Çocuk Kasık Fıtıklarına Yaklaşım
Özet
Çocuklarda en sık görülen cerrahi hastalıklardan biri olan kasık fıtıklarının insidansı %0,8 ile %4 arasında değişmekte olup prematürelerde, erkeklerde (%60 sağ taraf) daha sık gözlenir. Embriyolojik süreçte prosesus vajinalisin (PV) yetersiz obliterasyonu konjenital indirekt inguinal herni, hidrosel veya kord hidroseline yol açar. PV'nin açık kalma durumuna göre batın içi organlar veya sıvılar bu kanala göç eder. Anatomiye bakıldığında, iç ve dış halkalar arasındaki kasık kanalı içinden nervus genitalis, kremasterik kaslar ile erkeklerde spermatik kord, kızlarda round ligament geçer. Cerrahi açıdan inferior epigastrik damarların medialinde yer alan herniler direkt, lateralindekiler ise indirekt olarak sınıflandırılır. Fıtıklar sliding herni, Amyand herni, pantolon herni ve Littre hernisi olarak çeşitlenir. Klinik yaklaşımda asemptomatik infant hidroselleri 1-2 yaşına kadar spontan regresyon riski (%89-90) nedeniyle konservatif izlenebilirken, gerilemeyenlerde cerrahi gerekir. Kasık fıtıklarında inkarserasyon insidansı %12-17 arasındadır ve redükte edilemeyen hassas kitle, kusma gibi bulgularla acil yaklaşım gerektirir; %5 oranında strangülasyon riski taşır.
Inguinal hernias, one of the most common surgical diseases in children, have an incidence varying between 0.8% and 4%, and are observed more frequently in premature infants and males, predominantly on the right side (60%). In the embryological process, insufficient obliteration of the processus vaginalis (PV) leads to congenital indirect inguinal hernia, hydrocele, or cord hydrocele. Depending on the patency of the PV, intra-abdominal organs or fluids migrate into this canal. Anatomically, the inguinal canal between the internal and external rings transmits the genital nerve, cremasteric muscles, and the spermatic cord in males or the round ligament in females. Surgically, hernias located medially to the inferior epigastric vessels are classified as direct, while those lateral are indirect. Hernias vary as sliding hernia, Amyand hernia, pantaloon hernia, and Littre's hernia. In clinical approach, asymptomatic infant hydroceles can be followed conservatively until 1-2 years of age due to a high spontaneous regression rate (89-90%), whereas surgery is required for those that do not resolve. The incidence of incarceration in pediatric inguinal hernias ranges from 12% to 17%, presenting with an irreducible tender mass and vomiting, which requires urgent intervention and carries a 5% risk of strangulation.
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