What is a hernia or hydrocele?
Hernias and hydroceles occur when the lining of the abdominal cavity extends down into the scrotum creating a pocket in the inguinal area (inner thigh) and/or scrotal area.
If part of the intestines goes into the pocket, it is called a hernia; if only fluid goes into the pocket, it is called a hydrocele.
Causes and symptoms
Inguinal hernias can be present at birth or develop soon after, as tissues connecting these organs are often still developing. Abdominal muscles may be weak or the opening between the abdomen and scrotum not yet fully closed, which can allow part of the intestines into the pocket. Inguinal hernias can occur in boys and girls.
Hydroceles are most common in infants and typically occur before birth if the testicles do not move into the scrotum properly during development. A hydrocele can also develop later in life due to inflammation or an injury within the scrotum. Swelling of the scrotum or inguinal area may be a sign of a hernia or hydrocele.
Other symptoms and treatments vary based on specific causes: Simple hydroceles occur because bodily fluid becomes trapped in the pocket created by the extended abdominal lining. A simple hydrocele will typically become reabsorbed by the body and will most likely resolve on its own during the first year of life. Hydroceles can become quite large but are usually painless. This type of hydrocele is usually followed by a doctor with observation only.
Communicating hydroceles and hernias exist because there is a communication (or opening) between the abdomen and the scrotum. When this occurs, fluid and/or part of the bowel may move back and forth between the two areas. This type can change in size and may become larger depending on the child’s activity (crying or straining may enlarge it, for example) and may require surgery.
Some hernias can become incarcerated. This means that bowel tissue becomes trapped or stuck within the pocket causing restricted blood flow. If this occurs, which is uncommon, the area may become hard, red, swollen and painful. These symptoms may be accompanied by nausea, vomiting or fever. Contact your child’s doctor immediately or go to the emergency room if these problems occur.
Testing, diagnosis and treatment
An ultrasound (painless test that takes pictures of the inguinal and scrotal area) may be performed to evaluate for the presence of a hernia, but typically diagnosis of a hernia or hydrocele can be made by observation and physical exam findings. Based on the type, your child’s doctor may recommend surgery to correct the hernia or hydrocele.
With surgery, a small incision is made in the lower abdomen on the affected side. Your child’s doctor may recommend exploring the other side with a small camera through the belly button. If there is a defect on that side as well, it will be corrected at the time of surgery.