Inguinal hernia - Causes, Symptoms and Treatment .MF .
Inguinal hernia - a protrusion of abdominal viscera or parts thereof with the coating on the parietal peritoneum (the thin translucent membrane lining the inside of the abdominal wall) into the skin through the inguinal canal.The inguinal canal is located in the groin area on both sides and is a wide gap between the muscles of the abdomen, through which men are normal spermatic cord passes and his nerves, and for women - round ligament of the uterus.This channel has a slanting direction: from top to bottom, from outside to inside and from behind forward.In males it has a length of 4-5 cm, and in women slightly longer, but narrower than in men.The channel has an outer opening (superficial inguinal ring) disposed on the pubic bone, and an inner bore (deep inguinal ring), which is a hole in the transverse fascia covering the abdominal wall from the inside, at the point of passage through the wall of the spermatic cord (round ligamentamong women).
Schematic representation of an inguinal hernia in men.
Like any hernia abdominal, inguinal hernia has hernial ring (it is the inguinal canal), the hernial sac (it is formed by a parietal layer of the peritoneum) and the contents of the hernia sac (they can be the greater omentum, small intestine, blind, sigmoid colon, vermiformappendix, bladder, female genital organs).Hernial sac, in turn, has a mouth, neck, body and bottom.
Schematic representation of the basic elements of a hernia: 1- tapping intestine;2 - parietal peritoneum;3 - anterior abdominal wall;4 - hernial ring;5 - hernial sac;6- shell hernia sac;7- hernial contents - bowel loop
Inguinal hernias occur most frequently among all the external abdominal hernias, and account for 75% of the total.
causes of inguinal hernia
There are congenital and acquired inguinal hernia.Congenital inguinal hernias account for the bulk of hernias in children (90%), but can occur in adults (approximately 10-12%).They are caused by a congenital anatomical feature, which consists in the so-called cleft vaginal process of the peritoneum, which is formed during the descent of the testis from the abdomen into the scrotum, and the peritoneal cavity communicates directly with the cavity of the scrotum, which creates conditions for the occurrence of congenital hernia.
Acquired inguinal hernias are formed throughout life and make up 85% of inguinal hernias.Depending on the anatomical features of their structure, they are divided into direct and oblique.
emergence of acquired inguinal hernia can be caused by local factors and general.Common causes are divided into predisposing and produce.
predisposing causes are:
1) hereditary (genetic predisposition due to the appearance of hernia);
2) age (age increases the likelihood of hernia due to the developing muscle weakness and reduced elasticity of the anterior abdominal wall);
3) the floor (greatest weakness groin in males);
4) different physical characteristics;
5) the degree of fatness (rapid weight loss contributes to the occurrence of hernia);
6) frequent childbirth in women;
7) paralysis of the nerves that innervate the muscles of the abdominal wall.
producing causes are factors causing increased pressure in the abdomen.These include:
1) heavy physical labor;
2) heavy labor;
4), difficulty urinating (may be due to enlarged prostate, narrowing of the urethra);
5) persistent cough (respiratory diseases: tuberculosis, chronic bronchitis).
In the case of an inguinal hernia cause local character is the presence of inguinal canal itself - "weak" places the abdominal wall.
Symptoms of inguinal hernia
Manifestations inguinal hernia depends on its size and on what authority it is.Typical are the pain and discomfort in the groin area, especially when walking, indigestion and sometimes urination.At the groin there is swelling, increasing straining and coughing.For large inguinal hernias in men increases the corresponding side of the scrotum and the skin is stretched it, thus there is a deviation of the penis in the opposite direction.For very large inguinal hernias penis can completely hide under the skin.
When inguinal hernia large its content is no longer self-care into the abdominal cavity.In the case of being in the inguinal hernia bladder disturbed urination, which can take place in two steps, and sometimes requires patients forced body position;as filling the bladder urine hernia size increases.
inguinal-scrotal hernia of large size.
Nevpravimaya inguinal-scrotal hernia can be confused with hydrocele (hydrocele), in which there is also an increase in the size of the scrotum due to accumulation of fluid in it.For inguinal hernia it may also be made of varicocele - varicose veins of the spermatic cord: if it in the patient in the upright position of the body appear stupid Straining pain in the scrotum, and there is a slight increase in its size, but the veins easily fallen down with pressure on them and picked up the scrotum upwards.Women for inguinal hernia can be accepted round ligament cyst extending into the inguinal canal.
survey of suspected inguinal hernia
Laboratory examination with uncomplicated inguinal hernia is not self-diagnostic value.In the case of hospitalization for elective surgery for hernia underwent clinical laboratory tests (complete blood count, urinalysis, blood chemistry, blood glucose, research on hepatitis, HIV, syphilis), which allows to exclude contraindications to surgery.
Treatment of inguinal hernia
Treatment of inguinal hernias - operative.Radical surgery for inguinal hernia (inguinal hernia repair) is to remove the hernia sac and the strengthening of the weak portion of the anterior abdominal wall (inguinal canal) in the hernial ring by plastic local tissues, and possible plastic by sewing in the hernia defect mesh graft, made of polypropylene (Liechtenstein) method.The operation is performed under local anesthesia or general anesthesia.
polypropylene mesh for hernia repair.
Currently are spreading laparoscopic hernia repair techniques.Their advantages are the reduction in trauma surgery, patients with early return to activity, good cosmetic effect.However, there are disadvantages, which include: the need to perform the operation under general anesthesia, the possibility of damage to the intra-abdominal organs and blood vessels, damage to the peritoneal cover in four places (3 points trocar and the opening of the peritoneum over the hernial ring), which can lead to the development of adhesions in theabdominal cavity.
Preoperative about uncomplicated inguinal hernia is reduced to the appointment of a sanitary bath and cleaning enema before surgery, hair shaved groin, emptying the bladder before surgery.
recurrences of inguinal hernias after surgery are common: the oblique inguinal hernias in the range of 3-15%, with direct - in 15-35%.
Fatal outcomes in surgical treatment of uncomplicated hernias are extremely rare (0.04%).The total number of postoperative complications is less than 4.8%, and the abscess wound - 0.2%.
Temporary disability after hernia repair is an average of 1 month.Workers heavy physical labor is transferred for a period of up to 6 months in the light work.The development of recurrent hernias is a contraindication to all kinds of physical labor associated with significant or moderate physical exertion, prolonged walking, travel for a long time at a great distance from the hospitals because of the threat of infringement of hernia.
only radical method of treatment of congenital inguinal hernia is the operative method.Development anesthetics currently allows to perform surgery directly at any age after the detection of a hernia, including newborn.However, in the case of relative contraindications such as rickets, prematurity, some ported diseases, provided there are no complications of inguinal hernia can transfer planned surgery at a later date - until the age of 6-12 months.The goal of surgery is to remove the hernia sac, and in contrast to the hernia repair in adults spend strengthen the child of the anterior abdominal wall is not necessary.With the development of infringement of congenital inguinal hernia shows emergency surgery, but weak, premature babies, as well as in the presence of therapeutic contraindications within the first 12 hours after the infringement may conduct medical treatment aimed at facilitating the reposition of the hernia.To this end, atropine, and narcotic pain relievers, apply a 15-minute warm bath, the baby is placed on his back with a sublime position of the pelvis.In the absence of effect of conservative treatment for 1.5 hours shown emergency surgery.
Complications of inguinal hernia
major complications of inguinal hernia are: denial, coprostasia, nevpravimost, inflammation and damage to the hernia.More rare neoplasms and foreign bodies hernia.
infringement inguinal hernia is the most common and life-threatening complication of it, which is caused by the sudden compression of its contents and requires urgent surgical treatment.Left in the hernial sac abdominal organs often squeezed in hernial ring at the neck of the hernia sac.Impingement is elastic and fecal also possible combination thereof.
When elastic infringement larger than usual number of abdominal organs quickly slips through the hernial that pererastyagivayutsya when a sharp increase in intra-abdominal pressure due to significant physical activity, coughing, straining, or other factors.After the cessation of increase in intra-abdominal pressure, the hernial ring return to the previous state, which leads to a strangulated hernia.In inguinal hernia infringement most often occurs in the area of the external opening of the inguinal canal.With this type of infringement compression published viscera is happening outside.
fecal infringement occurs more often in older people and is caused by weakening of the wave-like bowel movements, aimed at promoting its content.In the intestine, located in the hernial sac, it accumulates a large amount of content, which leads to compression of the bowel loop outlet and then to increased pressure on the hernial ring hernial contents.Thus fecal infringement is aggravated by elastic and develops mixed infringement.
In uschemlёnnom body develop disorders of blood circulation and lymph circulation.The liquid from the vessels in propotevaet gut lumen and into the cavity hernia sac (hernia water), which further strengthens the infringement.Develops necrosis of the intestine, beginning with its mucosa.Gangrene of the bowel wall often leads to its perforation, intestinal mass exit from the contained microbes in the hernial sac and the development of peritonitis.Because of circulatory disorders pathological changes occur not only in the uschemlёnnoy intestine, but also in leading up to it and removing it from the intestine.
coprostasia (stagnation of feces) develops when the contents of the hernia sac is the colon, resulting in disorder of motor function of the intestine.Promotes coprostasis irreducible hernia, hearty meal and a sedentary lifestyle.More common in elderly patients with a high body mass.Manifested intractable constipation, abdominal pain and nausea, sometimes vomiting.Coprostasia can lead to fecal strangulated hernia.
irreducible hernia is the result of development in the hernial sac adhesions between internal organs and a hernia sac, which is due to traumatization of the hernia contents.Nevpravimost may be partial (where part of the contents can reduce a hernia in the abdominal cavity, and the other part is not) or full (all the contents of the hernia does not reduce a into the abdominal cavity).
Inflammation of hernia develops when infected hernia sac, which is possible with acute inflammation of the appendix (appendicitis) or Meckel diverticulum, caught in the hernia sac, with tuberculosis of the peritoneum.At the same time suffers from the general condition of patients, the body temperature rises, there is a fever, appear vomiting, delayed stool and difficulty passing flatus.Increases the size of the hernia, Kazha over her blushes.
Damage hernia can lead to rupture of the intestine in a hernial bag and found a sharp increase in intra-abdominal pressure, with direct injury as a result of injury or hernia of the abdominal wall away from the hernia.
Neoplasms hernia is very rare, can occur from the contents of the hernia, hernia sac or surrounding tissues and organs.The most common lipoma (wen) hernia sac.
foreign bodies in the hernial sac may protrude swallowed by the patient objects, worms, bladder stones.
Prevention inguinal hernia
In terms of prevention of occurrence of hernias are important regular physical exercise as a means of strengthening the muscles of the anterior abdominal wall and the body in general.Also important is the fight against obesity, and importantly, a strong weight loss after it, since these pathological states create favorable conditions for the formation of hernias.As the organizational measures in production requires the correct selection of workers to heavy physical labor in accordance with their physical abilities and health status.
is early identification of people suffering from hernia, and forwarding them to the planned surgery before will have time to develop complications To prevent the development of complications of inguinal hernias important.To this end, the organization of important preventive examinations of the population, particularly among people of school age and retirement.
Surgeon Kletkin ME