Paediatric General Surgery
Inguinal hernia and hydrocele (fluid around the testicle)
Inguinal hernia and hydrocele are more common in boys (girls can also develop hernias and rarely some fluid in the groin); they are caused by a passage between the abdomen and the scrotum that fails to close at the end of the pregnancy. If the passage is quite wide, bowel can bulge through it, causing a lump to form in the groin area. This is called an inguinal hernia. If the passage is quite narrow, only fluid from the abdomen can flow through it to the scrotum, causing a fluid-filled sac to develop. This is called a hydrocele. Hydrocele does not normally cause symptoms (it can be “uncomfortable” if is it is very large) and very often resolves spontaneously in the first few months; surgery is indicated if the hydrocele persists after 2-3 years of age. An inguinal hernia will need to be corrected with an operation. The bowel can get trapped in the scrotum and can become damaged; this is called strangulation and could lead to the bowel dying off, which can result in serious infection and bowel problems or damage to the testicle.
Dr Pacilli is one of the very few paediatric surgeons in Australia to perform surgery for inguinal hernia using keyhole surgery in infants and young children.
Umbilical hernia and epigastric hernia
These hernias are caused by a small opening in the abdominal wall or weakness in the abdomen, causing the tissues underneath to protrude. In umbilical hernias, the opening is caused by the umbilical cord not closing properly, allowing the abdominal lining or bowel to bulge out. In epigastric hernias, the tissue joining the muscles in the middle of the upper part of the abdomen has not closed properly, allowing a bit of fat to bulge out. Both types of hernia rarely cause problems; they can be safely observed for a long period of time and left untreated. Since umbilical hernias can close spontaneously in the majority of cases, surgery is rarely considered before 3-4 years of age. Epigastric hernias do not normally close spontaneously and surgery is considered after 2-3 years of age.
Lumps and skin lesions
Children can present with a variety of congenital and acquired lumps and skin lesions. The vast majority of these conditions are benign and can be observed for a period of time. However, some lumps or skin lesions can lead to complications, such as infection and bleeding, and therefore treatment is recommended. An ultrasound scan is often required to better understand the origin of the lesion. In some cases, when the origin of the lump or the skin lesion is uncertain, excision or a biopsy might be indicated.
There are many different aspects to consider before removing a lump or skin lesion which depends on the likely diagnosis, the likelihood to develop complications and the prospect of leaving an unsightly scar. Dr Pacilli will advice you on the best treatment for your child during the consultation.
Ingrown toenail
Ingrown toenail in children is quite common. This happens when a corner of a toenail, usually on the great toe, buries into the skin. This can happen because of tight or narrow-toed shoes, excessive sweating, following trauma and in the presence of naturally curving toenails. Ingrown toenails run in some families.
Most ingrown toenails in kids can be treated at home by putting a small piece of cotton wool under the toenail to help it out of the inflamed tissue. If the toe around the ingrown toenail is infected and has pus oozing from it, an oral or topical antibiotic might be required. Soaking the foot in warm salty water (1 to 2 tablespoons of kitchen salt for 1 litre of water) for 20 minutes a day can help to reduce the swelling and pain, as well as in drawing out the pus.
If the problem persists, you can visit your GP or a podiatrist who may treat the problem with surgery under local anaesthesia. Dr Pacilli only performs surgery for severe ingrowing toenail in hospital under general anaesthesia.
Disclaimer: Please note that the information contained on this website should not be used for the diagnosis or treatment of any medical condition. If you have specific questions about how the information relates to your child, please ask your doctor.