- Why does a hernia form?
- How is it formed?
- What are the signs of a child's pathology?
- What complications are possible with an untreated hernia?
- What is needed to confirm the diagnosis?
- How to prepare a child for the planned operation?
- How is the operation?
- What should I do in the postoperative period?
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The hernia of the white abdominal line in children is a relatively rare disease. Only 1% of the child population is identified. More often not in newborns, but in preschool age (5-7 years). Babies have umbilical hernias.
Pathology is the protrusion of the peritoneal cavity into the opening formed by the divergence of weak bundles of the tendons of the oblique and rectus abdominal muscles. The disease is characterized by a progressive course, the inability to fuse the defect in the child's growing up.
Why does a hernia form?
Scientists believe that the main changes occur during the development of the fetus during the formation of the abdominal wall. Slight thin sites with fibrous insufficiency of tendon tissues are formed (deficiency of collagen and elastin). They subsequently become an entrance gate for hernias.
In children, hereditary pathology comes first among causes of hernia. But it is necessary to reckon with the acquired factors that create unfavorable conditions. These include states that promote increased intra-abdominal pressure, weakening of muscle-tendon structures.
It is necessary to identify the cause of the baby's cry, a healthy child behaves calmly
The growth of pressure inside the peritoneum occurs in children under the influence of:
- frequent screaming;
- straining with constipation;
- severe cough in whooping cough, respiratory infections, laryngitis;
- excessive physical exertion;
- excess fat deposition.
In children with severe diseases of the cardiovascular system, the formation of ascites (a large belly due to sweating plasma from the peritoneal vessels) is possible. Disturbed development of muscle tissue contributes:
- lack of sufficient protein, vitamins, microelements (fruits, vegetables, fish) in the child's nutrition, predominance of fats and light carbohydrates (sweets, cakes, butter, fatty broths);
- underfed, hungry, exhaustion;
- abdominal trauma (bruises, wounds, transferred operations).
How is it formed?
In the structure of tendon fibers there are slit-like holes through which the vessels and nerves pass. They are filled with fatty tissue located in front of a leaflet of the peritoneum (preperitoneal). Most of the cracks are in the upper and middle parts of the white line. Therefore, the most common epigastric form of the hernia (nadpupochnaya).
On the localization, the hernia of the peri-puer zone (para-ulbical) located in the lower part (hypogastric) is still isolated. They are not widely spread, because in these areas the aponeurosis of the white line is more dense and thick. Hernia formation takes place in 3 stages or phases:
- Preceding- is accompanied by penetration through the expanded bundles of fatty tissue fibers, a preperitoneal lipoma is formed. It is not considered a hernia, but the place of the future pathology has already been indicated.
- Elementary- in a weak area the bundles of tendons diverge and form future hernial gates. Most often they are localized in the navel and above. The discrepancy varies from insignificant to 5-6 cm with hernias of medium size to 10-12 cm - with giant ones. In the area of the defect is squeezed out a leaflet of the peritoneum, behind it extends the omentum.
- Formation of a hernial sac- the continuation of negative influences leads to a significant exit of part of the peritoneum into the hernia gates. There is a formed saccular formation with a neck and a body, in which, apart from the omentum, there may lie a loop of the intestine (thin or transversal), a wall of the stomach.
The development of a hernia can stop at the first stage before the formation of the hernial gates. Such cases are most favorable, since there is no condition for falling out and infringement of internal organs. When the effect is not one, but several reasons, immediately formed 2-3 hernias in the white line of the abdomen. The variant is called plural.
On the photo, a doctor examines the abdomen of a baby
What are the signs of a child's pathology?
The hernia of the white line of the abdomen refers to diseases that are diagnosed almost unmistakably when the child is examined. The existing system of prophylactic receptions of newborns and preschool children with the participation of a surgeon gives parents the opportunity to consult with a specialist.
The main sign of the hernia is a painful soft protrusion under the skin on the abdomen of the baby on the projection of the white line. It increases if the child strains, screams. The older children are checked in standing position. With a fairly wide opening, the hernial sac palpable without straining, and the prickle disappears. If the children are concerned about soreness, then one should think about signs of temporary infringement.
Pain can cause formed spikes. The older children describe the pulling pains in the hypochondrium, in the back. Frequent symptoms of a hernia are bloating from stool retention and non-occurrence of gases. When these symptoms are combined with vomiting, nausea, and hernia's non-controllability in the recumbent state, serious fear arises for infringement of the hernial sac. This condition requires immediate surgical intervention.
What complications are possible with an untreated hernia?
The absence of timely measures can cause complications:
- trauma - promotes swelling, inflammation of the hernial sac components with the transition to the abdominal cavity;
- irreparability - can be caused not by pinching, but by a soldering process between the skin, the wall of the hernial sac, the leaflet of the peritoneum and the organs inside;
- infringement - compression of the bag contributes to the violation of blood circulation in the ingested formations, necrosis of the intestinal wall causes gangrene and diffuse peritonitis.
What is needed to confirm the diagnosis?
Usually doubts arise at the doctor at atypical pains. Then additional examinations are appointed to exclude the pathology of the stomach, liver, bile ducts. Careful palpation of the baby's abdomen allows you to define a soft, elastic formation with a characteristic localization. In the presence of an intestinal loop inside the bag, a rumble of gases is felt by hand.
Ultrasound is harmless to the child
To prepare for surgery, the surgeon needs to know more precisely which organs are involved in the prolapse, whether they are spliced together, and the size of the hernial gates. Therefore, an ultrasound is prescribed, a computer tomography. Less commonly used radiography with contrasting, herniography (sterile contrast substance is introduced into the cavity of the hernial sac).
To prepare a child for a planned operation and a safe postoperative course, the doctor needs to know the general condition of the patient. Therefore, blood, urine, and feces are analyzed. Perhaps additional types of examination.
How to prepare a child for the planned operation?
When a hernia of the white line is identified, the child is assigned surgical treatment in a planned manner. This means that there is time for preparation. Parents should not waste their energy on the advertised ways of "curing". It is this type of hernia that has no tendency to self-infestation.
The older child needs to be tuned to a future operation, you can not frighten him. Parents should not allow stress, explain calmly the need for treatment for further physical development. When agitation, sleep disturbance, you should consult a pediatrician and apply a light vegetable soothing medication. Particular importance is given to dietary nutrition.
Diet before surgery
Nutrition before the operation of the child requires sufficient protein and vitamins, carbohydrates to meet the requirements for "building material" and energy cells. Fats should be only necessary for the age of the amount. Products that can cause increased fermentation in the intestine are excluded, gas formation:
- fresh vegetables;
- chips, crackers;
- butter and animal fat;
- tomatoes, cabbage in all kinds;
- chocolate, sweets, cakes;
- Rye bread;
Do not affect cereal products (cereals, casseroles, soups), nutritionists especially recommend dark varieties of rice, carrots and cucumbers, stewed fruit, low-fat fish dishes, chicken, veal, egg white, cottage cheese. Dairy products are carried in different ways by children. If there is no gassing, it is better to give kefir or yogurt.
How is the operation?
Surgical treatment consists in an operation under general anesthesia. The child is done with a calming injection in the ward, in the presence of the mother, the baby falls asleep, so they do not frighten the operating room. The type of operation is called hernioplasty.
In the process of preparation, the surgeon develops a decision on how to close the abdominal wall defect. This largely depends on the size of the hernia. In small formations, the margins of the hernial foramina are tightly sealed. If the dimensions are medium or large, it is necessary to provide a plastic version.
When the necrotic area of the intestine is removed (resected), the ends are connected in various ways, the operation is delayed, in the postoperative period, a period of nutrition with intravenous solutions
It is performed by:
- own tissues;
- synthetic materials.
The surgeon opens the skin and abdominal wall. Inspects the condition of organs in the hernial sac. If there is no doubt about their damage, then immersion in the abdominal cavity, dissection of adhesions. The signs of the disturbed blood flow indicate the suffered impairment. This increases the complexity of the operation. It is necessary to remove all non-viable tissues. The bag formed from the peritoneum is excised.
In suturing the hernial gates, the use of synthetic mesh is most effective. It does not subsequently give as many relapses as the usual way of tightening the hole with threads. Tactics allows you to eliminate and fix the discrepancy of muscles, which ensures complete recovery of the child. The operation lasts 40-60 minutes. Children wake up in the aftercare room.
What should I do in the postoperative period?
In some clinics, early discharge of patients with uncomplicated operations is practiced - on the second day. Other doctors consider it necessary to observe at least 3-4 days. The time lengthens if the operation was carried out for emergency indications if there is an infringement of the organs. Removal of sutures is performed on day 8-10 in the children's polyclinic.
From the second day it is recommended to walk a little, to play sitting. The stitch is daily treated with greenery and sealed with a sterile napkin. To wash under a shower it is authorized only after removal of seams. Until then, the patient's body needs to be wiped with a warm warm towel, twice a day to wash the baby.
Meals in the early days are only liquid: low-fat broth from chicken meat, fish, porridge on the water (oatmeal, boiled rice), vegetable puree. Kefir, yoghurt, cottage cheese, fruit jelly, broth of a dogrose, not strong tea, sweetened with honey are solved. During the month should refrain from fried foods, sweets with cream.
Doctors advise in the rehabilitation period to give the child multivitamins with minerals, calcium preparations. They improve health, promote healing. Wearing a bandage is recommended 2-3 months. Strict restrictions on physical activity are needed in the first 20 days. Schoolchildren are exempted from physical education for a period of three months to six months.
Doctors recommend for disinfection of the wound to use not iodine, but "zelenok", it does not "burn" the edges, promotes healing
Serious prevention of hernias, as well as of other hereditary pathologies, should begin in the embryonic period, when the organism of the future mother is responsible for sufficient supply of the fetus with everything necessary for the proper construction of tissues and organs.
Infants have a regularity of feeding, the quality and timeliness of complementary feeding, doing exercises lying on their stomach, everything that prevents constipation. Screaming with any painful symptoms is a signal to call a doctor, creating dangerous conditions for increasing intra-abdominal pressure.
For older children, overfeeding is unnecessary, a set of excess weight, allow parents to eat fast food products, excessive sweets. It is useful to do sports, running, swimming. The experience of surgical treatment of hernias in childhood allows parents to recommend not to delay the period of preparation. Correct attitude to surgical intervention helps to avoid serious complications and provide the child with healthy physical development.