The neural tube, the system for the central nervous system, is formed by invagination from the neural canal. Thereafter, on both sides of the neural tube arise Ursegmente, which bulge in the primary abdominal cavity. The urinary kidneys and the kidney plants develop from these primary segments, with the urinary kidney becoming the gonadal tract. The further development and change of position of the gonadal tract depends on the sex of the seedling. While in female seedlings, the ovum of the anterior abdominal wall only approaches, the changes in position in male embryos are much larger.
The male gonads migrate with the help of peritoneum leaves in the scrotum, ie in a part located outside the abdominal cavity. This process can be explained by the heat conditions necessary to form the sperm cells, which are around 36 degrees Celsius. However, since the temperature inside the abdominal cavity, the so-called core temperature, is around 37.5 degrees Celsius, the lower heat conditions in the scrotum, due to the outside temperature, are more favorable for the development of the seed cells.
During their displacement in the scrotum, the gonads take along an appendix of the peritoneum, which envelops them together with blood vessels and the spermatic cord. Normally, the wall sections of the peritoneum appendage re-attach at the time of embryo maturity, that is, the peritoneum process (now referred to as a testicle sheath) separates completely from the abdominal cavity. Only the inguinal canal remains open, because the blood vessels that feed the gonads, and the spermatic cord, must continue to have a portal of passage, which is usually covered by strong muscle bundles.
But if this peritoneal fossa does not close, then there is an open connection between the abdominal cavity and the testicle sheath, which can become a hernial sac by the insertion of intestinal loops and other parts of the contents of the abdominal cavity. These anatomical and developmental circumstances also explain why the inguinal hernia is found in boys in about 90 percent of all cases.
Intestinal parts can slip into the hernial sac if the child, for various reasons, for example, when trying to empty hard stool regularly from the intestine, strongly squeezes the abdominal wall. Then a bulge in the groin is visible externally. In most cases, the contents of the fractured bag are loops of intestine, more rarely it is power supplies that normally cover the intestinal loops.
A right-sided inguinal hernia (60%) occurs more frequently than a left-sided (25%) or a bilateral (15%), since the complete displacement of the right gonad into the scrotum occurs later than on the left side, causing the right peritoneum stays open longer. Apart from these congenital inguinal hernias, the so-called acquired inguinal hernias are also known. They pass directly through a site of the abdominal wall where the abdominal wall is not completely superimposed by the muscle bundles going in different directions. So you do not need to follow the inguinal canal. In children, however, such inguinal hernias are rare.
The congenital hernias usually become visible only a few weeks to months after birth. Weak and premature babies tend to do so much more often than other children. The often heavy coughing, which occurs in whooping cough or other serious inflammatory diseases, always burdens the abdominal wall, increases the pressure inside the abdominal cavity and thus promotes the occurrence of inguinal hernia, especially in infants and toddlers. It will be understood that muscle training of the abdominal wall, which begins in early infancy with light gymnastic exercises and occasional abdominal support, then continues throughout the nursery and school years, helps prevent such breaks.
The rupture tumor can appear as a small, often hazelnut-sized protrusion in the groin. If it lingers for a long time and bulges more frequently, considerable sizes are achieved. It then often sinks into the scrotum, which can sometimes take a fist size, which affects the children greatly in their well-being. They are then often restless and cry a lot, have little appetite, vomit easily and take for these reasons little weight.
If the child is lying quietly or is put into a warm bath, the rupture swelling often retracts itself into the abdominal cavity. If this does not happen, the contents of the bag must be carefully pushed back by hand. Such a break becomes problematic (for parents and children, not for the surgeon) only when the contents of the rupture bag are trapped in the rupture gate, which can have many causes, two of which, however, come to the fore.
Suppose there is a small intestinal loop in the hernia sac. In such a case, the contents of the intestine pass through the feeding leg into the part of the intestine, which is stored in the breaking sac, and then further into the laxative leg. Twice, therefore, the contents of the intestine (which always contains bacteria and in which chemical processes take place) must pass through the section of the intestine that is narrowed in the hernia gate. A spasmodic contraction of the abdominal muscles would narrow the hernia. A congestion of the intestinal contents within the hernia and damage to the intestinal wall by chemical and bacterial processes would be the result.
Aside from this first condition, there is, as already said, a second one for the containment of the contents of the bag: if bacteria and poisons pass through the intestinal wall, they cause an inflammation of the peritoneum in this section, which causes suppuration, pain in the intestinal musculature, and adhesions. The other dangerous side of the entrapment is that the intestinal loops within the hernia are accompanied by vessels (arteries and veins).
A narrowing of the hernial gate also always leads to impairment of circulatory conditions, inasmuch as the thin-walled veins are first constricted and thus the blood drain is obstructed. If the arterial inflow remains in the intestinal loop of the fractured bag, blood stagnation, blood leakage from the vessels into the tissue gaps occurs, which in turn favors inflammatory processes.
The first signs of entrapment are restlessness and painfulness of the child. It suddenly starts to scream, apparently for no reason, and does not settle down. Often the children vomit. Since there is still stool below the constricted intestine, feces may be simulated by the same normal bowel movement.
After that, however, the contents of the intestines accumulate above the entrapment. Chair and flatulence do not go away anymore. The children vomit, and especially the vomiting of feces is a serious sign of illness.
The food intake is denied, the stomach slowly distended. The skin above the externally visible rupture tumor reddens, the tumor hurts as soon as pressure is applied to it. Even at the first sign of a trapped inguinal hernia, it is advisable to see a doctor. Although many childhood entrapments resolve spontaneously, which is often the case during transport to the hospital, it is important to seek immediate removal of the entrapment.
For the treatment of inguinal hernia there are basically two options: conservative and operative. It depends primarily on the age and general condition of the patient, which treatment the doctor will make. The unclamped inguinal hernia in early infancy was treated earlier with a scraper tape, which was designed to prevent the emergence of the rupture tumor by pressure on the inguinal canal. It was assumed that this would promote the closure of the open peritoneum process.
Today, however, it is known that a hernia after the first few months of life no longer heals spontaneously, neither with nor without a broken band. In addition, a prolonged wearing of the breaking strip is always unfavorable, because the skin easily inflames in the vicinity of the band and underneath in the infant. The underlying muscles are gradually weakened and regressed, and the guarantee that the peritoneal process has closed, is never given.
Therefore, the operation should not be waited too long if it can be expected of the child. The surgical procedure is easy to understand. The surgeon repositions the contents of the hernia bag into the abdominal cavity, sutures the peritoneum and then the other layers of the abdominal wall over the former hernia. Lastly, he cuts away superfluous skin parts that are greatly overstretched by the fracture and places a skin suture.
The procedure can be performed today without significant risk and relatively quickly. Infants or babies and babies can be operated on at the age of three months. Only in exceptional cases, for example in the case of an entrapment, an even earlier date must be chosen. Postponing the operation until the end of the first or second year of life, as such, does not pose any danger to the child, although it is associated with the fact that the fracture can be pinched at any time and endanger the child's life.
In the case of an uncomplicated course of healing, the children can be discharged from the hospital a few days after the operation. To facilitate the final healing, it is still necessary for a while to avoid bloating and excessive efforts of the abdominal press. For this reason, the doctor frees school-age children after a breakage surgery about three months from school sports. Pampering the child of the healed operation scar and ridding him of physical activities in the household is fundamentally wrong. Prolonged immobilization only weakens, so that those who save themselves can easily break away. Tags: