program  
What are hernias and hydroceles?
Hernia figure 1 A pediatric hernia is a protrusion of an organ, usually the intestine, into the groin that appears as a lump. An inguinal hernia occurs when the intestines or membranes known as omentum pass through the opening.

A hydrocele is the swelling of the scrotum due to fluid that has collected inside. A hydrocele occurs when fluid escapes through this opening and passes into the scrotum causing it to enlarge. This type of hydrocele is called a communicating hydrocele. A hydrocele is noncommunicating if fluid is in the scrotal sac, but there is no opening between it and the abdominal wall.

Hernia figure 2 Either of these conditions can occur when, during fetal development, the opening between the abdomen and the scrotum doesn't close like it should shortly prior to birth.

These conditions are generally not painful to the child. Infrequently the intestines (or the ovary in a girl) may become fixed within the hernia sac which can result in discomfort and the need for a more urgent surgical repair.

How often do these conditions occur?
The incidence of communication hydrocele / inguinal hernias in children is estimated to be between 10 and 20 per 100,000 live births. A hernia is five times as common in boys as in girls affecting approximately 3-5 % of all full term infants and 5 to 10 percent of male infants. Prematurity and low birth weights dramatically increase the risk of hernias and communicating hydroceles.
What are the symptoms of inguinal hernia and hydrocele?
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Inguinal Hernia
(click to enlarge)
Hernias usually occur in newborns, but may not be noticeable for weeks, months or even years after birth. Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable.

Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If your physician pushes gently on this bulge when the child is calm and lying down, it will usually get smaller or go back into the abdomen.

If the hernia is not reducible, then the loop of intestine may be caught or incarcerated. The following are the most common symptoms that indicate this has occurred. However, each child may experience symptoms differently. Symptoms may include:

  • a full, round abdomen
  • vomiting
  • pain or fussiness
  • redness or discoloration
  • fever
This is an emergent problem and that requires immediate medical attention.

The following are the most common symptoms of hydrocele. However, each child may experience symptoms differently. Symptoms may include the following:

  • A mass that is usually smooth and not tender.
  • A communicating hydrocele will fluctuate in size, getting smaller at night while lying flat, and increasing in size during more active periods.
  • If the hydrocele is large and tense, it may require more immediate attention.
How are hernias and hydroceles diagnosed?
Often, parents notice a bulge in the groin area or an enlarged scotum when the child is crying, straining, or laughing. During periods of rest the parents may notice a decrease in the size of the inguinal or scrotal bulge. Since the bulge may not be present during physical examination of your child, the doctor or specialist will want to know about the bulge and when you see it. In many cases, the information provided by parents alone is the basis for a diagnosis since the hernia or communicating hydrocele may not be present at the time of the visit as the fluid or intestinal contents return into the abdomen. The doctor will probably try to press on the abdomen to see if the inguinal hernia will emerge.
Treatment Options
Inguinal hernias must be repaired with surgery. In most cases, especially with infants, the surgeon will operate soon after a diagnosis is made to prevent any complications with the hernia. The surgery involves tying shut the sac that protrudes from the opening of the abdominal wall. When repairing an inguinal hernia on one side, the surgeon may use an endoscope (a slender instrument with a telescope and light) to see if the abdominal wall on the other side has a similar opening. If so, the surgeon will repair this as well.

A non-communicating hydrocele generally clears up on its own within the first year of life. The doctor will want to continue to check up on your child's hydrocele. If the problem persists beyond 1 year or your child's hydrocele is becoming intermittently enlarged that usually means the hydrocele is communicating and the doctor may recommend surgery to remove the excess fluid and close the opening in the abdominal cavity. It is always best to consult with your pediatric surgeon as to which patients are best observed and which are best repaired surgically.

For healthy infants and children, surgery to repair either a hernia or a hydrocele is performed as day surgery under general anesthesia. Postoperative discomfort is minimal due to the small incisions needed to correct this condition and the unique ability of children to tolerate this procedure with minimal discomfort.

Long-term outlook for inguinal hernia:
Once the hernia or hydrocele is closed, either spontaneously or by surgery, it is unlikely that either problem will reoccur. Reoccurrence happens slightly more frequently if the intestine was damaged.
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