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September 23, 2016 23:09

Inguinal - scrotal hernia : causes, symptoms , diagnosis, treatment

Flexing elements of the abdominal cavity through the inguinal canal is characterized as inguinal-scrotal hernia.Such a condition may be congenital or occur simultaneously with the age-related changes, and the male part of the population is observed much more frequently than women.

pathology responds well to treatment, especially timely.Advanced cases may face infringement of hernia sac and necrosis strangulated organs.

code ICD 10:

  • K 40 - inguinal hernia.
  • K 40.0 - Bilateral inguinal hernia with obstruction phenomena.
  • K 40.1 - Bilateral inguinal hernia with gangrenous complications.
  • K 40.2 - Bilateral inguinal hernia uncomplicated.
  • K 40.3 - unilateral or without refinements, with signs of obstruction.
  • K 40.4 - unilateral or without specifying a gangrenous complications.
  • K 40.9 - unilateral or without revisions, uncomplicated.

Causes inguinal-scrotal hernia

determinants of susceptibility to the occurrence of inguinal-scrotal hernias are considered:

  • heredity;
  • age after 50 years;
  • neurological disease affecting the nervous innervation of the abdominal wall;
  • obesity, the presence of extra kilos.

The functional factors that may lead to disease, include the following:

  • excessive exercise on the abdominal area;
  • chronic difficulty of defecation, constipation;
  • BPH flowing in violation of urination;
  • chronic cough.

immediate cause of the disease can be:

  • cleft vaginal peritoneal process (during embryonic development);
  • high intra-abdominal pressure (due to problems with the intestines, bloating and so on.);
  • frequent crying spells, and expressed or cough in a child;
  • lifting and carrying heavy loads.

pathogenesis of the disease

main causes of this disease is closely related to the structural features of the musculo-ligamentous apparatus of abdominal and groin area of ​​a particular patient.The most important point is considered to be state of the inguinal canal and inguinal ring.The weakness of these bodies predisposes to the appearance of a hernia.

inguinal-scrotal hernias are divided into the following types:

  • By location:
    • on the one hand;
    • on both sides.
  • By typicality:
    • direct hernia;
    • oblique hernia.
  • According to an embodiment of origin:
    • congenital type;
    • acquired type.
  • According to the degree of development:
    • initial form;
    • inguinal channel form;
    • full of oblique inguinal hernia;
    • inguinal-scrotal hernia;
    • gigantic form.
  • By the nature of the flow:
    • without complications (with reduction and without reposition);
    • complications (the infringement, with coprostasia, inflammation and so on.).
  • severity:
    • simple hernia;
    • transitional form;
    • complicated hernia.

Symptoms of inguinal-scrotal hernia

Oblique inguinal-scrotal hernia suffer more than a straight line.Direct hernia occurs only in 5-10% of cases, and even then mostly in the elderly.Such bulging in most cases it is bilateral.Oblique hernia usually appears in patients from adolescence to middle age, usually on one side.

One of the most characteristic symptoms of hernia pathology is the hillock as a swelling in the groin area.Oblique inguinal-scrotal hernia has an elongated shape, it is located along the inguinal canal and is often omitted in the scrotum.If the protrusion is large, part of the scrotum can be markedly increased, her skin is stretched, there is a visible deviation of the penis to the opposite side.When a giant hernia shaped member can sink into the skin folds.

Direct inguinal-scrotal hernia has a relatively round shape, is located in the middle part of the inguinal ligament.

In situations where the hernia defect is above the expected opening of the inguinal canal outlet, you must exclude okolopahovuyu or interstitial pathology.

inguinal-scrotal hernia in men manifests severe pain.Pain may occur when the feeling the place protrusion, after exercise, but in the rest the pain subsides.Individually may appear such symptoms as general weakness and discomfort, dyspepsia (nausea, vomiting).

inguinal-scrotal hernia in children can form at any age, most often on the right side.The first signs can be seen with the naked eye:

  • at a voltage of the abdomen, while laughing, sneezing, coughing in the groin area with a soft bump appears content;
  • bump disappears at rest or hide on pressure.

sometimes may appear discomfort, mild pain, mainly after exercise.

inguinal-scrotal hernia in newborns is congenital in nature and is formed more inside the mother's womb.Pathology can be determined already in the first months of baby's life: bump in the groin occurs and becomes larger during crying and anxiety of the child, and disappears when the baby calms down.Tubercle painless to the touch, has a round or oval shape, easy to reduce a.

strangulated inguinal-scrotal hernia is a dangerous condition and require urgent medical attention.How to recognize this complication?

  • skin at the site of protrusion becomes purple or blue.
  • There is severe pain, nausea, or vomiting.
  • appears upset stool, bloating, loss of appetite.

If the infringement bump becomes very painful at palpation.It back to the right is no longer possible, whereas neuschemlennaya inguinal-scrotal hernia easily hidden when pressed with a finger.

Constipation with inguinal-scrotal hernias occur when the infringement of bowel loops - there is a condition, the same characteristics as intestinal obstruction.Constipation may be accompanied by a significant deterioration in health, bloating, belching, heartburn, vomiting.Waiting for relief in such a condition is pointless - an urgent need to call the "emergency care".

Consequences

Complications of inguinal-scrotal hernias develop in the absence of timely treatment:

  • infringement hernia tubercle - the most common consequence of that is eliminated only by surgical methods;
  • necrosis got jammed in the hernia sac bodies - intestinal loops, omentum areas of the bladder;
  • peritonitis - a dangerous inflammatory response, which covers the entire abdominal cavity (can also be the result of prejudice);
  • acute attack of appendicitis - inflammation of the tissue in the appendix, which occurs as a result of compression of the vessels of the appendix inguinal ring;
  • clinical consequences of an inguinal hernia may be a disorder of the digestive process, breach of the intestines, bloating, etc.

The most severe complication is considered strangulated hernia -. This situation requires immediate medical care, hospitalization in a hospital emergency room and performing surgery.

Diagnostics inguinal-scrotal hernia

doctor establishes a diagnosis based on the patient's complaints, as well as on the results of external examinations.The feeling is carried by means of the index finger: the inguinal-scrotal hernia tubercle is palpated easily, and at the femoral it is quite difficult to probe.

Pediatric doctor simultaneously defines the omission of the testicles into the scrotum, their size and shape, the absence of varicocele.The compulsory condition is checked lymph nodes in the groin area.

hernia defect condition is checked in the horizontal and vertical position of the patient.Next

appointed instrumental diagnostics, which may include the following types of studies:

  • scrotal ultrasound scan, which helps to determine the contents of the hernia sac (for example, part of the bladder or bowel section).In addition, with the help of ultrasound can be distinguished from hernia hydrocele;
  • method of transillumination - a light translucence of the scrotum - a simple and inexpensive method of diagnosis.If the contents of the bag the liquid, the rays are illuminated through the mound without any problems.Thicker structure does not miss the rays, and the light will look dull and uneven.

Differential diagnosis is carried out with the femoral hernia, hydrocele, with periorhitom, cysts, lipoma, lymphadenitis, tumor.

Treatment of inguinal-scrotal hernia

Medical treatment for inguinal-scrotal hernia disease ineffective, and therefore cure this pathology only operative way.The operation can be carried out already from the age of 6 months (newborn to carry out undesirable interference from the use of general anesthesia).

Anesthesia is usually combined with tranquilizers and drugs for local anesthesia - it prevents the appearance of a sharp pain in the postoperative period.

Operation with inguinal-scrotal hernia is called a hernia repair:

  • doctor makes an incision in the inguinal canal area;
  • cuts and sutures hernial education;
  • elements authorities found themselves disadvantaged, reduce a physiological their place - restored a normal anatomic structure of the groin and abdominal area.

During surgery, the surgeon sees to it that was not damaged by the spermatic cord and excretory ducts.

Generally, hernia repair surgery is not related to the complex - the procedure takes less than an hour.Most often, patients are discharged the next day, but compliance with bed rest is recommended for another three days.If your doctor has imposed ordinary seams, they are removed after 7-8 days.

People's treatment of hernias - superimposition of tight bandages, attachment coins, lotions, magnets, compresses - a futile exercise.Pursuing such treatment, patient only wasting time, which can lead to complications in the form of infringement hernias that require urgent surgical intervention.If the patient was operated on for 2 or 3 hours after the hernia has been infringed, such a transaction, in most cases it is successful.Delaying intervention can lead to serious complications, and in some cases may even lethal consequences.

bandage under-scrotal hernia

There is only one conservative method, which is used in treatment of inguinal-scrotal hernia pathology - a bandage.

In some cases, your doctor may prescribe wearing a bandage:

  • Hernia formation of large size, if it is impossible for one reason or another to perform the operation;
  • reappearance of disease after surgical treatment;
  • contraindications for surgery (age restrictions, cardiovascular disease, problems with blood clotting, and so on.);
  • childhood diseases, in which the operation is postponed indefinitely.

At the same time, the band does not cure the disease dramatically.Its purpose - to facilitate the patient's condition, to stop the increase of herniation and to prevent infringement.However, if the patient stops using a bandage, then all signs of disease coming back.

So that gives you wearing a bandage:

  • decreases the degree of discomfort;
  • the patient returns to work capacity;
  • hernia loses its tendency to exacerbate and infringement.

bandage put on every morning, at the naked body in a horizontal position.At first it may be wearing a little uncomfortable, but after a few days the patient gets used and does not mark the discomfort.Of course, the right choice bandage without significance: this can help a medical specialist in a clinic or a pharmacy.

bedtime bandage can be removed, but if the patient has coughing fits at night, remove the supporting device is not required.

As practice shows, the band wearing - a temporary phenomenon, and sooner or later, the patient still has to decide on the operation.

Prevention

best kind of prevention inguinal-scrotal hernia is considered regular exercise, morning exercises, yoga and active lifestyle.And if you do not charge early, never too late to start.If in doubt, you can consult with a doctor who will evaluate your options for classes and select the most suitable exercises.

Equally useful would be walking at a distance of at least 3 kilometers daily.

desirable to normalize the daily routine.Your daily routine should be a place for both work and leisure.Sleep should be a full and sufficient for recovery.

peretruzhdaetsya should not, engage in excessive physical activity, carry weights and provide an unnecessary burden on the anterior abdominal wall.

Physical inactivity - no less dangerous extreme, which leads to a weakening of the musculo-ligamentous apparatus and can cause a hernia over time.Therefore, doctors strongly recommend exercise (you can not severe, but regularly).

Do not let the appearance of extra kilos.If you are inclined to corpulence - stick to a low calorie diet, with a predominant use of plant foods and limited sweets, bakery products, animal fats, and alcohol.In addition to weight loss, this diet will lead to the digestion, eliminate constipation, which also is a predisposing factor for the development of hernias.

forecast

Prognostic conclusions in uncomplicated form of hernia conditionally favorable.If surgical treatment is carried out in a timely manner, the ability to work is restored fully.The re-emergence of hernias after surgery found only in 3-5% of diseases.

When pinching the future depends on the disadvantaged sections of organs, a doctor's qualifications and time spent intervention.If the patient with infringement in no hurry to apply for emergency assistance, the vast majority of cases there are irreversible changes in the abdominal cavity, which can affect not only the future health of the patient, but also his life.

inguinal-scrotal hernia is considered harmless disease if treatment is carried out in a timely manner.If the delay in treatment to the doctor, and in severe cases the consequences can be extremely unfavorable.