inguino-scrotal hernia

Protrusion of abdominal organs through the inguinal canal is characterized as an inguinal-scrotal hernia. This condition may be congenital or appear simultaneously with age-related changes, and is observed significantly more often in the male population than in women.

The pathology responds well to treatment, especially timely. Neglected cases may threaten strangulation of the hernial sac and necrosis of the strangulated organs.

ICD 10 code:

• K 40 – inguinal hernia.
• K 40.0 – bilateral inguinal hernias with signs of obstruction.
• K 40.1 – bilateral inguinal hernias with gangrenous complications.
• K 40.2 – bilateral inguinal hernias, uncomplicated.
• K 40.3 – unilateral or unspecified, with signs of obstruction.
• K 40.4 – unilateral or unspecified with gangrenous complications.
• K 40.9 – unilateral or without specification, uncomplicated.

Causes of inguinoscrotal hernia

The factors that determine a person’s predisposition to the development of an inguinoscrotal hernia are considered to be:

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

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

• excessive physical stress on the abdominal area;
• chronic difficulty in defecation, constipation;
• prostate adenoma accompanied by urinary dysfunction;
• chronic coughing fits.

The immediate cause of the disease may be:

• non-closure of the vaginal peritoneal process (during the period of embryonic development);
• high intra-abdominal pressure (due to intestinal problems, bloating, etc.);
• frequent and severe bouts of crying or coughing in a child;
• lifting and carrying heavy objects.

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Pathogenesis of the disease

The main causes of this disease are closely related to the structural features of the muscular-ligamentous apparatus of the abdominal and inguinal zones of a particular patient. The most important point is the condition of the inguinal canal and inguinal ring. Weakness of these organs predisposes to the appearance of a hernia.

Inguinoscrotal hernias are divided into the following types:

• By location:
  • On the one side;
  • from both sides.
• By typicality:
  • direct hernia;
  • oblique hernia.
• By type of occurrence:
  • congenital type;
  • acquired type.
• By level of development:
  • initial form;
  • inguinal-canal form;
  • complete oblique inguinal hernias;
  • inguinoscrotal hernias;
  • giant form.
• By the nature of the flow:
  • without complications (with and without reduction);
  • with complications (with strangulation, with coprostasis, with inflammation, etc.).
• By severity:
  • simple hernia;
  • transitional form;
  • complex hernia.

Symptoms of inguinoscrotal hernia

Oblique inguinoscrotal hernia is more common than direct. Direct hernia occurs in only 5-10% of cases, and then mainly in older people. Such a protrusion is usually bilateral. Oblique hernia usually occurs in patients from adolescence to middle age, more often on one side.

One of the most characteristic symptoms of hernial pathology is a tubercle in the form of swelling in the groin area. An oblique inguinal-scrotal hernia has an elongated shape, it is located along the inguinal canal and is often lowered into the scrotum. If the protrusion is large, then part of the scrotum can be significantly enlarged, the skin on it is stretched, and a visible deviation of the penis to the opposite side occurs. With a giant hernial form, the penis can sink into the skin folds.

A direct inguinoscrotal hernia has a relatively round shape and is located in the middle section of the inguinal ligament.

In situations where the hernial defect is located above the expected exit of the inguinal canal, it is necessary to exclude periinguinal or interstitial pathology.

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

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

• when straining the abdomen, laughing, sneezing, coughing, a lump with soft contents appears in the groin area;
• the tubercle disappears when at rest or hides when pressed.

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

Inguinal-scrotal hernia in newborns is congenital and is formed inside the mother's womb. The pathology can be identified already in the first months of the baby's life: a tubercle in the groin appears and becomes larger during the baby's cry and anxiety and disappears when the baby calms down. The tubercle is painless to the touch, has a round or oval shape, and is easily repositioned.

A strangulated inguinoscrotal hernia is a dangerous condition and requires urgent medical attention. How to recognize such a complication?

• The skin at the site of the protrusion becomes purple or bluish.
• Severe pain, nausea or vomiting occurs.
• Bowel disorders, flatulence, and loss of appetite appear.

When strangulated, the tubercle becomes very painful to the touch. It is impossible to push it back in, whereas an unstrangulated inguinal-scrotal hernia easily hides when pressed with a finger.

Constipation with inguinoscrotal hernia occurs when the intestinal loop is pinched - a condition that fully corresponds to the characteristics of intestinal obstruction occurs. Constipation can be accompanied by a significant deterioration in well-being, bloating, belching, heartburn, vomiting. Waiting for relief in such a condition is pointless - it is necessary to urgently call "emergency care".

Consequences

Complications of inguinoscrotal hernia develop in the absence of timely treatment:

• strangulation of the hernial tubercle is the most common consequence, which can only be eliminated by surgical methods;
• necrosis of organs trapped in the pinched hernial sac - intestinal loops, parts of the omentum, and the urinary bladder;
• peritonitis is a dangerous inflammatory reaction that spreads throughout the entire abdominal cavity (can also occur as a result of strangulation);
• acute attack of appendicitis – inflammation of the tissues in the appendix, which occurs as a result of compression of the vessels of the appendix by the inguinal ring;
• The clinical consequences of an inguinal hernia may include digestive disorders, bowel dysfunction, bloating, etc.

The most serious complication is considered to be strangulation of the hernia – such a situation requires urgent medical care, with hospitalization and emergency surgery.

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Diagnosis of inguinoscrotal hernia

The doctor establishes a diagnosis based on the patient's complaints, as well as on the results of an external examination. Palpation is carried out using the index finger: with an inguinal-scrotal hernia, the tubercle is easily palpated, but with a femoral hernia, it is quite difficult to palpate it.

In children, the doctor simultaneously determines the descent of the testicles into the scrotum, their size and shape, and the absence of varicocele. The condition of the lymph nodes in the groin area is checked without fail.

The condition of the hernial defect is checked with the patient in a horizontal and vertical position.

Next, instrumental diagnostics are prescribed, which may include the following types of research:

• ultrasound scanning of the scrotum, which helps to determine the contents of the hernial sac (for example, part of the bladder or a section of the intestine). In addition, ultrasound can be used to distinguish a hernia from hydrocele;
• The diaphanoscopy method is a light transillumination of the scrotum - a simple and inexpensive diagnostic method. If the contents of the sac are liquid, the rays are illuminated through the tubercle without problems. A denser structure will not let the rays through, and the light will look dim or uneven.

Differential diagnostics are carried out with femoral hernia, hydrocele, periorchitis, cystic formation, lipoma, lymphadenitis, and tumor.

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Treatment of inguinoscrotal hernia

Drug therapy for inguinoscrotal hernia disease is ineffective, and therefore this pathology is treated only by surgery. The operation can be performed from the age of 6 months (it is undesirable to perform the intervention on newborns due to the use of general anesthesia).

Anesthesia is usually combined with tranquilizers and local anesthetic drugs - this helps prevent the occurrence of severe pain in the postoperative period.

The operation for an inguinoscrotal hernia is called herniotomy:

• the doctor makes an incision in the inguinal canal area;
• cuts off and sutures the hernial formation;
• the elements of the organs that were pinched are returned to their physiological place – the normal anatomical structure of the inguinal and abdominal region is restored.

During the operation, the surgeon ensures that the spermatic cord and the ejaculatory duct are not damaged.

As a rule, hernia repair surgery is not complicated – the procedure itself lasts no more than half an hour. Most often, the patient is discharged the next day, but bed rest is recommended for another three days. If the doctor applied regular stitches, they are removed after 7-8 days.

Traditional treatment of hernia - applying tight bandages, coins, lotions, magnets, compresses - is useless. By doing such treatment, the patient only loses time, which can lead to complications in the form of strangulation of the hernia, which will require urgent surgical intervention. If the patient was operated on within 2 or 3 hours after the hernia was strangulated, then such an operation is successful in most cases. Delay in intervention 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 treatment of inguinal-scrotal hernia pathologies - a bandage.

In what cases can a doctor prescribe wearing a bandage:

• hernial formations of large sizes, when it is impossible for one reason or another to perform surgery;
• recurrence of pathology after surgical treatment;
• the presence of contraindications to surgical intervention (age restrictions, cardiovascular pathologies, problems with blood clotting, etc.);
• childhood illnesses in which surgery is postponed indefinitely.

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

So, what does wearing a bandage give you:

• the degree of discomfort decreases;
• the patient regains his ability to work;
• the hernia loses its tendency to worsen and become strangulated.

The bandage is put on every morning, on the naked body, in a horizontal position. At first, wearing it may be a little uncomfortable, but after a few days the patient gets used to it and does not notice any discomfort. Of course, choosing the right bandage is important: a medical specialist at a clinic or pharmacy can help with this.

The bandage can be removed before going to bed, but if the patient experiences coughing fits at night, 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 surgery.

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Prevention

The best way to prevent inguinoscrotal hernia is regular exercise, morning exercises, yoga and an active lifestyle. And if you haven’t done exercises before, it’s never too late to start. If you have any doubts, you can consult a doctor who will assess your ability to exercise and select the most suitable exercises.

Walking at least 3 kilometers daily will be no less useful.

It is advisable to normalize your daily routine. Your daily routine should include both work and rest. Sleep should be complete and sufficient for the body to recover.

You should not overexert yourself, engage in excessive physical activity, carry heavy objects, or put excessive strain on the anterior abdominal wall.

Hypodynamia is an equally dangerous extreme, which leads to weakening of the muscular-ligamentous apparatus and over time can cause a hernia. Therefore, doctors strongly recommend doing physical exercises (not heavy ones, but regularly).

Do not allow extra pounds to appear. If you are prone to obesity, stick to a low-calorie diet, with predominant consumption of plant foods, and limiting sweets, flour products, animal fats, and alcohol. In addition to excess weight, such a diet will improve digestion, eliminate constipation, which is also a predisposing factor to the development of hernias.

Forecast

Prognostic conclusions for uncomplicated hernias are conditionally favorable. If surgical treatment is performed in a timely manner, then working capacity is fully restored. Recurrence of hernias after surgery is detected in only 3-5% of diseases.

In case of strangulation, the future depends on the condition of the strangulated parts of the organs, the qualifications of the doctor and the timely intervention. If a patient with strangulation does not rush to seek emergency care, then in the vast majority of cases irreversible changes in the abdominal organs are observed, which can affect not only the patient's further health, but also his life.

An inguinoscrotal hernia is considered a harmless disease if treated promptly. If you delay seeing a doctor, as well as in advanced cases, the consequences can be extremely unfavorable.

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