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Medical Forum / General / General / November 2006epigastric hernia in 2 y/o male
My son, at his 2 year well visit, was diagnosed with a hernia. Our pediatrician could see just by looking at him with his shirt off that his "bump" was a hernia. We were referred to a pediatric surgeon with whom we met. He recommends surgery. He informed us the surgery would be approximately 20 minutes in length and the blood loss would be next to nothing, but he would have to undergo general anesthesia. This pediatric surgeon told us that his hernia is defect in the muscle and it would never close, unlike an umbilical hernia. However, we spoke with pediatrician who has been practicing for 40 years and he recommends waiting. He states that this particular hernia has a (+/-) 60% chance of closing on its own. Can anyone direct us to any valid statistics on the likelyhood of the hernia closing and/or incarceration? It seems that the percentages of occurence of incarceration and closure are anecdotal at best. > My son, at his 2 year well visit, was diagnosed with a hernia. Our > pediatrician could see just by looking at him with his shirt off that [quoted text clipped - 10 lines] > incarceration? It seems that the percentages of occurence of > incarceration and closure are anecdotal at best. I would recommend a second opinion from a pediatric surgeon. We can't examine your son. Plus, as you point out, epigastric hearnias are quite rare. Jeff > My son, at his 2 year well visit, was diagnosed with a hernia. Our > pediatrician could see just by looking at him with his shirt off that [quoted text clipped - 10 lines] > incarceration? It seems that the percentages of occurence of > incarceration and closure are anecdotal at best. I agree that epigastric hernias don't close on their own. They can indeed incarcerate and strangulate, but if they do, they incarcerate preperitoneal fat, not small bowel. The risk to your child's life is minimal if you do nothing. However, the risk of him having ongoing pain from it is more significant, and acute incarceration, should that occur of preperitoneal fat is VERY painful. OTOH, the risk of this surgery in a child older than 1 year old is minimal as well. HMc Thank you for your input. So in your experience this type of hernia does not resolve on its own? He is asymptomatic at this point. I fear that at this point we have many opinions and ultimately it is our decision, but we are committed to being as informed as possible prior to any action taken. When he was born the stomach muscles were not closed but the surgeon told us that this is a separate issue. And that his muscles are continuing to grow and will eventually close. But as a layperson, I don't see how the two are not related. Thoughts? > > My son, at his 2 year well visit, was diagnosed with a hernia. Our > > pediatrician could see just by looking at him with his shirt off that [quoted text clipped - 20 lines] > > HMc > Thank you for your input. So in your experience this type of hernia > does not resolve on its own? He is asymptomatic at this point. I fear [quoted text clipped - 29 lines] > > > > HMc This link talks about operations and alternatives in laymens terms. http://www.surgerydoor.co.uk/so/detail2.asp?level2=Epigastric%20Hernia%20Repair% 20-%20Child > Thank you for your input. So in your experience this type of hernia > does not resolve on its own? He is asymptomatic at this point. I fear [quoted text clipped - 4 lines] > his muscles are continuing to grow and will eventually close. But as a > layperson, I don't see how the two are not related. Thoughts? No, it won't close on its own. It sounds to me like you don't have many opinions, just two -- the surgeon who said it should be fixed, and the pediatrician who said it shouldn't. An epigastric hernia is very unlikely to be a life threatening problem, just potentially painful, and the repair is quite simple with very little risk. I presume that the stomach muscle issue you're talking about is diastasis rectus, and that is not related to an epigastric hernia. The hernia is a defect in the fascia and has nothing to do with the status of the rectus muscles. HMc |
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