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Treatment for herniation of stomach into scrotum.

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Dear Doctor,

My wife and I have a situation that has us concerned for the life of our third child and second son. We live in Ecuador. My son was born on May 27, 2014 after a full term pregnancy. He has a hernia that we first noticed 10 days ago when part of his stomach protruded into his scrotum. We had an ultrasound and the hernia measures 1.31 cm. Yesterday, for the second time in about a week, part of his stomach again protruded into his scrotum. It has since returned to his stomach. Both times this happened the baby stopped eating and was throwing up. The doctors told us that this has nothing to do with the hernia and that his stomach was full of gas. I have read that emergency surgery for a strangled hernia results in death 7 times more frequently than a planned surgery. But at just 6 1-2 weeks old, surgery is risky. So my questions are these: Is it really just a coincidence that the baby stops eating and throws up when part of his stomach protrudes into his scrotum, or is this a result of the protrusion? Will this hernia necessarily need to be corrected through surgery? Is it better to have a planned surgery, and if so, how old should the baby be at the time of surgery? What is the risk that while we wait for surgery the hernia will become strangled requiring emergency surgery? There are no surgeons who specialize in pediatrics where we live. I know this is just and opinion question, but would you recommend me sending my wife and baby to live alone in a different city where there are specialty surgeons in case an emergency arises? Thank you for your help. Steve Wuori


Category: Pediatric Surgeon

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Category: Pediatric Surgeon
Dr. Hari Charan Perigela is online now

Expert:  Dr. Hari Charan Perigela replied 4 Days.

Hello Mr. Wuori.
Thank you for your query at DoctorSpring.com.
Your son seems to have Congenital Hernia. In this type, there will be a communication between abdomen and scrotum. However, most of the times, this passage of communication is narrow, which allows only fluid from abdomen into scrotum leading to fullness in the scrotum. Intestines enter into the hernial sac and get strangulated very rarely in this congenital variety.
Any hernia has to be operated including congenital hernia.
If an experienced Paediatric surgeon is available along with good anaesthesia facilities, the child can get operated now itself. Planned surgery is always better than an emergency surgery.
There is no specific time for hernia surgery.
We cannot predict the strangulation. However, in children with narrow communication, it is rare.
You can consult a senior paediatric surgeon in nearby town, take his opinion and proceed further.
Nothing to worry.
I hope this was helpful. Feel free to ask queries.
Wishing him good health,
Regards.


Patient replied :

Dear Doctor,
Thank you for your reply. It was helpful. As I previously wrote, the hernia was measured as 1.31 centimeters by the ultrasound. Is this considered a narrow communication? When the scrotum increases in size, it is very hard and does not feel like liquid because it is so hard. Does the hardness indicate that more than fluid is passing into his scrotum, perhaps part of the intestine? If I understand your answer correctly, you are stating that it is no more risky to have the surgery now when the baby is less than 2 months old, than four months from now when he will be 6 months old. Is this correct, that there is no greater risk of complications by operating on a 2 month old baby than a 6 month old baby? Again I thank you for your help.
Steve


Expert:  Dr. Hari Charan Perigela replied 3 Days.

Hi. Thank you for writing to us again.
The measurement of 1.3cms is confusing. Hernia which is of 1.3cms long will not extend into scrotum.It could be the diamter of the neck of the hernial sac.IF the neck is narrow,it does not allow any abdominal content to enter into the scrotum.If the neck is 1.3cms,it can allow part of the intestine,mostly small intestine as it is freely mobile.But,the intestine will be soft to touch.Another content of the abdomen called Omentum(fat) can enter the hernial sac upto the scrotum.It will be hard.Any content can go inside the abdomen when the neck of the hernial sac is wide.
There should be well equipped operation theatre,good/senior anaesthetist who can give anaesthesia to months child,senior paediatric surgeon to do surgery in a 2months old child.So,if all the above criteria is fufilled ,you can proceed with surgery even at 2 months .
Wish him good health,
Regards


Patient replied :

Doctor,
Your information has been very helpful. I have 3 final questions. We have found a great hospital with an anesthesiologist and experienced surgeon. First, do you recommend that we have surgery now or do you recommend that we wait until the baby is older? Second, which anesthesia is best for a 2 month old baby: general, spinal, or local? And third, which surgery for a 2 month old baby is better, hernioplasty with mesh, or herniorrhaphy without mesh? Thank you so much doctor. You have been a blessing to my family in this difficult time.
Steve


Expert:  Dr. Hari Charan Perigela replied 2 Days.

Hello. Thank you for writing to us again.
1.In my opinion, you can wait for few more months for surgery of your child.
2.If you want to go for surgery now,General anaesthesia is best for 2 months old child.
3.For 2 years old child, we do Herniotomy , i.e. Excision of hernia sac.There is no need for herniorrhaphy which is done in young adults and Hernioplasty which is done in old age people.
Feel free to ask further questions,
Regards


Dr. Hari Charan Perigela
Category: Pediatric Surgeon
Experience: 
Fellowship: DNB, General Surgery, National Board of Examinations, New Delhi, 2001
Residency: MS, General Surgery, Sri Venkateswara Medical College,Tirupathi, 2000
Medical School: MBBS, Kurnool Medical college, 1995
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