Inguinal Hernia

What is an inguinal hernia?

A hernia is present when an opening is present in the abdominal wall through which a sac protrudes from the abdominal cavity through the abdominal wall. In pediatric patients it is generally a congenital abnormality and not something which develops after birth.

In adults, these may occur from progressive weakness of the abdominal wall, but this is rarely true in infants, children, or teenagers. A hernia will be apparent if there is a soft bulge in either the inguinal area (the crease between the abdomen and the top of the leg) or in the scrotum.

A hernia that occurs in the groin area is called an inguinal area. Part of the abdominal contents, such as intestines, can be pushed through this opening. Inguinal hernias occur in 2 percent of all children but are more common in boys than girls. They may occur on either side, but they are more frequent on the right side.

Illustration of an inguinal hernia into scrotum and inguinal hernia into canal.

What causes an inguinal hernia?

The testicles develop in boys in the back of the abdomen just below the kidney. During development of the fetus, the testicle descends from this location into the scrotum pulling a sac-like extension of the lining of its abdomen with it (inguinal hernia into scrotum). This sac surrounds the testicle into adult life, but the connection to the abdomen generally entirely resolves. If this does not occur a hernia will result with the sac extending from the abdomen through the abdominal wall and into the inguinal canal (inguinal hernia into canal), where it ends in the groin or it can persist going all the way into the scrotum and the sac surrounding the testicle.

Inguinal hernias are apparent only when there are contents from the abdominal cavity within the sac. In infants and children, the sac may not be apparent if contents from the abdominal cavity have not escaped from the abdomen into the sac because the opening in the abdominal wall is too narrow to allow this to occur.

With development, the abdominal wall becomes stronger and can push contents through the opening into the sac often dilating this opening. Some factors place children at higher risk for inguinal hernias such as:

Although girls do not have testicles, they do have an inguinal canal, so they can develop hernias as well. It is often the tube and ovary that fall into the hernia sac.

Occasionally, in both boys and girls, the loop of intestine that protrudes through a hernia may become stuck and cannot return to the abdominal cavity. If the intestinal loop cannot be gently pushed back into the abdominal cavity, that section of intestine may lose its blood supply. A good blood supply is necessary for the intestine to be healthy and function properly.

What are the symptoms of an inguinal hernia?

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 as the contents of the sac go back into the abdomen.

If the hernia is not reducible, then the loop of intestine may be too swollen to return through the opening in the abdominal wall and it may require urgent surgery.

How we care for inguinal hernias

The Boston Children’s Hospital Department of Urology is a world leader in pediatric urology, offering specialized care for a wide range of urologic disorders in children and adolescents. Our team has special expertise in the treatment of inguinal hernias.

The Boston Children’s Department of Surgery provides general and specialized surgical services to infants and children suffering from inguinal hernias. Our team has special expertise in the treatment of inguinal hernias and will collaborate with you to design a care plan appropriate for your child.