Male2: Inguinal hernias are different. I am going to draw a picture of what happens in inguinal hernia. An inguinal hernia is a hernia that occurs in the groin, so if you imagine a little baby, and I am going to use a boy as an example, if you imagine a baby boy developing inside his mother. The testes start out in development, I will turn this so you can see, start out in development just below the kidneys on each side. The testes, as the baby is growing, still inside his mom, what happens is the testes move down in the belly, they come around to the front and they come down into the scrotum. So the testes come down around to the front and down into the scrotum. One of the things that pediatricians do, the first time they meet a new baby in the nursery is they feel to see if the testes have come down to see if the testes have descended properly. Sometimes, the testes stops somewhere along the way, that is called undescended testes, that is a problem that I can talk to you about some other time, but it is one of the first things that is examined for in a baby boy. Well, if you think about it, to get from inside in the back to what is essentially outside of the belly in the front, the testes has to go through different layers of muscle and tissue, what happens is, as it goes through, it actually pulls that tissue along behind it and it makes a little hole and it pulls a little pocket of tissue down behind it, so there is a little opening that is connected to the inside of the belly. That opening and that pocket is called the processus. Now, if there is normal development, what is supposed to happen is you are supposed to have the testes descend, a processus forms on each side and then before the baby is born, the processus is supposed to close up. So a normal baby has testes in his scrotum and no connection to the inside of his belly. Unfortunately, in premature babies, and even relatively frequently in full-term babies, that does not happen properly. What happens is, the opening to the inside, the processus does not close. Now, if the processus does not close completely, but closes partly and I will draw it separately over here, there is a small opening through the inside and then a pocket of tissue that comes down below, what happens is that liquid from inside your belly, there is always a small amount of liquid inside your belly can come through the opening and it can collect in the processus and it blows up almost like a water balloon and when that happens, it is called a hydrocele. So a baby boy who is born with a hydrocele, sometimes called water on the testes actually has a little opening in the processus which allows liquid from the belly to come down.
Male1: Do all hydroceles lead to hernias?
Male2: The answer is no. Sometimes, the hydrocele opening is so small that it closes by itself even after the baby is born. So if we see a baby who is born or has a hydrocele, what we do is we wait until they are about one year old. At age one, if the hydrocele is still there, we would operate to fix it. If it has gone away by itself, if the fluid has been absorbed and it is not swelling up, if it is not swelling from time to time, we just leave it alone. Now the other possibility is that the opening is not so small that it stays quite large. So you have an open processus, a pocket of tissue and an opening to the inside of the belly and in that situation what happens is your internal organs, mostly intestine in boys and little girls when they have a hernia, it is almost always the ovary, can slip into the hernia sac. So if you imagine, the intestine is a tube within the belly and if a loop of the intestine slips into an opening in the processus into the hernia sac, what happens is that that loop of intestine causes the hernia to swell up. Now hernias are different from hydroceles because you actually have a loop of intestine inside the hernia sac and there is a danger that this loop of intestine will get stuck. If it gets stuck, that is called an incarcerated hernia. You have a loop of intestine stuck inside a hernia sac, it is called an incarcerated hernia.
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