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Pinched inguinal hernia: main causes, signs, treatment and prognosis
Last reviewed: 04.07.2025
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A strangulated inguinal hernia is a fairly common complication, occurring in up to 20% of cases of inguinal hernia. When strangulated, the organs that have fallen out of the abdominal cavity are compressed in the hernial opening, in which case the organs remain in the inguinal canal.
The formation of a hernia is caused by weakness of the groin muscles, excessive physical exertion, injury or surgery.
Causes inguinal hernia impingement
According to the mechanism of occurrence of strangulated hernia, there are two main types: fecal and elastic.
Fecal impaction causes the intestinal loop that has fallen into the inguinal canal to become overfilled with fecal matter; if left untreated, this leads to intestinal tissue necrosis after a few days.
Elastic strangulation provokes a sudden prolapse of a large number of internal organs into a narrow hernial opening (usually this happens with high intra-abdominal pressure - severe coughing, lifting weights). The prolapsed organs are pinched by a narrow opening, which causes severe pain. The tissues of the prolapsed organs with elastic strangulation begin to die within 2-5 hours.
Elastic strangulation always occurs with a narrow hernial opening, while fecal strangulation can also occur with a fairly wide opening.
In fecal incarceration, physical overexertion is not as important as in elastic incarceration; in this case, a major role is played by decreased intestinal peristalsis, which is often observed in old age. Also, fecal incarceration can be provoked by twisting, bending, adhesion; usually, such a complication of inguinal hernia develops with a long-term disease.
Various organs can penetrate the hernial opening; most often, the omentum, small and large intestines, uterus, appendages, etc. fall out.
For human health, the most dangerous condition is considered to be intestinal strangulation, as it can lead to tissue necrosis and intestinal obstruction, which, in addition to severe pain, provokes severe intoxication.
Pathogenesis
During strangulation, a closed cavity is formed with compressed organs, in which blood circulation is disrupted. When the intestine is strangulated, venous stasis initially develops, then edema develops. Along with this, hemorrhage occurs in adjacent tissues, decomposition of fecal matter with the release of toxins.
The cavity with the prolapsed organs also accumulates fluid (hernial fluid), which over time changes color from colorless to dark red.
The death of intestinal tissue leads to microbes penetrating into adjacent tissues and causing purulent inflammation (in the later stages).
It is worth noting that when the intestine is strangulated, the adductor section, which is located in the abdominal cavity, is also affected. Due to intestinal obstruction, fecal matter stretches the intestine, which leads to thinning of the walls.
Severe pain shock may develop due to compression of nerve endings.
This condition is life-threatening and requires urgent surgery and intensive postoperative treatment.
Symptoms inguinal hernia impingement
Pain is the main symptom of strangulated inguinal hernia. It occurs suddenly and acutely, most often after physical overexertion. Often the patient experiences pain not only at the site of strangulation, but throughout the entire abdomen.
After strangulation, diarrhea may bother you in the first few hours, then constipation and lack of gases appear (in some cases, false urge to defecate is observed).
At the beginning of the pinching, vomiting may appear; if the process continues for a long time, vomiting practically does not stop.
If the bladder is infringed, there is frequent and painful urination, irregular heartbeat, increased temperature, decreased blood pressure, and an increased risk of developing moderate to severe shock.
It is worth noting that the symptoms of an incarcerated inguinal hernia can develop rapidly.
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First signs
The first sign of strangulation is severe pain in the groin area, the hernia becomes painful, the bulge does not disappear when changing position, general well-being worsens, nausea and vomiting appear.
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Strangulated inguinoscrotal hernia
In case of strangulation of the inguinoscrotal hernia, the most dangerous condition is acute intestinal obstruction and inflammation of the peritoneum. In this case, a median laparotomy is performed, which leaves a scar on almost the entire abdomen.
Strangulated inguinal hernia in children
When an incarcerated inguinal hernia occurs in children, two options are suggested, depending on the child’s condition.
If the condition is satisfactory and there are no signs of intoxication or intestinal ischemia, manual hernia reduction is recommended. If the child is crying, then first of all it is necessary to calm him down, in some cases it is necessary to take sedatives, an older child should be laid on his back and the pelvis should be raised, which will facilitate the reduction of the prolapsed organs.
After the child has completely calmed down, manual reduction is performed: one hand gently presses on the inguinal ring, the other returns the organs to their normal position. If the reduction of the hernia is successful, an operation to remove the hernia is scheduled in two days.
If the child's condition is serious and there are signs of toxic poisoning, then emergency surgical care is required, but before that the child's condition must be normalized.
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Complications and consequences
Regardless of the reasons for the development of strangulated inguinal hernia, treatment should be started immediately, since the consequences can be dire: tissue and organ necrosis, which leads to inflammatory processes in the peritoneum and subsequent death.
When internal organs are pinched in the hernial opening, internal intoxication begins, and after tissue and organ necrosis, toxic shock develops, which causes a prolonged coma or death.
Diagnostics inguinal hernia impingement
Diagnosis of a strangulated inguinal hernia is usually not difficult for a specialist. During examination, a hernial protrusion in the groin area (on the left or right side) is clearly visible, and redness and swelling in this area may also be observed.
The protrusion gives off severe pain when pressed, when changing the body position it does not disappear, it remains tense. In addition, the specialist may note the absence of a cough impulse (the hernia does not increase with tension).
When organs such as the fallopian tube or ovary are strangulated, diagnosis presents a number of difficulties. The pain in this case is aching, and the woman's general condition does not worsen. Due to the increased risk of necrosis, surgical intervention is performed immediately as soon as strangulation is suspected.
Children react very violently to the infringement - they cry heart-rendingly, bend or kick their legs, and in some cases the baby loses consciousness.
Tests
Before any operation, it is recommended to undergo a complete blood count, urine test, and if necessary, a blood clotting test is prescribed.
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Instrumental diagnostics
An incarcerated hernia is usually diagnosed based on pronounced symptoms; an ultrasound examination of the abdominal cavity allows the detection of intestinal obstruction.
Differential diagnosis
If there is a suspicion of strangulation of an inguinal hernia, the specialist must exclude other pathological conditions with similar symptoms. Usually, the doctor makes a diagnosis without any particular problems, due to the obvious symptoms of strangulation, but in rare cases (with the first strangulation, concomitant pathologies of the abdominal cavity) it is quite difficult to recognize a strangulated inguinal hernia.
First of all, the doctor must distinguish strangulation from a rather rare pathology - an irreducible hernia. Usually, such hernias are not tense and transmit the cough impulse well, which is not observed with strangulation.
It is also necessary to exclude the development of a stagnant process in the intestines, which most often occurs in old age with irreducible hernias. Symptoms of stagnation appear gradually, first of all constipation, increased gas formation, pain is usually not intense and increases slowly, while with strangulation, symptoms develop at a rapid rate.
Also in the practice of surgeons there is a so-called false strangulation, which occurs with external abdominal hernias and the symptoms of this condition are similar to strangulation, but are usually associated with acute diseases of the internal organs.
Also, an erroneous diagnosis can be made in cases of renal or hepatic colic, peritonitis, intestinal obstruction, pancreatic necrosis, which will lead to an incorrectly chosen method of surgical treatment.
Only a thorough and complete examination of the patient will help avoid mistakes.
But with any difficulties in making an accurate diagnosis, doctors tend to favor an incarcerated hernia, since they believe that it is less dangerous for the patient’s life and health to perform an operation (even if it ultimately turns out to be unnecessary) than to waste time, mistaking the incarceration for another disease.
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Treatment inguinal hernia impingement
The main goal of the operation for strangulated inguinal hernia is to eliminate the strangulation and its consequences. With such a pathology, there is always a high probability that the internal organs have already died and the surgeon must carefully examine the contents of the hernial sac.
If tissue necrosis has not occurred, then the prolapsed organs are repositioned and the inguinal canal is reconstructed.
At the first signs of tissue death, medications can help save the organ.
If complete necrosis has occurred, part of the organ is removed.
When opening the hernial contents, the risk of infection penetrating into the abdominal cavity increases, which is why antiseptic and aseptic agents are used during the operation.
During the operation in men, the proximity of the spermatic cords and the vas deferens is taken into account, and the man’s subsequent ability to conceive depends on the qualifications of the surgeon.
In women, the decision to perform hernial orifice repair is made during the surgical intervention.
In childhood, there are specific features of strangulation - weak pressure of the hernial opening, high elasticity of blood vessels, improved blood flow in the intestine. Therefore, there are often cases when strangulation of a hernia in children, including newborns, is reduced manually. This requires complete rest, which will help relax the muscles and remove the spasm of the hernial opening. However, in case of strangulation in girls, an urgent operation is necessary, since with a strangulated ovary or fallopian tube, the risk of necrosis and infertility in the future increases.
Boys are usually prescribed conservative treatment (trimeperidine, atropine) in the first hours; if such treatment is ineffective, emergency surgery is prescribed.
Medicines
There are no special medications for strangulated inguinal hernia, in this case the only treatment method is surgery, with the exception of children and contraindications to surgery. In such cases, they try to push the hernia back in manually, but only if no more than 2 hours have passed since the strangulation. Before the manipulations, the patient is given antispasmodics (atropine), the bladder is emptied, an enema is given, and the stomach is emptied.
Folk remedies
In case of a strangulated inguinal hernia, traditional medicine recommends placing the patient in a bath with warm water, which will relax the muscles and remove spasms, and also cleanse the intestines of contents using an enema. In the water, you can try to return the fallen organs to the abdominal cavity.
If a person is experiencing severe vomiting, they can be given small pieces of ice to swallow, and an ice pack can help relieve severe pain.
It is worth noting that giving any laxatives is strictly prohibited.
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Surgical treatment
Hernia removal surgery is performed in several ways, the choice of which depends on the type of strangulated hernia.
In case of strangulation of the small intestine, herniolaparatomy is performed; in case of extensive adhesions in the abdominal cavity, which prevent the strangulated loop from returning to its normal position; in case of phlegmon, diffuse peritonitis, an additional midline incision of the anterior abdominal wall is made.
Before the operation, it is advisable for the patient to empty the bladder, intestines, and stomach, but if these measures delay the operation, they are skipped.
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Forecast
The prognosis for strangulated inguinal hernia is favorable only if surgery is performed in a timely manner. The longer the surgery is delayed or the person does not seek help, the higher the probability of a fatal outcome.
A strangulated inguinal hernia is a serious complication that, without treatment, leads to dire consequences. Men and boys are more susceptible to hernia formation. In women, the disease occurs less frequently and mainly in adulthood.
Treatment of the pathology is mainly surgical, with rare exceptions, when for various reasons it is impossible to perform surgery, they try to return the pinched organs to the abdominal cavity manually.