Hernia of the linea alba in children is a relatively rare disease. It is detected in only 1% of the child population. More often not in newborns, but in preschool age (5–7 years). Umbilical hernias predominate in infants.
The pathology is a protrusion of the viscera of the peritoneum into an opening formed by the divergence of weak bundles of tendons of the oblique and rectus abdominis muscles. The disease is characterized by a progressive course and the inability of the defect to heal as the child grows older.
Why does a hernia form?
Scientists believe that the main 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 entry point for hernias.
In children, hereditary pathology takes first place among the causes of hernia formation. But it is also necessary to take into account acquired factors that create unfavorable conditions. These include conditions that contribute to increased intra-abdominal pressure and weakening of muscle-tendon structures.
It is necessary to identify the cause of the baby’s cry; a healthy child behaves calmly
An increase in pressure inside the peritoneum occurs in children under the influence of:
- frequent screaming;
- straining due to constipation;
- severe cough due to whooping cough, respiratory infections, laryngitis;
- excessive physical activity;
- excess fat deposits.
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In children with severe diseases of the cardiovascular system, the formation of ascites (a large belly due to the sweating of plasma from the peritoneal vessels) is possible. Impaired development of muscle tissue is promoted by:
- lack of sufficient amounts of proteins, vitamins, microelements (fruits, vegetables, fish) in the child’s diet, predominance of fats and light carbohydrates (sweets, cakes, butter, fatty meat broths);
- underfeeding, starvation, exhaustion;
- abdominal injuries (bruises, wounds, previous surgeries).
Hernias of the white line occur with strong or prolonged exposure to the listed factors.
How is it formed?
In the structure of tendon fibers there are slit-like openings through which vessels and nerves pass. They are filled with fatty tissue located in front of the peritoneum (preperitoneum). Most of the gaps are in the upper and middle parts of the linea alba. Therefore, the most common form of hernia is epigastric (supra-umbilical).
Based on localization, hernias of the peri-umbilical zone (paraumbilical) are also distinguished, located in the lower part (hypogastric). They are not common, since in these areas the aponeurosis of the white line is denser and thicker. The formation of a hernia goes through 3 stages or phases:
- The previous one is accompanied by penetration through the expanded bundles of adipose tissue fibers, a preperitoneal lipoma is formed. It is not yet considered a hernia, but the location of the future pathology has already been indicated.
- Initial - in a weak area, bundles of tendons diverge and form a future hernial orifice. Most often they are localized in the navel area and above. The size of the discrepancy ranges from insignificant to 5–6 cm for medium-sized hernias to 10–12 cm for giant hernias. A piece of peritoneum is squeezed into the area of the defect, followed by the omentum.
- Formation of a hernial sac - continuation of negative influences leads to a significant exit of part of the peritoneum into the hernial orifice. A formed saccular formation appears with a neck and body, which may contain, in addition to the omentum, a loop of intestine (small or transverse colon), and the wall of the stomach.
The development of a hernia can stop at the first stage until a hernial orifice forms. Such cases are the most favorable, since there are no conditions for prolapse and infringement of internal organs. When exposed to not one, but several causes, 2-3 hernias form in the linea alba of the abdomen at once. The option is called multiple.
In the photo, a doctor examines the belly of an infant
What are the signs of pathology in a child?
Hernia of the white line of the abdomen is a disease that is diagnosed almost accurately when examining a child. The existing system of preventive visits for newborns and preschool children with the participation of a surgeon provides parents with the opportunity to consult with a specialist.
The main sign of a hernia is a painful soft protrusion under the skin on the baby’s abdomen along the projection of the white line. It increases if the child strains or screams. Older children are tested in a standing position. With a fairly wide opening, the hernial sac can be palpated without straining, and disappears while lying down. If children are concerned about soreness, then they should think about signs of temporary impairment.
Pain can be caused by formed adhesions. Older children describe nagging pain in the hypochondrium and in the back. Frequent symptoms of a hernia are bloating from stool retention and failure to pass gas. When these symptoms are combined with vomiting, nausea, and non-reducibility of the hernia when lying down, serious concerns arise about strangulation of the hernial sac. This condition requires immediate surgical intervention.
What complications are possible with an untreated hernia?
Lack of timely measures can cause complications:
- trauma - promotes swelling, inflammation of the components of the hernial sac with transition to the abdominal cavity;
- irreducibility - may be caused not by infringement, but by an adhesive process between the skin, the wall of the hernial sac, the peritoneum and the organs located inside;
- strangulation - squeezing the sac contributes to impaired blood circulation in the formations trapped inside; necrosis of the intestinal wall causes gangrene and diffuse peritonitis.
Diastasis is dangerous due to its consequences
Usually people come to surgeons with a complaint about an unsightly “pregnant” or “beer” belly. But diastasis is dangerous not because of aesthetics, but because of its health consequences.
Sooner or later, diastasis will be joined by an abdominal hernia, when fat or a small fragment of intestine comes out between the stretched fibers of the linea alba. A hernia is formed if you torment yourself with loads and intense training: pumping up your abs, doing squats, lifting weights.
A hernia with diastasis is a time bomb that carries the risk of strangulation and necrosis. Any necrosis is treated by emergency removal of the strangulated area, and in the case of the intestines causes lifelong problems.
The mechanism of formation of abdominal hernia.
A second pregnancy with diastasis of the abdominal muscles carries the risk of oxygen starvation in the child and weak labor.
The disease manifests itself not only externally. Due to changes in the anatomy of the abdominal cavity, organs are displaced and their activity is disrupted. Therefore, the presence of diastasis is usually accompanied by numerous digestive disorders from the intestines - spasms, lower back pain, bloating, flatulence, constipation, a feeling of fullness in the abdomen. Over time, these symptoms intensify and include urinary incontinence.
What is needed to confirm the diagnosis?
Usually, doubts arise from the doctor when there is atypical pain. Then additional examinations are prescribed to exclude pathologies of the stomach, liver, and biliary tract. Careful palpation of the child’s abdomen allows one to identify a soft, elastic formation with a characteristic localization. If there is an intestinal loop inside the sac, the rumbling of gases can be felt with your hand.
Ultrasound examination is harmless to the child
To prepare for the operation, the surgeon needs to know more precisely which organs are involved in the prolapse, whether they are fused to each other, and to clarify the size of the hernial orifice. Therefore, ultrasound and computed tomography are prescribed. Less commonly used are contrast-enhanced radiography and herniography (a sterile contrast agent is injected into the cavity of the hernial sac).
To prepare a child for a planned operation and a safe postoperative course, the doctor needs to know the general condition of the patient. Therefore, blood, urine, and stool tests are performed. Additional types of examination may be required.
Memo before surgery
Pre-operation memo for patients
- click on the image to download.
Before surgery
before hospitalization
Before hospitalization, you will need:
- come to an appointment with the surgeon to receive a reminder and instructions
- undergo all necessary examinations before hospitalization
- bring compression stockings of class 1 compression, if necessary (the doctor decides) - class 2
on the eve of hospitalization
- make sure that all original examinations necessary for hospitalization are available
- Check with your doctor for the exact time of arrival at the emergency department
on the day of hospitalization (the day before surgery)
- in the morning before leaving for the hospital, take a shower (you can use antibacterial agents)
- undergo a hospitalization procedure, examination by a surgeon and an anesthesiologist in the hospital
- the evening before surgery - a light dinner until 20:00, then only liquids are allowed
- before bed - shower
On the day of surgery
- immediately after waking up, without getting out of bed, put on compression stockings
- In the morning before surgery you cannot eat or drink. An exception is taking a sip of water to wash down the medicine.
- honey. the staff will help with shaving the surgical area and guide you to the operating room
- in the operating room, the anesthesiologist will once again explain the anesthesia procedure and actions after the operation
- In preparation for the operation, you will have a venous catheter and, if necessary, an epidural analgesia system installed.
- you will come to in the operating room or intensive care unit
- If an epidural catheter is present, it will be removed in the intensive care unit
- after that you will be transferred to a ward
How to prepare a child for planned surgery?
If a hernia of the linea alba is detected, the child is prescribed surgical treatment as planned. This means there is time to prepare. Parents should not waste their energy on advertised “cure” methods. It is this type of hernia that does not tend to heal on its own.
The lost time works against the patient: the tendon tissue is stretched even more, the hernial sac grows, and the risk of strangulation increases.
The older child must be prepared for the future operation; he must not be frightened. Parents should avoid stress and calmly explain the need for treatment for further physical development. If you have anxiety or sleep disturbances, you should consult a pediatrician and use light herbal sedatives. Particular importance is attached to dietary nutrition.
Diet before surgery
Nutrition of a child before surgery requires a sufficient content of proteins, vitamins, and carbohydrates to meet the needs for “building material” and energy for the cells. Fats should be only the amount required by age. Avoid products that can cause increased fermentation in the intestines and gas formation:
- fresh vegetables;
- legumes;
- chips, crackers;
- butter and animal fat;
- tomatoes, cabbage in all types;
- chocolate, sweets, cakes;
- Rye bread;
- citrus.
Cereal products (porridge, casseroles, soups) do not affect gas formation; nutritionists especially recommend dark varieties of rice, carrots and cucumbers, stewed fruits, low-fat fish dishes, chicken, veal, egg whites, and cottage cheese. Dairy products are tolerated differently by children. If there is no gas formation, then it is better to give kefir or yogurt.
How is the operation performed?
Surgical treatment consists of an operation under general anesthesia. The child is given a sedative injection while still in the ward; the baby falls asleep in the presence of his mother, so he is not frightened by the walls of the operating room. The type of operation is called hernioplasty.
During the preparation process, the surgeon makes a decision on how to close the abdominal wall defect. This largely depends on the size of the hernia. For small formations, the edges of the hernial opening are tightened with tight sutures. If the sizes are medium or large, it is necessary to consider the option of plastic surgery.
When removing (resection) a necrotic section of the intestine, the ends are connected in various ways, the operation is delayed, and in the postoperative period a period of feeding with intravenous solutions will be required
It is performed:
- own tissues;
- synthetic materials.
The surgeon opens the skin and abdominal wall. Examines the condition of the organs located in the hernial sac. If there is no doubt about their damage, then immersion into the abdominal cavity and dissection of adhesions is carried out. Signs of impaired blood flow indicate a strangulation injury. This increases the complexity of the operation. All non-viable tissue must be removed. The sac formed from the peritoneum is excised.
In suturing the hernial orifice, the use of synthetic mesh is most effective. It does not subsequently cause as many relapses as the usual method of tightening the hole with threads. Tactics allow you to eliminate and consolidate muscle discrepancies, which ensures the child’s complete recovery. The operation lasts 40–60 minutes. The children wake up in the recovery room.
"Conspiracy" against hernia
Hernias of the lower part of the anterior abdominal wall in children and adults have different origins, and, therefore, the methods of their treatment in children and adults differ. Treatment of a hernia is possible only with surgery. The indication for surgery is an established diagnosis of a hernia, regardless of age. In children under 1 year of age, repeated strangulations are indications for hernia repair. The main purpose of the operation is the isolation and high excision of the hernial sac. The technique is traditional, but the art of the surgeon is to correctly assess the situation during the operation and try, if possible, to maintain the normal anatomical relationships of the organs in the groin area. The fact is that in the inguinal canal in boys there passes the spermatic cord, the elements of which are a vein and an artery that supply the testicle, as well as the vas deferens. Compression of these elements during surgery can lead to the death of the testicle, and insufficient strengthening of the wall of the inguinal canal can lead to recurrence of the hernia. In girls, when isolating the hernial sac, it is imperative to release the round ligament of the uterus, damage to which can cause infertility. It should also be taken into account that strangulation of a hernia in a girl is no less dangerous than in a boy, since the ovary very often descends into the hernial sac in girls, which, if strangulated, can die in 20 - 30 minutes.
What should be done in the postoperative period?
Some clinics practice early discharge of patients for uncomplicated operations - on the second day. Other doctors consider observation of at least 3–4 days necessary. The period is extended if the operation was performed for emergency reasons in the presence of organ infringement. Sutures are removed on days 8–10 in a children's clinic.
Gastric hernia
From the second day it is recommended to walk a little and play while sitting. The seam is treated daily with brilliant green and sealed with a sterile napkin. You are allowed to take a shower only after the stitches have been removed. Before this, the patient’s body should be wiped with a wet, warm towel, and the baby should be washed twice a day.
In the first days, the diet is only liquid: low-fat broth from chicken, fish, porridge with water (oatmeal, boiled rice), vegetable puree. Kefir, yogurt, cottage cheese, fruit jelly, rosehip decoction, weak tea sweetened with honey are allowed. For a month you should refrain from fried foods and sweets with cream.
Doctors advise giving the child multivitamins with minerals and calcium supplements during the rehabilitation period. They improve well-being and promote healing. Wearing the bandage is recommended for 2–3 months. Strict restrictions on physical activity are needed in the first 20 days. Schoolchildren are exempted from physical education for a period of three to six months.
Doctors recommend using “brilliant green” rather than iodine to disinfect a wound; it does not “burn” the edges and promotes healing
One day and no hernia!
Operations are performed under general anesthesia, specially designed for one-day hospitals. All medications used during surgery and for postoperative pain relief do not cause adverse or perverse reactions, which makes it possible to treat children with increased allergies and concomitant diseases. After the operation, the small patient is brought to the ward in a state of medicated sleep, where his parents or other loved ones are waiting for him, and where he is under the supervision of medical staff until he fully awakens. This achieves psychological comfort for both children and their parents, ensures the safety of postoperative awakening, and also neutralizes the elements of excitement characteristic of the post-anesthesia period. Treatment ends a week later with a visit to our Center for a follow-up examination of the child and removal of the suture.
Prevention
Serious prevention of hernias, as well as other hereditary pathologies, should begin in the embryonic period, when the body of the expectant mother is responsible for sufficiently supplying the fetus with everything necessary for the proper construction of tissues and organs.
For infants, regularity of feeding, quality and timeliness of complementary feeding, performing exercises while lying on the stomach, everything that prevents constipation is important. Screaming with any painful symptoms is a signal to see a doctor; dangerous conditions are created for increased intra-abdominal pressure.
For older children, overfeeding, gaining excess weight, allowing parents to eat fast food, and excess sweets are undesirable. It is useful to play sports, running, swimming. Experience in surgical treatment of hernias in childhood allows us to recommend that parents not delay the preparation period. The correct attitude towards surgical intervention helps to avoid serious complications and ensure healthy physical development of the child.
True and false abdominal diastasis after childbirth
Not every pregnancy requires treatment for abdominal diastasis after childbirth. Take your time immediately after giving birth to look for signs of diastasis and make a diagnosis for yourself.
After childbirth, the body is still focused on recovery. Everything that is softened and stretched tends to contract, and the stomach gradually returns to normal. Therefore, it is premature to suspect muscle diastasis immediately after the birth of a child. The body comes to its senses gradually, and it is quite possible that a soft stomach is a temporary phenomenon that will pass on its own.
It makes sense to help yourself avoid diastasis of the abdominal muscles after childbirth with the help of a corset and a fitness instructor. And don't delay! Only in the first months after childbirth can you do without surgery and significantly reduce the initial stages of diastasis.
A year after giving birth it will be too late, and no home methods will give results.