Inguinal-scrotal hernia

The protrusion of the elements of the abdominal organs through the inguinal canal is characterized as an inguinal and scrotal hernia. Such a condition can be congenital or appear simultaneously with age-related changes, and in the male part of the population it is observed much more often than in women.

Pathology is well treatable, especially timely. Running cases may threaten the infringement of the hernial sac and the necrosis of the restrained organs.

Code on the ICD 10:

• K 40 - inguinal hernia.
• K 40.0 - bilateral inguinal hernia with the phenomena of obstruction.
• K 40.1 - bilateral inguinal hernia with gangrenous complications.
• K 40.2 - bilateral inguinal hernia uncomplicated.
• K 40.3 - unilateral or without clarification, with the phenomena of obstruction.
• K 40.4 - unilateral or without clarification with gangrenous complications.
• K 40.9 - unilateral or without clarification, uncomplicated.

Causes of inguinal and scrotal hernia

The factors determining the predisposition of a person to the occurrence of inguinal and scrotal hernia are:

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

The functional factors that can lead to the appearance of pathology include the following:

• excessive physical exertion on the abdominal area;
• chronic obstructive dysfunction, constipation;
• adenoma of the prostate, flowing with violation of urination;
• chronic coughing attacks.

The immediate cause of the disease can be:

• nevraschenie vaginal peritoneum process (in the period of embryonic development);
• high intra-abdominal pressure (due to problems with the intestines, bloating, etc.);
• frequent and severe attacks of crying or coughing in the child;
• lifting and carrying weights.

[1], [2], [3]

Pathogenesis of the disease

The main causes of this disease are closely related to the peculiarities of the structure of the musculoskeletal apparatus of the abdominal and inguinal zone of the particular patient. The most important moment is the condition of the inguinal canal and inguinal ring. The weakness of these organs predisposes to the appearance of a hernia.

Pahovo-scrotal hernia is divided into the following types:

• By location:
  • one side;
  • from two sides.
• By typical:
  • a direct hernia;
  • oblique hernia.
• According to the variant of occurrence:
  • congenital type;
  • acquired type.
• By degree of development:
  • initial form;
  • inguinal and canal form;
  • full oblique inguinal hernia;
  • inguinal and scrotal hernia;
  • a giant form.
• By the nature of the current:
  • without complications (with and without correction);
  • with complications (with infringement, with coprostasis, with an inflammation and so forth).
• By severity:
  • simple hernia;
  • transition form;
  • complex hernia.

Symptoms of inguinal and scrotal hernia

The oblique ingument and scrotal hernia are more often affected than the straight. Direct hernia occurs in only 5-10% of cases, and even then mostly in the elderly. This protrusion is in most cases bilateral. The oblique hernia usually appears in patients from adolescent to middle age, often on the one hand.

One of the most characteristic symptoms of a hernial pathology is a tubercle in the form of an edema in the groin area. The oblique ingument and scrotal hernia has an oblong form, it is located along the inguinal canal and is often lowered into the scrotum. If the protrusion is large, then the part of the scrotum can be markedly enlarged, the skin on it stretches, there is a visible deviation of the penis into the opposite side. With a giant hernia form a member can be buried in the skin folds.

The direct inguinal and scrotal hernia has a relatively round shape, located on the middle part of the inguinal ligament.

In situations where the hernial defect is located above the intended outlet of the inguinal canal, it is necessary to exclude near-cerebral or interstitial pathology.

The inguinal and scrotal hernia in men is manifested by severe painful sensations. Pain can appear when you feel the place of protrusion, after physical exertion, but at rest the pain subsides. Individually, such symptoms as general weakness and discomfort, dyspeptic phenomena (nausea, vomiting) may appear.

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

• with stomach tension, during laughter, sneezing, coughing in the inguinal zone appears a tubercle with soft contents;
• The tubercle disappears in a state of rest or hides under pressure.

Sometimes there may be uncomfortable sensations, mild pain, mainly after physical exertion.

The inguinal and scrotal hernia in newborns has an inborn character and is formed even inside the womb of the mother. Pathology can be determined already in the first months of life of the baby: a tubercle in the groin arises and becomes larger during the cry and anxiety of the child and disappears when the baby calms down. The tubercle is painless to the touch, has a round or oval shape, it is easy to be guided.

Injured inguinal and scrotal hernia is a dangerous condition and requires urgent medical attention. How to recognize this complication?

• The skin in place of protrusion becomes crimson or cyanotic.
• There is severe pain, nausea, or vomiting.
• There is a disorder of the stool, flatulence, appetite.

When infringed, the tubercle becomes very painful when palpated. It is already impossible to fix it back, whereas an uncomfortable inguinal and scrotal hernia easily hides when pressing with a finger.

Constipation for inguinal and scrotal hernia occur when the intestinal loop is infringed - a condition appears that fully corresponds to the characteristics of the intestinal obstruction. Constipation may be accompanied by a significant deterioration of well-being, bloating, belching, heartburn, vomiting. Wait for relief in this state is meaningless - it is necessary urgently to call "emergency help".

Effects

Complications of inguinal and scrotal hernia develop in the absence of timely treatment:

• infringement of the hernial tubercle is the most common consequence, which is eliminated only by surgical methods;
• necrosis of organs trapped in the herniated sac - intestinal loops, gland sections, bladder;
• peritonitis - a dangerous inflammatory reaction that spreads to the entire abdominal cavity (can also appear as a result of infringement);
• acute appendicitis attack - inflammation of the tissues in the appendix, which occurs as a result of compression of the vessels of the appendix in the inguinal ring;
• the clinical consequences of inguinal hernia can be disorders of the digestive process, disruption of the intestine, bloating, etc.

The most formidable complication is the infringement of a hernia - this situation requires urgent medical care, with hospitalization in a hospital and the conduct of an emergency surgical operation.

[4], [5], [6], [7], [8]

Diagnosis of inguinal and scrotal hernia

The doctor establishes the diagnosis based on the patient's complaints, as well as the results of the external examination. Feeling is carried out with the help of the index finger: in the inguinal and scrotal hernia, the tubercle is palpable easily, and when it is femur it is difficult to probe.

At children the doctor simultaneously defines an omission of testicles in a scrotum, their size and the form, absence varikotsele. The condition of lymph nodes in the groin area is checked without fail.

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

Then instrumental diagnostics is assigned, which can include the following types of research:

• ultrasound scan of the scrotum, which helps determine the contents of the hernial sac (for example, part of the bladder or bowel area). Additionally, with the help of ultrasound it is possible to distinguish a hernia from a dropsy testicle;
• the method of diaphanoscopy is the light transmission of the scrotum - an uncomplicated and inexpensive method of diagnosis. If the contents of the bag are liquid, then the rays are enlightened through the tubercle without problems. A denser structure will not miss the rays, and the light will look dull or uneven.

Differential diagnosis is performed with femoral hernia, testicle, periorhitis, cystic formation, lipoma, lymphadenitis, tumor.

[9], [10], [11], [12], [13]

Treatment of inguinal and scrotal hernia

Drug therapy with inguinal herniated hernial disease is ineffective, and therefore this pathology is cured only in an operative way. The operation can be carried out from the age of 6 months (neonates to intervene undesirably due to the use of general anesthesia).

Anesthesia is usually combined with tranquilizers and preparations for local anesthesia - this helps prevent the emergence of sharp pain in the postoperative period.

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

• the doctor makes a cut in the inguinal canal zone;
• cuts and sutures hernia formation;
• the elements of organs that turned out to be infringed are placed on their physiological site - the normal anatomical structure of the inguinal and abdominal regions is restored.

During the operation, the surgeon makes sure that the spermatic cord and the outflow duct are not damaged.

As a rule, the operation of hernia repair does not apply to complex - the procedure itself lasts no more than half an hour. Most often the patient is discharged the next day, but for another three days it is recommended that bed rest is observed. If the doctor applied ordinary stitches, then they are removed after 7-8 days.

Alternative treatment of hernia - the imposition of tight bandages, the application of coins, lotions, magnets, compresses - a useless exercise. Being engaged in such treatment, the patient only loses time, which can lead to complications in the form of infringement of a hernia, which will require urgent surgical intervention. If the patient is operated on for 2 or 3 hours after the hernia has been impaired, then this operation in most cases is successful. Procrastination with interference can lead to serious complications, and in some situations even fatal consequences are possible.

Bandage for scrotal-inguinal hernia

There is only one conservative technique that is used in the scheme of treatment of inguinal and scrotal hernia pathologies - this is a bandage.

In what cases can the doctor prescribe wearing a bandage:

• hernial formations of large size, if it is impossible to conduct an operation for one reason or another;
• re-emergence of pathology after surgical treatment;
• presence of contraindications to surgical intervention (age limitations, cardiovascular pathologies, problems with blood coagulation, etc.);
• children's illnesses, in which the operation is postponed indefinitely.

At the same time, the bandage does not cure the disease radically. Its purpose is to alleviate the condition of the patient, stop the hernial protrusion and prevent infringement. However, if the patient stops using the bandage, then all signs of pathology return.

So, what gives the wearing of the bandage:

• decreases the degree of discomfort;
• the patient is returned to work;
• hernia loses its propensity to aggravate and infringe.

Bandage is worn every morning, on a naked body, being in a horizontal position. At first, wearing it can be a bit inconvenient, but after a few days the patient gets used and does not notice any discomfort. Of course, a competent choice of a bandage is important: a medical specialist in a polyclinic or in a pharmacy can help.

Before going to bed, the bandage can be removed, but if at night the patient has coughing attacks, then it is not necessary to remove the support device.

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

[14], [15], [16],

Prevention

The best type of prevention of inguinal and scrotal hernia is regular exercise, exercise in the morning, yoga and an active lifestyle. And if you did not exercise before, it's never too late to start. If there is any doubt, you can consult a doctor who will assess your chances of doing the exercises and pick up the most appropriate exercises.

No less useful are walking tours, at a distance of at least 3 kilometers a day.

It is desirable to normalize the regime of the day. In your daily routine there should be a place, both for work and for rest. Sleep should be complete and sufficient to restore the body.

Do not overwork, engage in excessive physical activity, carry weights and exert excessive stress on the anterior abdominal wall.

Hypodinamy is an equally dangerous extreme, which leads to a weakening of the musculoskeletal system and may eventually cause a hernia. Therefore, doctors strongly recommend exercise (you can be moderate, but regularly).

Do not allow the appearance of extra pounds. If you are inclined to fullness - stick to a low-calorie diet, with the predominant use of plant foods, and with the restriction of sweets, flour products, animal fats, alcohol. In addition to excess weight, such a diet will allow us to adjust digestion, eliminate constipation, which is also a predisposing factor to the development of hernias.

Forecast

Prognostic findings with uncomplicated hernia formally conditional. If surgical treatment is carried out in a timely manner, then the work capacity is restored to the fullest. Re-emergence of hernias after surgery is detected only in 3-5% of diseases.

When pinching the future depends on the condition of the stricken parts of the organs, on the qualification of the doctor and on the time of the intervention. If a patient with an infringement does not hurry to seek emergency care, then in the vast majority of cases there are irreversible changes in the organs of the abdominal cavity, which can affect not only the patient's further health, but also his life.

The inguinal and scrotal hernia is considered a non-dangerous disease, if the treatment is carried out in a timely manner. If delayed with a visit to the doctor, as well as in neglected cases, the consequences can be extremely unfavorable.

[17], [18], [19]