Hernia of the white line of the abdomen in children. Symptoms of a hernia of the white line of the abdomen in a child, treatment without surgery and surgery

In the first months of life, doctors can diagnose a number of pathological conditions in newborns, including hernia of the linea alba in children.

The pathology develops due to divergence of the umbilical tendon plate. White line is a connective tissue that is concentrated in the area from the xiphoid process chest and below. The middle of the plate runs in the navel area. Here its width is 15-20 mm based on individual characteristics baby.

Provoking factors

A hernia of the linea alba is characterized by protrusion of the omentum. The risk of pinching the tumor is reduced if the divergence of muscle tissue is more than 10-12 mm. Doctors call the reasons for this phenomenon genetic predisposition or anatomical weakness of fibrous fibers.

Video: hernia of the white line of the abdomen in children abstract

Due to the weakening of the fibers, significant changes occur in the muscle and connective tissues of the abdomen, including:

• the appearance of slit-type holes;
• separation of muscle tissue;
• increase or decrease of muscles.

Provoking factors include mechanical injuries, underdevelopment of the tendon plate, which consists of collagen tissue. In babies, a hernia of the white line of the abdomen, a photo of which allows us to examine the pathology in more detail, occurs due to a long, continuous cry, frequent constipation, serious diseases.

Symptoms of the pathological condition

A hernia in a child is visible to the naked eye, but the diagnosis must be confirmed in a laboratory. It can be recognized visually not only by doctors, but also by parents. The main manifestation of the disease is a strong bulging of the abdomen. In this case, the child experiences a painful condition.

Video: Hernias in children. "Acute" stomach

If the newborn expresses painful sensations through crying, then older children complain of pain, which intensifies during increased stress and bowel movements. The pathological condition is accompanied by painful sensations not only in the abdomen, but also in the hypochondrium and lower back. If severe pinching occurs, nausea, painful, discomfort, colic. At the first symptoms of the disease, you must visit a pediatrician who will prescribe effective and timely treatment.

Surgical intervention

A hernia can only be removed with the help of surgical intervention. If your child has been diagnosed with this pathological condition, then there is no need to search and try to be treated. folk remedies. Surgery for a hernia of the linea alba will help you. After the operation, a course of rehabilitation and adherence to recommendations is necessary.

Video: Abdominal hernia. Symptom of cough shock

But before making a diagnosis and performing surgery, the doctor examines the patient and prescribes ultrasonography, passing tests. If the diagnosis is confirmed, then it is necessary to convince the child that he will have surgery. Hernia of the white line of the abdomen cannot be treated in any other way. No help here medicines, nor physiotherapeutic procedures.

Before surgery, you should remove a number of foods from your diet, including high-calorie, hot and spicy foods. Parents should exclude from the diet of a child who has been diagnosed with a hernia, all foods and drinks that contribute to gas formation and bloating.

Video: HOW TO RAISE A CHILD WITH DIASTASIS | Technique for lifting weights for umbilical hernia LilyBoiko

The operation to remove the tumor is called hernioplasty. It is performed under anesthesia, so the child will not feel the slightest pain. The duration of the operation is on average 1 hour. If there are no complications after it, then after a couple of days the patient can be discharged, having prescribed a series of necessary recommendations which must be strictly followed.

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A hernia of the linea alba in a child is a protrusion of the contents of the abdominal cavity through a natural or pathological opening. Pathology is formed due to a defect in the muscle layer of the anterior abdominal wall. A similar defect is formed during embryonic development fetus The constituent parts of the tissue layers of the white line of the abdomen do not develop well and correctly on different stages intrauterine development child.

How is a supra-umbilical hernia formed?

The linea alba is a collection of tendon strips that originate from the xiphoid process and reach the pubic fusion. It is wider in the upper half of the abdomen and gradually narrows at the bottom. The linea alba is made up of collagen fibers and connective tissue that connect the right rectus abdominis muscle to the left. It is formed as a result of the fusion of aponeuroses (tendon plate) of muscles on the anterior wall of the peritoneum.

A hernia is formed due to the divergence of tendons on the white line of the abdomen. With increased intra-abdominal pressure, the contents of the cavity, together with the serous membrane of the peritoneum, exit through the resulting hole under the skin, maintaining the integrity of the tissue.

A hernia is a complex formation, which includes:

• Hernial orifice is an opening between the tendons of the white line of the abdomen (in other words, a gap irregular shape), through which the contents of the abdominal cavity exit.
• The hernial sac is represented by a serous membrane lining the abdominal cavity from the inside. It forms a kind of pockets in the openings of the aponeuroses. This formation gradually increases with coughing or tension in the abdominal wall.
• Hernial contents - omentum, intestinal loops, sometimes other abdominal organs are found: bladder, pancreas. You can see what a supra-umbilical hernia looks like in the photo.

Symptoms and causes

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In children, pathology is usually detected at the age of 5 years, but it also occurs in newborns. Prerequisites for the formation of hernias are:

• scars from abdominal surgery;
• heredity;
• obesity;
• frequent constipation;
• hysterical cough and scream;
• ascites;
• congenital defect of the abdominal muscles;
• underdevelopment of tendons;
• binge eating.

The symptoms of the disease are unclear, so they are determined by the doctor during examination. Under certain conditions, a bulge in the abdomen is noticeable, which increases when lifting heavy objects or after eating. Painful sensations are found in the upper abdomen when pressed with hands. In the lying position, the hernia is barely noticeable; with pressure, it also decreases.

Some signs should alert mothers and fathers of children. These include abdominal pain after eating, heartburn and a feeling of heaviness in the abdomen, possibly indigestion and decreased or absent appetite. In infants, the pathology may be the result of constant strong crying or coughing, which increases pressure in the abdominal cavity.

For large hernias painful sensations localized in the sternum and on the back; it can also hurt under the shoulder blades. When you sneeze or cough for a long time, the hernia increases. If the child’s well-being sharply deteriorates and the pain worsens, then a complication of the disease in the form of injury to the hernial sac is possible.

Types and stages of hernia development

Depending on the location, there are the following types hernia:

• Epigastric. This pathology accounts for about 80% of all cases of the disease. It is located above the navel. Also known as supra-umbilical and epigastric hernia.
• Paraumbilical. Localized near the navel, but not in it (see also:). This type of pathology is very rare - about 1% of all cases.
• Subumbilical. Localized under the navel. Occurs in 10% of sick children.

When forming, pathology goes through several stages of development:

1. Preperitoneal lipoma. Usually not accompanied by any symptoms, there is no pain. A piece of fatty tissue emerges through the hole between the weakened tendons of the linea alba. The hernial sac is not yet formed. It is almost impossible to establish pathology.
2. Initial stage. The process of formation of the hernial sac is activated. It is already possible to diagnose pathology in children.
3. Formed hernia. The stage at which the intestinal loops and internal organs of the abdomen fill the hernial sac. The disease is accompanied by certain symptoms and is easily diagnosed.

Diagnostics

To establish the disease, you need:

• Examination and consultation with a surgeon.
• Auscultation. A method of listening to sounds produced by the work of internal organs.
• Palpation. A diagnostic method by palpating the patient's body. Used to study the condition of organs and tissues.
• Blood, urine, stool tests.
• Ultrasound examination. Shows the state of organs in hernial sac.
• X-ray. Provides information about the position and condition of the abdominal organs and the hernia in general.
• Magnetic resonance imaging. Useful for complex pathological processes.

Hernia treatment

If a hernia is detected in a newborn child early stage, still possible drug treatment. Therapy is aimed at pain relief and treatment of inflammation.

This method does not affect the hernia itself, but only eliminates the symptoms. It is effective only when the disease does not develop rapidly. Conservative treatment methods:

• physiotherapy;
• massage;
• special bandage;
• reduction of the hernia.

Massage is allowed only from two weeks of age. After eating, make light clockwise movements along the baby's tummy. This will improve blood supply and peristalsis.

Special dressings, adhesive plasters or bandages have a positive effect in the treatment of hernia. They must be used under the supervision of a physician.

If conservative methods Treatments for the pathology in children have been unsuccessful; surgery remains. It is indicated after 3 years for pain or pinching of the hernial sac. The operation is also performed for large hernias.

Complications and consequences

The most dangerous complication- this is an infringement of the hernial sac and its contents. In a pinched organ, blood supply is disrupted and cells die. The result of this is inflammation of the abdominal cavity.

Symptoms that indicate a strangulated hernia.

Hernia of the white line of the abdomen in children - comparatively rare disease. It is detected in only 1% of the child population. More often not in newborns, but in preschool age(5–7 years old). In infants they predominate umbilical hernias.

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, 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 with whooping cough, respiratory infections, laryngitis;
• unsustainable physical activity;
• excess fat deposits.

In children with serious illnesses of cardio-vascular system possible formation of ascites ( big belly due to the sweating of plasma from the peritoneal vessels). Impaired development of muscle tissue is promoted by:

• lack of child nutrition sufficient quantity proteins, vitamins, microelements (fruits, vegetables, fish), the 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 negative impacts 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.

The photo shows a doctor examining the abdomen 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 Hernias are bloating caused by 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.

What is needed to confirm the diagnosis?

Usually, doubts arise from the doctor when there is atypical pain. Then they are appointed additional examinations to exclude pathologies of the stomach, liver, 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 the child for elective surgery and safe postoperative course, the doctor needs to know general state patient. Therefore, blood, urine, and stool tests are performed. Additional types of examination may be required.

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 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 to 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 surgery 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 a period of nutrition will be required in the postoperative period intravenous solutions

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.

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 carried out according to emergency indications in the presence of organ infringement. Sutures are removed on days 8–10 in a children's clinic.

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 physical activity is 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

Prevention

Serious prevention of hernias, like other hereditary pathology, 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. Scream at any painful symptoms is a signal to see a doctor, are created hazardous conditions increased intra-abdominal pressure.

For older children, overfeeding is undesirable, excess weight, parental permission to eat fast food, excess sweets. It is useful to play sports, running, swimming. Experience surgical treatment hernias in childhood allows us to recommend to parents not to delay the preparation period. The Right Attitude to surgery helps to avoid severe complications and ensure the child’s healthy physical development.

Hernia of the white line of the abdomen is a disease that is not typical for children. It occurs in 0.7-0.8% of all hernias. This disease is detected in a child later in age 5 years, in case of unsatisfactory formation of aponeurosis. The consequence of this condition is the appearance of gaps in the tendon bridges. Pinching occurs in very rare cases.

Causes and forms of pathology

The white line is a tendinous stripe, it is located between the pubic fusion and the xiphoid process. In the upper part of the abdomen it is widened, in the lower part it is narrowed. Accordingly, tendon divergence most often occurs in the upper part. Diastasis - the divergence of tendon fibers - can be up to 10 cm, and there is a high risk of transition to an umbilical hernia.

Hernial orifices can have different shapes:

• oval;
• rounded;
• diamond-shaped

Hernia strangulations often occur when the hernia is tight. Sometimes several hernial protrusions are diagnosed, located one above the other.

The cause of the disease may be:

• hereditary pathogenesis;
• acquired anatomical weakness of fibrous fibers;
• underdevelopment of the tendon plate caused by intrauterine anomalies.

Stages of the disease

The abdominal muscles diverge and become thinner, and holes form among the tendon fibers. With pathology of the tendon plate, there is insufficient collagen production.

The origin of the hernia is influenced by the child's unnecessary weight and abdominal trauma. When screaming or prolonged tension, intra-abdominal pressure increases, which also provokes discrepancy muscle fibers. A long increase in intra-abdominal pressure appears with whooping cough and bronchitis - during debilitating coughing attacks, with continuous constipation.

You can systematize the severity of the disease into 3 stages.

At the third stage, the protrusion becomes visible visually and can be palpated without effort. In rare cases, several hernias occur, located on top of each other. In this case, supra-umbilical, umbilical and infra-umbilical hernia are diagnosed at the same time.

Symptoms of tendon fiber separation

After the diagnosis has been established, treatment for a hernia of the linea alba in children begins. A characteristic sign of the condition is a protrusion in the form little bumps on the surface of the peritoneum closer to the epigastric region. In this case, additional symptoms appear - heartburn, nausea - which intensify with steep movements, say, bending over.

The disease in the first stage may not manifest itself in any way and may be detected during a medical examination by a doctor.

However, even the asymptomatic course of the disease is accompanied by the child’s claims and some signs. The baby often complains of abdominal pain, and after physical exertion he develops diarrhea or constipation. During bowel movements, constipation causes pain in the epigastrium.

Complications of a hernia – strangulation of the hernial sac.

Signs of the condition – sharp pain at the site of the hernia, heat, vomiting, bloating. Touching the stomach causes pain, which intensifies during movement.

Diagnosis of the disease

Speak to official medicine needed for abdominal pain of any kind. Extremely relevant this advice in the case of small children, because Their condition worsens very quickly.

A hernia is diagnosed by palpation, during an ultrasound examination, computed tomography on the abdominal organs.

The following additional research may be needed:

• radiography digestive organs– stomach and duodenum;
• gastroscopy;
• study of the patency of intestinal loops with assistance contrast agent– herniorrhaphy.

Often parents start looking traditional healers who offer to treat and reduce the hernia manually, believing that then surgery will not be required.

But even special medical bandages do not help prevent subsequent worsening of the condition. It is unthinkable to wear them continuously, and there is no guarantee that colic in the intestines will not occur the moment the bandage is removed. An increase in intra-abdominal pressure will immediately provoke subsequent bulging of intestinal loops.

The only way to get rid of the disease is to remove the protrusion during surgery. If this is not done in a timely manner, the child may develop intestinal obstruction or the organs located in the hernial sac will fuse with its walls.

Surgery for hernia of the white line of the abdomen in children

Before surgery, appropriate preparation must be carried out. The child is transferred to a special diet - all dishes that stimulate increased intestinal motility are completely excluded from it. The diet is also changing - now the baby is fed small portions every 2-3 hours, no more.

You will have to give up your children’s favorite treats: chips, crackers, sugary carbonated drinks, processed foods, chocolate, citrus fruits. Food should be prepared without spices, and the amount of fiber in the diet should be increased through porridges - oatmeal and buckwheat.

It is recommended to include chestnut rice, asparagus, carrots and fresh cucumbers, cauliflower. Meat and fish are only lean, yolks are removed from eggs, lactic acid products are selected with a low fat content.

Removal of a hernia of the white line of the abdomen in a child is carried out under general anesthesia. The operation is called hernioplasty.

In the third degree of severity, suturing is often carried out with support using unnatural materials - synthetic prostheses.

During the operation, the hernial sac is opened, its contents are removed and replaced - if permissible - or sutured, but the main goal of the surgical intervention is to eliminate diastasis. If this is not done, the disease will recur.

Based own fabric suturing is carried out quite rarely - in this case, the deficiency of the aponeurosis is sutured with a special non-absorbable suture material. But there is a risk of repeated bulging of the problem area when intra-abdominal pressure increases - the stitches may erupt.

In order not to expose the child to danger - reoperation– install the mesh frame. The design distributes the load evenly across the seams and closes the diastasis. In future connective tissue germinates and the risk of relapse is minimized. The operation is considered simple, and you can get back on your feet the next day. But you should not take the baby home - it is desirable that the patient be under the doctor’s supervision for 48 hours, no less.

The rehabilitation process requires adherence to a diet - it is not much different from the diet
the one that was needed at the time preoperative preparation. Portions are gradually increasing, the time between meals is lengthening. Dishes that irritate the intestines are still excluded from the diet, but emphasis should be placed on liquid foods or jelly-like dishes.

It is necessary to scrupulously monitor bowel movements and include laxative foods in the diet. The number of fruits should be limited - excess fiber can lead to flatulence.

Physical activity increases little by little. Rehabilitation period can take from 2 months to six months.

Preventive actions

To reduce the risk of developing the disease in infants, from the very beginning early age you need to monitor the regularity of bowel movements and avoid hysterical roaring.

Older children should be involved in sports to strengthen their muscles abdominals– this helps to seal the aponeurosis.

But even if a child has been diagnosed with a disease, there is no need to panic. Parents should immediately agree to the operation in order to prevent complications from developing. The operation to eliminate a hernia is considered ordinary, and for the baby it is less dangerous than a permissible pinching.

Health to your children!

A hernia of the white line of the abdomen in children (epigastric hernia) is a protrusion of the hernial sac that appears through the aponeurosis in the anterior wall of the abdomen. Removing a hernia requires highly qualified surgical intervention.

Mechanism of hernia formation

A hernia of the white line of the abdomen appears in the area of ​​the so-called. The white line is a tendon strip that runs from the xiphoid process to the pubic fusion. The linea alba is wider in the upper part of the abdomen and narrows in the lower part, so the risk of a hernia is higher here.

When a hernia appears, the tendon fibers may diverge along the white line by 10-12 cm (diastasis). There is a possibility of diastasis turning into an umbilical hernia.

The shape of the hernial orifice can be round, oval or diamond-shaped. The narrower they are, the more likely strangulated hernia. With reducible hernias, palpation of the hernial orifice is possible.

Unlike other types of hernias, a hernia of the linea alba in a child is quite rare (approximately 0.8% of cases). It usually occurs after 5 years of age due to insufficient development of the aponeurosis. As a result, gaps may appear in the tendon bridges. A strangulated hernia occurs rarely.

Often, a hernia of the white line is single, but in some cases several hernias are observed, which are located one above the other.

Symptoms of a hernia in a child

The main sign of a hernia is a bulge, which causes pain, usually in the epigastric region.

When the hernial sac is strangulated, there are following symptoms: strong pain at the site of the hernia, in severe cases - vomiting, fever, general weakness, bloating and peritoneal irritation.

The hernia is very difficult to reduce inside; touching it causes pain. In some cases, a hernia occurs without symptoms and is detected only when the child is examined by a doctor.

Increased pain is possible after eating, sudden movements, straining, and physical activity. Digestive disorders are often observed: belching, nausea, constipation, heartburn.

Causes of hernia

The causes of white line hernia in children are usually congenital. The main reason is congenital weakness of connective tissues. Other reasons include gender (hernia occurs more often in boys), obesity, constipation, ascites, Chronical bronchitis and whooping cough, postoperative scars and etc.

Types of hernia and stages of its development

Depending on the location of the hernia in relation to the navel, several types of hernia of the white line are distinguished:

• supra-umbilical;
• subumbilical;
• peri-umbilical.

There are three main stages of hernia development:

• preperitoneal lipoma - protrusion of subperitoneal fat.
• the initial stage is the appearance of a hernial sac, into which the internal organs begin to fall out.
• formed hernia - divergence of the rectus muscles and prolapse of certain sections of the walls of the small intestine into the pouch.

Diagnosis of hernia

A complete diagnosis of white line hernia will help to detect the disease in a timely manner and effectively treat it. The abdominal examination is carried out horizontally and vertical position patient with tense and relaxed abdominal wall muscles.

The following methods are used to diagnose the disease:

• examination of the patient;
• interview and history taking;
• auscultation and palpation of the hernia;
• X-ray examination of the stomach;
• gastroscopy;
• urine and blood tests;
• MRI and CT scan of hernia (in difficult situations).

Differential diagnosis of white line hernia is usually carried out for the following diseases:

• cholecystitis;
• pancreatitis;
• stomach ulcer;
• tumor metastases to the omentum.

Hernia treatment

Photo: special bandage for a child

After making a diagnosis, the doctor chooses a method of treating the hernia. Most effective method- surgical intervention. If the hernia is not removed in time, there is a risk of complications of the hernia and its further development. Activities such as massage for a hernia, wearing a bandage, etc. can only slow down the development of a hernia, but not eliminate the disease.

Contraindications to surgery are severe illness, the presence of infections in the body and the irreducibility of the hernia. In the presence of these contraindications, it is necessary to prevent the hernia from increasing in size. To do this, the child must wear a special bandage.

Surgical removal of a hernia – hernioplasty. The operation is usually performed under general anesthesia. The main types of operations: plastic surgery with local tissues (tension) and hernia repair using an endoprosthesis (non-tension).

Hernioplasty using your own tissue is performed to remove small hernias. In this case, the hernia is removed using continuous purse-string sutures. Tension hernioplasty can cause a recurrence of the hernia, since the sutures may not withstand heavy loads and cut through.

Hernioplasty using an endoprosthesis is usually performed to remove small and medium-sized hernias. This is the most effective surgical method for treating a hernia. Modern endoprostheses are characterized by high reliability and elasticity, without limiting the mobility of the abdominal wall.

The use of an endoprosthesis provides the following advantages compared to tension plastic surgery:

• painlessness. Typically, patients do not need to take pain medications after surgery.
• short rehabilitation period. The operation lasts about an hour, and the little patient can be discharged the next day. In some cases, he may remain in the hospital for a couple more days.
• low risk of relapse. The probability of relapse after using this method is no more than 1%, whereas when using tension plasty it is 20-40%.

Diet for hernia

When preparing a child for surgery, you should feed him dishes made from vegetables, cereals, rice, fruits, fish, egg whites, low-fat cheese etc. It is necessary to exclude spicy and fatty foods, including spices, from the diet.

To speed up postoperative rehabilitation the doctor prescribes a special diet rich in fruits and vegetable juices, cereals, and also purees. However, it is not recommended to overuse fiber to avoid colic and flatulence. The child should also be given calcium, vitamins B and C after surgery.

IN postoperative period It is highly undesirable to consume foods that contribute to the development of constipation and gas formation.

Complications of hernia

The main complication of a hernia of the white line of the abdomen is its strangulation, in which the hernial contents are suddenly compressed in the hernial orifice.

If a hernia is strangulated, the child undergoes emergency surgery, which may involve large volumes of resection. The main symptoms of strangulation are vomiting, nausea, severe abdominal pain, inability to reduce the hernia, and the presence of blood in the stool.

Another complication of a hernia of the white line of the abdomen is the irreducibility of the hernia. In this case, the contents of the hernia are connected to the walls of the hernial sac.

In addition, injuries and inflammation are possible internal organ located in the hernial sac, as well as intestinal obstruction.

Hernia prevention

To prevent a hernia of the linea alba in infants, regular bowel movements should be performed. You should also ensure that the baby does not overeat and that his intestines work reliably.

For children aged 5-10 years effective prevention Hernia formation is moderate physical exercise.

It is necessary to regularly take your child to routine examinations See a doctor and accustom your baby to moderate hardening.

In conclusion, it should be noted that a hernia of the white line of the abdomen in children can only be eliminated with the help of surgery. It is very important to carry out diagnosis and surgery in a timely manner, otherwise complications are possible, first of all, strangulation of the hernia. But even after the operation, careful adherence to all doctor’s recommendations is necessary to prevent relapses.