And What To Do About It In Malaysia
Most of the time, the groin swelling or lumps in young children is caused by either Hernias, Hydrocoeles, or other problems with the testis or ovaries.
Some conditions are more urgent than others.
Here are a few questions you need to consider before bringing your child to the doctor:
Does it come and go easily
Is the swelling there all the time?
You need to seek urgent consult with a child surgeon if the lump in the groin for your child is painful and is there all the time.
Hernias occurs in about 1% of boys and 5% of all hernias seen in children are in girls. An inguinal hernia is caused by a part of the bowel, or fat in the tummy protruding through an opening in the lining of the abdomen, near to the groin. Hernias are more common on the right side and in approximately 15% of cases, it will occur on both sides. An inguinal hernia will usually present during the first year of life, but may present at any stage during childhood. The usual presentation is a lump in the groin, which comes and goes. If a child becomes distressed, the hernia may become more prominent.
In children under the age of 1 year, there is a strong chance that the hernia will become stuck. If this happens, the child will be in pain, and the protruding bowel is at risk of becoming damaged. In boys, there is also a risk of damage to the blood supply of the testicle. Sometimes the hernia may extend all the way down into the scrotum. In girls, the ovary may protrude into the groin. This can be painful and risks losing the ovary. Inguinal hernias may also present with a bowel obstruction, causes swelling of the abdomen and bile vomit.
For children under 1, the hernia is fixed under general anesthesia soon after presentation to a child surgeon, as the risk of being stuck is high. It is less urgent for kids over 1 but nevertheless; it is repaired within a few months to avoid complications and it never “goes away” by itself. Very rarely when the hernia is stuck and when the child surgeon cannot push it back, your child may require urgent surgery. The same goes for girls with a hernia and the ovary protruding out. This has risk of strangulating the blood supply or twisting the ovary and cutting off the blood supply to the ovary, which may die if not repaired immediately.
The hernia operation is performed under general anesthesia and the preferred method is by keyhole surgery. This allows the child surgeon to examine all the structures inside, making sure they are all fine and to check if your child is one of the 15% who has a developing hernia on the other side. This will avoid the potential of a second surgery down the line when it presents as a groin lump. The operation is conducted the same way for both boys and girls. It takes about 30 to 45 minutes to conduct one or both sides if present. The operation for inguinal hernia repair in children is extremely successful and the chance of recurrence is less than 1%. The scar will become barely visible in time.
A hydrocoele is a collection of fluid, usually around the testicle. In most of cases it is caused by fluid from the tummy that has trickled down through a communicating tube and trapped in a space that surrounds the testicle. Occasionally, it may occur after infection or inflammation of the testicle and it may occur following a twist of a part of the testicle. A hydrocoele may also develop after injury to the testicle and very occasionally may occur in the presence of a testicular cancer. Over 50% of baby boys are born with some degree of hydrocele. It can rarely occur in girls who have a small out-pouching of the lining of the abdomen. A hydrocoele usually presents at birth with a soft painless swelling in the scrotum. It does not cause any distress to the babies.
A child surgeon will examine your child to make the diagnosis of a hydrocoele. However, an ultrasound may occasionally be used to confirm the diagnosis. The majority of hydrocoeles presenting at birth will disappear by the age of 2. Since it does not cause any symptoms or trouble to the testis, it can safely be left alone. If still present at the age of 3 it’s best to be repaired, as it may now never “go away” by itself. The repair is almost identical to the hernia operation, again by the keyhole technique under general anesthesia with excellent outcomes.
The testis comes down from inside the tummy through the groin and into the scrotum, before little boys are born. In some the testis does not come down fully. More commonly, on the right, compared to the left. Sometimes these can be felt as an lump in the groin but what’s important is check that its truly the testis and that there isn’t a testis already in the scrotum. The testis in the groin can sometimes twist and cut off its blood supply, this will make it inflamed and swell up and appear red and tender to touch. If this happens, it is an emergency and you child need to be rushed to a hospital, preferably one with a child surgeon. Undescended testis however is not an emergency. To improve the sperm production function of the undescended testis, it is fix it down into the scrotum surgically at about 6 months of age. Other benefits of fixing the testis are to prevent twisting (torsion of testis), reduce risk of cancer or to enable self-examination and for cosmetic appearance.
A painful testis needs to be looked at by a surgeon urgently to exclude a twist or torsion of the testis.
Lymph nodes are small gland like structures that help develop the white blood cells to combat infection or inflammation. These are found everywhere in the body. Any infection to the leg may cause the lymph nodes in the groin to swell and get bigger. This can get really big and “pointed”, then it has become an abscess, full of pus.
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