Inguinal Hernia and Hydrocele in Children
These problems are seen as swelling in the lower part of the abdomen or scrotum. If the swelling remains constant in size it is usually due to accumulation of fluid around the testis, known as hydrocele. However if the swelling increases in size on crying, coughing, straining at the time of defecation or lifting weight and reduces on remaining calm, then it is known as inguinal hernia. In hernia, intestines descend from the abdomen to inguinal canal and reduce on remaining calm.
There is a possibility of spontaneous resolution of fluid by the age of 2 years, hence we can safely wait till two years of age in hydrocele child. However, in case of hernia, the intestines can get trapped at any time, hence should be operated as soon as the condition is diagnosed(even in the newborn period).
Surgery in both these cases is similar and daycare surgery. In both these conditions, the passage through which fluid/intestines descend down is closed.
Undescended testis or cryptorchidism is a condition in which testis doesn’t drop and /or can not be brought into the scrotum with external manipulation. Before the male child is born, testes of the unborn baby are situated inside the tummy. They slowly move down into the scrotum through a small passage called inguinal canal during 7th month of pregnancy. Scrotal sac is cooler than the rest of the body temperature, which is ideal for the function of testis.
UDT occurs in 3% of newborn males and up to 21% of premature newborns. Most of the testis come down to the scrotum by 6 months of age. UDT can be found in belly, inguinal canal or perineal region. In 10-15% of the cases UDT is seen on both sides, while in 6% of cases, father also had the history of UDT.
UDT which is located at an abnormal is exposed to higher temperatures hence spermatogenesis is hampered. Abnormally located testis is more likely to get traumatized during day to day activity. Testicular torsion is also more common in UDT in which there is twist and reduction of blood supply which leads to eventual loss of the testis. UDT are having higher chances of cancer than normal.
UDT should be operated as soon as possible after 6 months of age. Orchidopexy is done as a daycare surgery. Laparoscopic orchiopexy is performed when testis can not be felt on clinical examination or can not be located sonographically.
It is very important to differentiate between retractile testis from UDT as former doesn’t require surgical correction.