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Paediatric hiatus hernia

OVERVIEW

A hernia occurs when a part of an organ protrudes through an opening in the surrounding muscle wall. In the case of a hiatal hernia, the top part of the stomach pushes up into an opening called the hiatus, which is located in the diaphragm muscle between the chest and stomach. Normally, the oesophagus passes through this opening to join the stomach, but in a hiatal hernia, the upper part of the stomach travels into the chest through this opening.

As a result, the upper part of the stomach may become compressed, and stomach acid may reflux back through the opening, causing symptoms such as heartburn. Hiatal hernias can be of two types: sliding and paraesophageal. The sliding hernia is the most common, occurring when the junction between the oesophagus and stomach slides up into the chest through the hiatus. The paraesophageal hernia is less common but can be more severe, as it involves a portion of the stomach pushing through the hiatus and lying next to the oesophagus in the chest.

Signs and symptoms of hiatus hernia in children

While many cases of hiatal hernia do not exhibit symptoms, some people may experience various symptoms such as burping, nausea, vomiting, reflux of acid or stomach contents into the throat or oesophagus, heartburn, regurgitation, and difficulty swallowing. Paraesophageal hernias may cause more severe symptoms, including difficulty swallowing solid foods, feeling full quickly after eating small amounts of food, chest or abdominal pain, abdominal bleeding, or anaemia.

In some cases, a paraesophageal hernia can cause a medical emergency when the stomach or abdominal organs twist or turn, leading to severe pain. If the stomach's blood supply is compromised (strangulation), it can result in an emergency that requires immediate surgery.

The symptoms associated with hiatal hernia may mimic those of other medical conditions. It is crucial to seek medical attention from a healthcare provider to ensure an accurate diagnosis.

Treatment

If your child's hiatal hernia is mild and does not produce any symptoms, treatment may not be necessary.

However, if the hiatal hernia is causing symptoms, surgery may be required. Usually, this surgery is performed along with an anti-reflux procedure called a Nissen fundoplication. Typically, laparoscopic techniques, which involve inserting a small camera into the body, are used to perform these surgeries. Your child will be under general anaesthesia during the procedure.

During the surgery, depending on your child's specific situation, the paediatric surgeon may make the diaphragm opening (hiatus) smaller by suturing it closed, moving the stomach down into the abdomen, or removing the hernia sac that is pressing through the diaphragm.

After the surgery, your child will be monitored closely by their medical team in a recovery area as they wake up from the anaesthesia. Your child may need to stay in the hospital for a few days to recover.

REQUEST A CONSULTATION

Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1How is a hiatal hernia diagnosed?

Imaging tests like X-rays, CT scans, and endoscopies can be used to diagnose a hiatal hernia.

2Are hiatal hernias dangerous?

Most hiatal hernias are not dangerous, but they can cause discomfort and lead to other health problems if left untreated. In rare cases, complications such as strangulation can occur and require emergency surgery.

3What causes a hiatal hernia?

It is a congenital anomaly in children, which means that they were born with it.

4Can a hiatal hernia be prevented?

There is no sure way to prevent a hiatal hernia in children.