A hernia of the white line of the abdomen in children (epigastric hernia) is a protrusion of the hernial sac that appears through the aponeurosis slits in the anterior wall of the abdomen. To remove a hernia, highly skilled surgical intervention is required.
A hernia of the white line of the abdomen appears in the area of the so-called. white line - tendinous band, which goes from the xiphoid process to the pubic fusion. The white line is wider in the upper abdomen, narrows in the lower part, so the risk of a hernia is higher here.
When a hernia appears, tendon fibers can disperse along the white line by 10–12 cm (diastasis). There is a possibility of diastasis in the umbilical hernia.
The shape of the hernia gate can be round, oval or diamond-shaped. The narrower they are, the greater the likelihood of hernia being strangled. With disposable hernias palpation of the hernial ring is possible.
Unlike other types of hernia, hernia of the white line of the abdomen in a child is quite rare (about 0.8% of cases). It usually occurs after 5 years due to insufficient development of aponeurosis. As a result, the appearance of cracks in the tendon bridges. Hernia infestation is rare.
Often the hernia of the white line is single, but in some cases there are several hernias that are located one above the other.
Symptoms of hernia in a child
The main symptom of a hernia is bulging, in which pain is observed, usually in the epigastric region.
When a hernial sac is strangulated, the following symptoms are observed: severe pain at the site of the hernia, in severe cases vomiting, fever, general weakness, bloating and irritation of the peritoneum.
Hernia is very difficult to right inside, touching it causes pain. In some cases, the hernia proceeds without symptoms and is detected only when the child is examined by a doctor.
Increased pain is possible after eating, sudden movements, straining, exercise. Often there are digestive disorders: belching, nausea, constipation, heartburn.
Causes of hernia
Causes of white line hernia in children are usually congenital. The main reason is congenital weakness of connective tissues. Among other reasons, it should be noted gender (hernia often occurs in boys), obesity, constipation, ascites, chronic bronchitis and whooping cough, postoperative scars, etc.
Hernia types and stages of its development
Depending on the location of the hernia in relation to the navel, there are several types of hernia of the white line:
There are three main stages of hernia development:
- preperitoneal lipoma - bulging of subperitoneal fat.
- the initial stage is the appearance of a hernial sac, where internal organs begin to fall.
- formed hernia - the divergence of the rectus muscles and the loss in the bag of individual sections of the walls of the small intestine.
Diagnosis of hernia
A complete diagnosis of hernia of the white line will help to detect the disease in a timely manner and effectively cure it. Examination of the abdomen is carried out in the horizontal and vertical position of the patient with tense and relaxed muscles of the abdominal wall.
The following methods are used to diagnose the disease:
- examination of the patient
- questioning and history taking,
- auscultation and palpation of hernia,
- X-ray examination of the stomach
- Ultrasound of the contents of the hernial bag,
- urine and blood tests,
- MRI and CT hernia (in difficult situations).
Differential diagnosis of hernia of the white line is usually carried out with the following diseases:
- stomach ulcer,
- metastasis of the tumor in the omentum.
Photo: a special bandage for a child
After the diagnosis, the doctor chooses hernia treatment. The most effective method is surgery. If the hernia is not removed in time, then there is a risk of hernia complication and its further development. Activities such as massage for hernia, wearing a bandage, etc. can only slow down the development of a hernia, but not eliminate the disease.
Contraindications to surgery are serious diseases, the presence of infections in the body and the non-attachability of the hernia. In the presence of data contraindications required to prevent an increase in hernia in size. To do this, the child must wear a special bandage.
Surgical removal of a hernia - hernioplasty. The operation is usually performed under general anesthesia. The main types of operations: plastic surgery with local tissues (tension) and plastic hernia with an endoprosthesis (non-tension).
Hernioplasty with the use of its own tissue is carried out to remove small hernias. In this case, the hernia is removed with the help of continuous netchild catgut sutures. Stretch hernioplasty can cause hernia recurrence, since the stitches can not withstand heavy loads and cut through.
Hernioplasty using the endoprosthesis is usually performed to remove small and medium sized hernias. This is the most effective surgical treatment of hernia. Modern endoprostheses are characterized by high reliability and elasticity, without limiting the mobility of the abdominal wall.
The use of the endoprosthesis provides the following advantages in comparison with the tension plastic:
- painlessness As a rule, patients do not need to take painkillers after surgery.
- short term rehabilitation. The duration of the operation is about an hour, and the next day the little patient can be discharged. In some cases, he may stay in the hospital for another couple of days.
- slight risk of recurrence. The probability of recurrence after using this method is no more than 1%, whereas when using the tension plastic - 20-40%.
Photo: surgical removal of hernia
When preparing a child for surgery, he should be fed with vegetables, cereals, rice, fruits, fish, egg white, low-fat cheese, etc. Sharp and fatty foods, including spices, should be excluded from the diet.
To speed up postoperative rehabilitation, the doctor prescribes a special diet, rich in fruit and vegetable juices, cereals, and mashed potatoes. However, it is not recommended to abuse fiber in order to avoid colic and flatulence. Calcium, vitamins B and C should also be given to the child after surgery.
In the postoperative period, the use of products that contribute to the development of constipation and gas formation is extremely undesirable.
The main complication of the hernia of the white line of the abdomen is its incarceration, in which the hernial contents in the hernial ring are suddenly compressed.
If a hernia is strangled, the child is given emergency surgery, which may involve large amounts of resection. The main symptoms of infringement are vomiting, nausea, severe abdominal pain, inability to correct a hernia, the presence of blood in the feces.
Another complication of the hernia of the white line of the abdomen is the non-attachability of the hernia. In this case, the hernia contents are connected to the walls of the hernial sac.
In addition, possible injury and inflammation of the internal organ located in the hernial sac, as well as intestinal obstruction.
As a prophylaxis of hernia of the white line of the abdomen in infants, regular bowel movements should be carried out. You should also ensure that the baby does not overeat, and its intestines worked reliably.
For children aged 5-10 years of age, moderate physical activity classes are effective prevention of hernia formation.
It is necessary to take the child regularly for routine check-ups to the doctor and to teach the child to moderate hardening.
In the presence of a hernia, weight lifting is strictly prohibited. In this case, the intra-abdominal pressure increases, due to which the hernial ring is stretched, and the internal organs fall into the hernial bag.
In conclusion, it should be noted that hernia of the white line of the abdomen in children can only be eliminated with the help of a surgical operation. It is very important to carry out the diagnosis and operation in a timely manner, otherwise complications may occur, first of all, the incarceration of the hernia. But after the operation, it is necessary to carefully follow all the recommendations of the doctor to prevent relapse.
Hernia of the white line of the abdomen is diagnosed very often in children older than 2-3 years. Sizes vary from small, not more than a centimeter, to giant hernias. In the midline of the abdomen, you can see with the naked eye a rounded, smooth, elastic formation, most often painless and easily adjustable. Usually, only preperitoneal fatty tissue goes into the defect of aponeurosis. Also, the expansion of the connective tissue causes diastasis (divergence) of the rectus abdominis muscles. In the case of a complication, there may be painful sensations that are associated with the entry into the hole of the aponeurosis of a sheet of parietal peritoneum forming the hernial sac. It has its own nerve endings that can react and cause pain.) If the hernial bag has contracted and the contents did not have time to go back into the intra-abdominal cavity, a hernia of the white line of the abdomen occurs, which is accompanied by an inflammatory reaction, severe pain and a violation of bowel motility. Although it is worth noting that in children such a complication is extremely rare because of the elasticity of the abdominal walls.
Diagnosis of hernia of the white line does not cause much difficulty. The characteristic clinical picture, the collection of complaints of the child or his parents and the determination of the location of the defect during palpation almost always makes the correct diagnosis. To confirm the most often used ultrasound, which confirms the presence of a defect and allows you to determine the type of contents in the hernial bag. If the doctor has any doubts, or there is a suspicion of pinching a hernia, then in the hospital can use such diagnostic methods as radiographic examination of the stomach, MRI or MSCT. They will help to differentiate a hernia from intestinal obstruction or to make an accurate diagnosis.
Treatment of hernia of the white line of the abdomen, including the umbilical, only surgical. If a hernia is found at an early age (1-2 years) or in a newborn, pediatric surgeons recommend refraining from immediate surgery because at that age the muscles of the front wall are still formed and an independent healing is possible. Parents are recommended to massage the baby’s tummy and buy him a special corset that will support and protect the aponeurosis from excessive pressure from the inside. At a later age, such activities are compensatory in nature, they no longer eliminate the disease, only inhibit its development.
The operation is performed after diagnosis. If tightened with resection of the hernia, then the risk is possible to get a complication or to allow a further increase in protrusion. After passing the clinical blood and urine tests, setting the exact location of the damage, the child enters the surgical hospital and is operated on in a day or two.
Hernia formation mechanism
The occurrence of a hernia is associated with the unfinished development of an aponeurosis, in which gap-like defects remain. These flaws exist for the passage through them of nerves, blood vessels that connect the preperitoneal fatty tissue with the subcutaneous. A typical and characteristic place for the onset of a pathological condition, called hernia, is considered the upper region of the white line, the umbilical (paraumbilical) and hypogastric localization is very rare to be found.
During the increase in intra-abdominal pressure, the pre-abdominal fatty tissue falls out, which is subsequently called the preperitoneal lipoma. Squeezing this lipoma causes acute pain.
This pain syndrome can be confused with similar symptoms in such conditions as inflammation of the pancreas, gallbladder, peptic ulcer, peritonitis, or other abdominal pathologies. Later the peritoneum falls out and a hernial sac is formed, into which the internal organs exit. This moment is the formation of a true hernia. Accordingly, there are three such stages of development of hernia of the white line of the abdomen:
- preperitoneal lipoma,
- initial stage,
- formed hernia.
O.P. Krymov identifies types of hernia of the white line of the abdomen, depending on its location:
- supra umbilical (hernia epigastrica),
- sub umbilical (hernia paraumbilicalis),
- paraumbilical (hernia hypogastrica).
The latter type is very rare, because this is facilitated by the anatomical features of the whitestone itself, which narrows and thickens below the navel, so defects are less often formed here. A child very rarely can develop not one, but several hernias of the white line of the abdomen. In this case, the pathology is called multiple hernia.
If the hernia is large, most often its contents will be the omentum, the loops of the small intestine, and sometimes the wall of the transverse colon.
Most often, the hernia is asymptomatic, and her parents or doctors find her during a routine examination.
In the middle line there will be a noticeable rounded protrusion, smooth and elastic to the touch, which during sneezing, coughing, lifting weights increases, if you click on it, it can decrease. Also protrusion may decrease in the supine position. As for pain, it is mainly localized in the upper abdomen and increases with pressure, straining and after eating. Also, parents should be alert to digestive disorders. These include complaints of nausea, vomiting, heartburn, constipation.
- examination and collection of the history of a small patient,
- auscultation (listening), palpation (palpation) of the hernia,
- general blood and urine analysis
- Ultrasound of the contents of the hernial bag,
- X-ray examination of the abdominal organs,
- CT or MRI in difficult situations.
Ultrasound of the white line of the abdomen is considered a very safe and informative method of investigation. It is used to clarify the nature, location of the hernial defect, clarify the contents of the hernial bag.
Abdominal palpation procedure to detect abdominal white line hernia
Differential diagnosis should be carried out with such diseases:
- Peptic ulcer of a stomach / duodenum,
- Metastasis of the tumor in the omentum.
This requires a detailed instrumental and laboratory diagnosis of the digestive system.
- Pinch hernia. The problem with this is a violation of blood circulation in the organs that are in the hernial sac. The consequence is intestinal gangrene. Moreover, the inflammatory process, which is rapidly spreading to neighboring organs, begins to intensify. And this will indicate a diffuse peritonitis.
- The hernia is irreducible. It is characterized by the fact that it is not possible to correct the hernial contents. This is due to the splicing of the hernial sac organs together.
- Injury to the formation is dangerous following injury and inflammation of the abdominal organs.
How to cure?
Any mother should contact the surgeon immediately. He will do everything necessary to further diagnose and treat your child.
Doctor's note: Even for small hernias, it is necessary to be observed by a surgeon, because there is a high risk of hernia being strangled.
Treatment of hernia of the white line of the abdomen only by surgery. Such an operation is called hernioplasty. It is planned and not very difficult. All surgical procedures are performed only under general anesthesia. Now surgeons use modern and safe means for children, so that little patients tolerate surgery well.
Physician's Note: Traditional methods of treating hernias in children relate only to umbilical hernias in the early stages of the disease. Abdominal bandage does not treat a hernia, if it has already appeared.
Surgery as a treatment for abdominal white line hernia
Depending on the stage of the disease, local or artificial material is used. The surgeon must eliminate the diastasis (divergence of the rectus abdominis). If local fabrics are used, the defect is eliminated with a synthetic thread. This method often leads to recurrence of the hernia, because the load on the seams is quite large. Therefore, during surgery, synthetic mesh frameworks or prostheses are often used, which cover the aponeurosis and the load on the sutures becomes uniform. The probability of a relapse with these frameworks is almost nil.
The procedure lasts an average of 25-40 minutes, it depends on the complexity and volume of surgical manipulation.
A few hours after the operation, the children with their parents have the opportunity to return home. The stitches are removed after a week - one and a half.
After the surgical procedure, a restrictive regimen must be observed for three days, and physical activity is limited for 20 days.
You must follow a diet:
- you can not eat fatty, fried, spicy,
- liquid food, such as cereals, soups, vegetable or chicken broth, mashed potatoes, dairy products facilitate the digestive process in the baby,
- To restore strength and improve peristalsis, you need to add juices, fruit and vegetable purees to your diet,
- flatulence and colic can occur with excessive use of fiber.
Prevention in infants is the prevention of constipation. The child should not overeat and cry from crying. Adults are recommended to play sports, it contributes to the seal of the aponeurosis.
In order to prevent recurrence and reduce pressure on the abdominal wall, you can use a bandage.
With hernia of the white line of the abdomen, a very important and necessary moment is considered timely diagnosis and treatment, otherwise complications are inevitable. Operative intervention will completely eliminate the disease.
Why is a hernia formed?
Scientists believe that major changes occur during fetal development during the formation of the abdominal wall. Weak thin spots are formed with fibrous insufficiency of tendon tissue (collagen and elastin deficiency). They subsequently become the entrance gate for hernia.
In children, hereditary pathology comes out on top among the causes of hernia formation. But it is necessary to reckon with the acquired factors that create unfavorable conditions. These include conditions that contribute to an increase in intra-abdominal pressure, weakening of the muscle-tendon structures.
The growth of pressure inside the peritoneum occurs in children under the influence of:
- shouting often
- straining with constipation
- severe cough with whooping cough, respiratory infections, laryngitis,
- excessive physical activity
- excess fat deposits.
In infants with severe diseases of the cardiovascular system, ascites may be formed (large abdomen due to plasma sweating from the peritoneal vessels). Disturbed development of muscle tissue contribute to:
- the lack of a sufficient amount of protein, vitamins, microelements (fruits, vegetables, fish) in the child’s diet, the predominance of fats and light carbohydrates (sweets, cakes, butter, fatty meat broths),
- undernourishment, starvation mode, exhaustion,
- abdominal trauma (bruises, injuries, surgeries).
How is it formed?
The structure of the tendon fibers has slit-like openings through which the vessels and nerves pass. They are filled with fatty tissue, located in front of a piece of peritoneum (preperitoneal). Most of the cracks are in the upper and middle part of the white line. Therefore, the most common epigastric form of the hernia (above umbilical).
According to localization, hernia of the umbilical zone (paraumbilical) located in the lower part (hypogastric) is isolated. They are not widespread, since in these areas the aponeurosis of the white line is denser and thicker. Hernia formation goes through 3 stages or phases:
- The preceding one is accompanied by penetration of fatty tissue through the extended bundles of fibers, and a preperitoneal lipoma is formed. It is not yet considered a hernia, but the place of the future pathology is already indicated.
- The initial one - in a weak area, tendon bundles diverge and form a future hernial ring. Most often they are localized in the navel zone and above. The magnitude of the discrepancy varies from insignificant to 5–6 cm with hernias of average size up to 10–12 cm - with giant ones. A sheet of peritoneum is squeezed into the area of the defect, followed by an omentum.
- Formation of a hernial sac - the continuation of negative effects leads to a significant exit of a part of the peritoneum into the hernial ring. A formed sacculate formation with a neck and body, in which, in addition to the omentum, a loop of the intestine (thin or transverse-flank), the wall of the stomach, may appear.
The development of a hernia can stop at the first stage until the formation of a hernia gate. Such cases are most favorable, since there is no condition for loss and infringement of internal organs. Under the influence of not one, but several reasons, 2–3 hernias form in the white line of the abdomen at once. The variant is called plural.
Causes of a hernia of the white line of the abdomen in children
A hernia of the white line of the abdomen in a child appears with a weakening of the midline. There may be congenital cracks in the elastic tendon plate due to the underdevelopment of the structure. The two main factors that influence the development of the disease are weakness of the muscles of the anterior abdominal wall and increased intra-abdominal pressure.
In medicine, hernia of the white line of the abdomen is divided into three types:
- supra umbilical (epigastric),
- sub umbilical.
In 80% of cases, pathology occurs in the upper abdomen. In this area, the tendon is the widest and softest. The anatomical structure of the body in children practically prevents the formation of the umbilical hernia. Below the navel, the tendon becomes narrow and strong, which also reduces the risk of developing education.
With an increase in intra-abdominal pressure at the point of divergence of the aponeurosis, a small tubercle appears. Fatty tissue penetrates the gap and a lipoma is formed. Quite often, it is mistakenly associated with extraneous diseases.
Gradually the hernial orifice increases, a part of the external part of the abdominal cavity falls out into it. So there is a hernial sac, in which the internal organs sink.
The main causes of the disease:
- congenital abnormalities and weakness of the white line or abdominal wall,
- peritoneal injuries,
- previous operations on abdominal organs,
- weight loss,
- exhaustion or significant weakening of the body due to past diseases.
The reasons for the increase in intra-abdominal pressure, which provokes the emergence of education in children and newborns:
- prolonged crying (the child seems to be straining),
- chronic constipation
- excessive physical activity
- excess weight,
- chronic cough,
- postoperative scars and scars on the abdomen,
- genetic predisposition.
How does it manifest itself?
The main symptom is a rounded bump on the child’s stomach, it is impossible not to notice. Over time, the protrusion increases in size. Weak muscles diverge further, which causes further ablation of the abdominal cavity and internal organs.
During physical activity, the hernia increases significantly, while lying down, it decreases or completely sinks. When pressed, children experience discomfort and pain. To the touch, the hernial sac is soft and elastic.
The photo below shows examples of different types of disease and stage. Initially, the size of a cone may be a walnut, but in the absence of the necessary treatment, the bulge increases.
Related symptoms, the appearance of which should be addressed to the hospital:
- vomiting and nausea
- prolonged constipation.
At the slightest suspicion you need to contact the treating pediatrician. If necessary, he will direct to narrow specialists. Diagnostics is complex, combines an oral conversation with parents and a child (if the baby is talking) to collect anamnesis and various diagnostic studies:
- visual inspection of the child,
- auscultation (listening to the area of protrusion),
- palpation of the abdominal cavity and hernia in particular
- laboratory tests (blood, urine, feces)
- Ultrasound (provides information about the contents of the hernial bag),
- X-ray (shows the big picture)
- MRI or CT (if necessary).
Causes and forms of pathology
The white line is the tendinous strip, it is located between the pubic fusion and the xiphoid process. In the upper abdomen, it is dilated, in the lower part it is narrowed. Accordingly, more often the divergence of the tendons occurs in the upper part. Diastasis - the divergence of tendon fibers - can be up to 10 cm, there is a high risk of transition to the umbilical hernia.
The hernial ring may have a different shape:
- diamond shaped.
Hernia injuries more often occur at narrow gates. Sometimes several hernial protrusions are diagnosed, located one above the other.
The cause of the disease can be:
- hereditary pathogenesis
- acquired anatomical weakness of fibrous fibers,
- underdevelopment of the tendon plate caused by intrauterine abnormalities.
Stage of the disease
The abdominal muscles disperse and thin, holes are formed among the tendon fibers. In case of pathology of the tendon plate, there is a deficiency in collagen production.
The occurrence of a hernia is affected by overweight and abdominal trauma. When shouting or prolonged tension increases intra-abdominal pressure, which also provokes the divergence of muscle fibers. Prolonged increase in intra-abdominal pressure occurs with whooping cough and bronchitis - during debilitating cough attacks, with persistent constipation.
You can classify the severity of the disease in 3 stages.
- A preperitoneal lipoma forms - preperitoneal cells protrude through a slit-like opening, which is formed by diverging tendon fibers,
- The formation of a hernial sac begins, its contents - a portion of the small intestine and part of the omentum,
- 3. In the third stage, a hernia may form from the lipoma, consisting of the hernial ring, and the hernial sac, which includes - except for a part of the small intestine and omentum of the transverse colon, and even the stomach wall.
At the third stage, the protrusion becomes visible visually, and is effortlessly palpated during palpation. In rare cases, several hernias appear, located one above the other. In this case, the supra umbilical, umbilical, and subelastic hernia are diagnosed simultaneously.
Symptoms of tendon fibers
After the diagnosis is established, the treatment of hernia of the white line of the abdomen in children begins. A characteristic sign of the condition is a protrusion in the form of a small lump on the surface of the peritoneum closer to the epigastric region. When this occurs, additional symptoms - heartburn, nausea - which is aggravated by sudden movements, such as inclinations.
The disease in the first stage may not manifest itself and be detected during the medical examination by a doctor.
However, even an asymptomatic course of the disease is accompanied by complaints from the child and some signs. The baby often complains of pain in the abdomen, diarrhea or constipation develops after physical effort. During stool, constipation causes pain in the epigastrium.
Complications of a hernia - pinching of the hernial sac.
The signs of the condition are acute pain in the place of the hernia, high fever, vomiting, bloating. Touching the abdomen is caused by pain, which increases during movement.
The operation of the hernia of the white line of the abdomen in children
Before surgery, you must conduct appropriate training. The child is transferred to a special diet - all dishes that stimulate increased intestinal motility are completely excluded from it. The diet also changes - now the baby is fed in small portions in 2-3 hours, not more.
We'll have to abandon the favorite treats of children: chips, crackers, sugary carbonated drinks, convenience foods, chocolate, citrus. Food should be cooked without spices, increase the amount of fiber in the diet due to cereals - oatmeal and buckwheat.
It is recommended that brown rice, asparagus, carrots and fresh cucumbers, cauliflower be introduced into the diet. Meat and fish are only lean, eggs are removed from the yolks, lactic acid products are selected with a low fat content.
Removal of the hernia of the white line of the abdomen in a child is carried out under general anesthesia. The operation is called hernioplasty.
In the third degree of severity, closure is most often carried out with the help of artificial materials - synthetic prostheses.
During the operation, the hernial sac is opened, its contents are removed and put into place - if possible - or sutured, but the main purpose of the surgery is to eliminate the diastasis. If this is not done, the disease recurs.
On the basis of its own tissue, suturing is performed quite rarely - in this case, the aponeurosis defect is sutured with a special nonabsorbable suture material. But there is a risk of repeated bulging of the problem area with an increase in intra-abdominal pressure - the seams can erupt.
In order not to expose the child to danger - re-operation - set the mesh frame. The design distributes evenly the load on the seams and closes the diastasis. In the future, connective tissue grows, and the risk of relapse is minimized. The operation is simple, you can get up on your feet the next day. But one should not take the child home - it is desirable that the patient is under the supervision of a doctor for 48 hours, no less.
The rehabilitation process requires compliance with the diet - it is not much different from the diet,
which was necessary during the preoperative preparation. Portions are gradually increasing, the time between meals is extended. Foods that irritate the intestines are still excluded from the diet, but emphasis should be placed on liquid food or gelatinous dishes.
It is necessary to carefully monitor the bowel movement, include laxative products in the diet. The amount of fruit should be limited - excess fiber can lead to flatulence.
Physical activity increases gradually. The rehabilitation period can take from 2 months to six months.
To reduce the risk of disease in infants, from an early age, it is necessary to monitor the regular bowel emptying, not to allow hysterical crying.
Older children should be introduced to the sport to strengthen the abdominal muscles - this helps to seal the aponeurosis.
But even if the child was diagnosed with the disease, there is no need to panic.Parents should immediately agree to an operation to prevent the development of complications. An operation to remove a hernia is considered common, and for a baby it is less dangerous than a possible pinch.
How to treat a hernia?
In any case, pathology requires compulsory and competent treatment. To date, the only method of treatment is surgery. However, in some cases, practice therapy without surgery, although it does not guarantee a 100% result.
The treatment regimen is determined by the pediatric surgeon based on the results of the examination, tests and hardware diagnostics. It should be noted that the hernia of the white line of the abdomen in children responds well to therapy, since the children's organism is hardy and quickly recovers.
The white line of the abdomen - the location of the elastic vertical muscles, which stretches from the chest to the pelvis of the child. At the level of the navel is the middle of the tendons, their width is 2-3 cm and narrows closer to the pubic joint. Hernia occurs in children when the tendon ligaments diverge in the center, forming a lumen. Through this gap, internal organs begin to bulge out, which are located in this area. Intestinal loops and sebaceous glands begin to protrude. Typically, the lumen is about 6-7 cm. If the discrepancy of the fibers is increased, then the hernia will develop at low pressures in the abdominal cavity.
The most common cause of abdominal white line children in children is a genetic predisposition and, with time, acquired anatomical weakness of the muscle fibers. For this reason, there is a constant expansion of the fibrous fibers and their thinning. When the muscles diverge strongly in one place, there are slit-like holes.
Abdominal trauma, over-eating and obesity can provoke disease in young children. If the child had to undergo surgery in the abdomen, the remaining scars on the body can also lead to the development of a hernia. Postoperative scars are not a threat, but they create an opportunity for other negative factors.
There are other causes of the disease. It is possible to find in children weak development of the wide tendinous plate in the abdominal cavity, it consists of elastic collagen fibers. As a result of their constant deformation, a hernia of the white line occurs.
Hernia can occur with frequent and prolonged cry, high pressure in the abdominal cavity, with the disease of chronic bronchitis, whooping cough. The disease, during which children often have to cough, with their symptom has a constant load on the muscles and tendons of the abdomen.
In young children, these muscles are not yet strong and very elastic, so regular exposure to them leads to deformation.
Hernia of the white line of the abdomen at the first stage passes without certain signs. Such health problems begin to develop slowly and the symptoms are not felt.
Children may feel a slight protrusion of the skin in the abdominal area and not give it importance. If children are not worried about pain, then they may not complain about a strange education.
The protrusion can not be noticed at the first sign of a hernia. Bulging of the muscles of the white line of the abdomen occurs when the load and tension of the abdominals. The protrusion disappears if the child is lying on his back or is in a relaxed state. Hernia white line of the abdomen can have two varieties. A disposable hernia changes with muscle tension, may decrease when the baby is in a horizontal position. The unchangeable almost does not change, it can grow with time, but not decrease. Unlike reducible hernia, unreducible, with strong pressure on the protrusion, does not disappear in the abdominal cavity, it does not change in size and retains its shape.
After a time, the protrusion becomes painful and gradually increases. The feeling of pain during a hernia is often concentrated in the stomach. In the more acute form of the disease, painful sensations extend to the lower back, ribs, and inner region of the abdominal cavity. The pain can be pulling, cutting, creating periodic injections at the protrusion of the internal organs and aching, which will disturb the child throughout the day.
The feeling of pain in children is always increased after eating food or fluids. Any tension in the abdominal muscles and tendons leads to increased pressure and abdominal pain. Physical stress, sneezing, coughing and defecation can increase pressure.
After reducing the pressure on the abdominal muscles and the walls of the abdominal cavity, the pain gradually decreases. When still sleeping, it may be completely absent.
Dr. Komarovsky, pediatric pediatrician, notes that in addition to pain, the child with a hernia also has other signs of the disease - dyspeptic. Muscle contraction can lead to nausea and vomiting, the baby has dysfunction of the digestive system, which is accompanied by frequent heartburn, belching and unpleasant smell from the mouth.
With an increase in the protruding sac with an internal organ, children may develop a gastric ulcer and duodenal ulcer, with complications gastritis, pancreatitis, cholecystitis.
When the protruding formation is pressed into the abdominal cavity, the child has acute pain, which becomes more intense. Signs of a severe white line hernia can be very severe. Children are accompanied by constant vomiting, bloating and aching pain, defecation and involuntary gas, painful peristalsis occurs.
In such a situation, conventional treatments will not help. The patient needs an operation to remove the formed bag to prevent serious damage to internal organs. The operation in practice is carried out quite often, if the signs of the infringement of the hernia increase.
The removal of the hernia of the white line of the abdomen is surgically also called hernioplasty. The operation always takes place under anesthesia of the patient. The operation has 2 types: tension and non-tension.
The light form is operated on using the child’s own tissues to remove the protrusion and eliminate the gap in the abdominal muscles. Hernia is removed with catgut sutures. After surgical treatment, the child needs to eliminate increased physical exertion, as this can lead to seam divergence and recurrence of the disease.
Another method is performed using an endoprosthesis. Such an operation is performed to remove a more serious hernia. This method is the most effective. The advantage of endoprostheses is characterized by the reliability and elasticity of the tissues. At the same time, children are not limited in mobility and physical activity.
For surgical intervention there are some contraindications - serious diseases, infection and protrusion, which is not set in the abdominal cavity. With such contraindications, the child must stop the increase in protrusion. For this, doctors prescribe a bandage, which must be constantly worn.
Complications and Prevention
With a complication, the disease of the white line of the abdomen can turn into a paraumbilical hernia. This is considered a disease pathology. Paraumbilical hernia is characterized by a strong appearance of the internal organs in the abdominal cavity and reaches the umbilical ring. Usually, this form of hernia is congenital or is caused by chronic diseases of the intestine, digestive and respiratory systems. The most serious complication is the herniation failure.
As a preventive measure, it is necessary to ensure that the baby does not overeat and regularly empty the intestines. At the age of 5, the child should gradually begin to engage in physical exercise.
Video "White hernia of the abdomen in children"
In the issue, Dr. Okulov talks about the features of white hernia in children and describes the methods of the most effective fight against the disease.
Stages of development
- Preperitoneal lipoma formation - bulging of preperitoneal cells through the slit-like lumen between the tendon fibers. Very often, the development of pathology stops at this stage.
- Transformation of a lipoma into a hernial sac — as the pathology develops, the lipoma “masters” the hernial ring.
- Hernia is visible to the naked eye and is easily recognized during palpation of the abdomen.
In most cases, hernias are formed locally, but it is also possible that several tumors are located one above the other.
Rarely enough, a hernia in a child goes unnoticed, as the disease develops acutely and with pronounced symptoms:
- A small protrusion appears in the abdominal area, which is easily visible visually. Education has a rounded shape and with pressure can "fall" into the abdominal cavity,
- In newborns, the development of a hernia is accompanied by increased weeping, as the baby is bothered by pain and discomfort in the navel,
- The development of a neoplasm is accompanied by bloating, diarrhea or constipation,
- The new growth in the running form leads to the infringement or necrosis of the internal organ.
The course of the disease is complicated by the addition of inflammatory or infectious processes in the abdominal cavity.
Pinching hernia poses a serious danger to the newborn. When pinching the internal organ (intestine or epiploon) is compressed in the hernial sac, after which the blood circulation is disturbed. Possible complications of infringement - rupture of an internal organ or peritonitis.
How to confirm the diagnosis?
If the child often has a tummy ache, or he becomes restless and capricious, then this is a good reason to go to the doctor.
- When visual detection of a bulge in the abdomen, the doctor prescribes a medical examination.
- With the help of palpation is determined by the mobility and consistency of the tumor.
- When pressing on the protrusion is determined by the reaction of the child.
- The little patient is sent for ultrasound, gastroduodenoscopy.
- Before the appointment of a method of treatment is taken a blood test, feces, urine.
Treatment of hernias of the white line of the abdomen is only surgical. If a pathology in infants is detected, the operation is postponed, but conservative treatment (massage, physiotherapy, medicines) is monitored and prescribed.
In which cases the operation is shown:
- The development of pathology is observed up to 2 years - the defect increases in size,
- Till 5 years the treatment methods were unsuccessful.
- An infringement or other complication is diagnosed at any age.
The operation in children is carried out by the method of open tension-free hernioplasty or laparoscopy. In a planned surgical intervention, not equipped with complications, laparoscopy is prescribed. If there is a risk of damage to internal organs - open surgery is shown.
The operation is performed under general anesthesia (safe for the child). Closure of the defect is most often carried out with artificial material, since natural tissues are still weak due to age. When suturing the mesh achieved the best results, the risk of relapse is virtually absent. After the operation, the child is in the ward for a day, in the absence of complications, he is discharged home. Postoperative sutures are removed after a week.
For a certain period of time, it is necessary to wear a postoperative bandage, refusal from physical exertion and adherence to a therapeutic diet. For the fastest recovery of the body after the operation, children need to take vitamins C and B, calcium.
The method of treatment without surgery is rather supportive and prophylactic, it helps the disease not to get worse.
Non-surgical therapy includes the regular wearing of a special bandage that resembles a wide and elastic velcro strap. The bandage should support the abdominal cavity and not allow the hernia to grow.
The second stage is the strengthening of the abdominal muscles with the help of special therapeutic gymnastics (exercise therapy). You need to perform only the assigned exercises. Unreasonable training will lead to deterioration or pinching of the hernia.
In addition, it is very important to take care of the baby's diet and choose the right diet, which will be aimed at preventing the occurrence of constipation and increased gas formation.
The method of surgical intervention is called hernioplasty. A planned operation is usually assigned, to which the child is carefully prepared. In case of infringements or additional complications, emergency surgical intervention is carried out.
Before the procedure, children should be examined by a general practitioner and a cardiologist, and they must pass the necessary tests. The day before the operation you can not eat, you can only drink water. Then the baby is given an enema and given an injection, which suspends the bowels. In addition, the child is given a sedative, so he slept and was not afraid.
The procedure is carried out in two ways:
- Classical hernioplasty. The surgeon makes an incision, assesses the condition of the internal organs. Putting them in place, sutured the hernia sac. At the small size of the pathology, the hole is closed with its own tissues. Aponeurosis overlap for better fixation. Such a method is dangerous with possible relapses and seam divergence. If the hernia is large, the surgeon places a special mesh on the hernial orifice that closes it securely.
- Laparoscopy. Modern minimally invasive technique. It takes only a few small incisions to enter the laparoscope. On the probe there are cameras that show the state of the abdominal cavity and give an overall picture. Advantages: low injury rate, short recovery time, no heavy bleeding. However, the operation has a number of contraindications.
What complications can a child have?
Lack of medical care for dangerously serious complications:
- Hernia injury. Edema and inflammation of the hernial sac develops, which passes to the entire abdominal cavity.
- The inability to right. Adhesions develop between the skin, hernial sac, peritoneal wall and internal organs.
- Jamming. Squeezing the bag leads to impaired normal blood circulation in this area. Hernia organs gradually die off, necrosis and gangrene begin.
Prevention is mainly aimed at solving the problems that cause the disease:
- moderate physical activity
- proper nutrition without overeating,
- can not lift weights
- treating or preventing constipation
- timely treatment of cough,
- if possible, avoid prolonged crying (in newborns),
- regular visits to the surgeon for a routine inspection.