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Injured inguinal hernia: underlying causes, signs, treatment and prognosis
Last reviewed: 17.10.2021
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Injured hernia is a rather common complication, which occurs up to 20% of cases of inguinal hernia. When infringing, the organs falling from the abdominal cavity are transferred into the hernial opening, in this case the organs remain in the inguinal canal.
To the formation of a hernia leads to weakness of inguinal muscles, excessive physical activity, trauma or surgery.
Causes of the infringement of inguinal hernia
According to the mechanism of the infringement of the hernia, there are two main types: caloric and elastic.
Feces infringement provokes an overflow of the intestinal loops that have fallen into the inguinal canal with the calves, the absence of treatment after a few days leads to the necrosis of the intestinal tissues.
Elastic infringement provokes a sharp dropout of a large number of internal organs into a narrow hernial opening (usually this happens with a high intra-abdominal pressure - a strong cough, lifting weights). Dropped organs are pinched by a narrow hole, which causes severe pain. The tissues of the fallen organs begin to die off with elastic infringement for 2-5 hours.
Elastic infringement is always formed with a narrow hernial opening, here is how a calico infringement can occur even with a fairly wide opening.
In case of fecal impairment, physical overstrain does not have such a value as in elastic, in this case the decrease in intestinal motility plays a big role, which is often observed in old age. Also caloric infringement can provoke twists, excesses, fusion, usually such complication of an inguinal hernia develops at longly current disease.
Various organs can penetrate the hernial opening, most often, the omentum, thin and large intestine, uterus, appendages, etc., drop out.
For human health, the most dangerous condition is the infringement of the intestine, since this can lead to necrosis of the tissues and intestinal obstruction, which, in addition to severe pain, provokes severe intoxication.
Pathogenesis
During the infringement, a closed cavity with clamped organs is formed, in which blood circulation is disturbed. When the intestine is infringed, the venous stasis develops initially, then the swelling develops. Along with this, there is a hemorrhage into adjacent tissues, the decomposition of stool with the release of toxins.
In the cavity with the fallen organs, liquid (hernial water) also accumulates, which eventually changes color from colorless to dark red.
Dying of intestinal tissues leads to the fact that microbes penetrate into adjacent tissues and cause purulent inflammation (in later stages).
It should be noted that when the bowel is infringed, the leading section, which is in the abdominal cavity, is also affected. Because of intestinal obstruction, stool masses stretch the intestine, which leads to thinning of the walls.
Due to the transmission of nerve endings, severe pain shock may develop.
This condition is dangerous for human life and requires urgent surgery and intensive postoperative treatment.
Symptoms of the infringement of inguinal hernia
Pain is the main symptom of infringement of the inguinal hernia. It arises sharply and acutely, most often, after physical overstrain. Often the patient experiences pain not only in the place of infringement, but also throughout the abdomen.
After infringement in the first few hours, diarrhea can be disturbed, then constipation and gas absence appear (in some cases, there are false urge to excrement).
At the beginning of the jam, vomiting may occur, with prolonged process, vomiting practically does not stop.
If there is an infringement of the bladder, frequent and painful urination is observed, a violation of the heartbeat, an increase in temperature, a decrease in blood pressure, an increase in the risk of developing a shock of moderate and severe severity.
It is worth noting that the symptoms of infringement of inguinal hernia can develop rapidly.
First signs
The first sign of infringement is severe pain in the groin area, the hernia becomes painful, the bulge does not disappear when the position changes, the general well-being worsens, nausea, vomiting.
[21], [22], [23], [24], [25], [26], [27]
Injured inguinal and scrotal hernia
When infringement of the inguinal and scrotal 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 trace on almost the entire abdomen.
Injured inguinal hernia in children
With infringement of inguinal hernia in children, two options are suggested, depending on the condition of the child.
If the condition is satisfactory and there are no signs of intoxication or ischemia of the intestine, it is recommended that the hernia be guided by manual methods. If a child cries, first of all it needs to be reassured, in some cases it is necessary to take sedatives, the older child should be put on his back and raise the pelvis, which will help to correct the fallen organs.
After the child completely calms down, the manual direction is performed: one hand gently presses on the inguinal ring, the second - returns the organs to their normal position. If the hernia has been successful, two days later, an operation to remove the hernia is prescribed.
If the child's condition is serious, there are signs of toxic poisoning, then urgent surgical care is required, but before that the child's condition needs to be normalized.
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Complications and consequences
Regardless of the reasons for the development of infringement of inguinal hernia, treatment should be urgently started, as the consequences can be deplorable: the necrosis of tissues and organs, which leads to inflammatory processes in the peritoneum and subsequent death.
When internal organs are infringed in the hernial opening, internal intoxication begins, after necrosis of tissues and organs toxic shock develops, which causes prolonged coma or death.
Diagnostics of the infringement of inguinal hernia
Diagnosis of an impaired inguinal hernia is usually not difficult for a specialist. During the examination, the hernial protrusion in the inguinal zone (from the left or right side) is clearly visible, reddening and puffiness in this place can also be observed.
The protrusion gives a strong pain when pressed, when the position of the body changes, it does not disappear, remains tense. In addition, a specialist can note the absence of a cough thrust (at a strain hernia does not increase).
When the organs such as the fallopian tube or the ovary are infringed, the diagnosis presents a number of difficulties. Pain in this case aching, and the general condition of a woman does not deteriorate. Because of the increased risk of necrosis, surgical intervention is performed immediately, as soon as suspicion of infringement appears.
Children react to infringement very violently - crying inflexibly, bending or knitting, in some cases the baby loses consciousness.
Analyzes
Before carrying out any operation, it is recommended to submit a general blood test, urine, if necessary, a blood test for coagulability.
[34], [35], [36], [37], [38], [39], [40], [41], [42], [43]
Instrumental diagnostics
Restricted hernia is usually diagnosed by severe symptoms, to establish intestinal obstruction allows ultrasound examination of the abdominal cavity.
Differential diagnosis
If there is a suspicion of infringement of inguinal hernia, the specialist should exclude other pathological conditions with similar symptoms. Usually the doctor puts the diagnosis without any problems, in view of the striking symptoms of infringement, but in rare cases (with the first infringement, concomitant pathologies of the abdominal cavity) it is difficult to recognize the restrained inguinal hernia.
First of all the doctor should distinguish infringement from rather rare or infrequent pathology - an unrecoverable hernia. Usually, such hernias are not strained and transmit a cough push well, which is not observed when infringing.
It is also necessary to exclude the development of a stagnant process in the gut, which most often occurs in old age with unrecoverable hernias. Symptoms of stagnation occur gradually, primarily constipation, increased gas formation, pain is usually not intense and grows slowly, while when infringed the symptoms develop at a rapid rate.
Also in the practice of surgeons there is a so-called false infringement that occurs with external abdominal hernias and the symptomatology of this condition is similar to infringement, but is usually associated with acute diseases of internal organs.
Also, an erroneous diagnosis can be made with renal or hepatic colic, peritonitis, intestinal obstruction of pancreatic necrosis, which will lead to an incorrectly chosen method of surgical treatment.
Only a thorough and thorough examination of the patient will avoid mistakes.
But, in spite of all the difficulties in making an accurate diagnosis, doctors tend to restrain hernia because they believe that it is less dangerous for the life and health of the patient to undergo an operation (even if in the end it is not necessary) than to miss the time by accepting infringement for another disease.
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Treatment of the infringement of inguinal hernia
The main goal of surgery with an injured inguinal hernia is to eliminate infringement and its consequences. With such a pathology, there is always a high probability that the internal organs have already become dead and the surgeon must carefully examine the contents of the hernial sac.
If the necrosis of the tissues does not occur, then the falling organs and plastics of the inguinal canal are guided.
At the first signs of tissue death, the body will be helped by drugs.
If there is complete necrosis, part of the organ is removed.
When the hernia contents are opened, the risk of penetration of the infection into the abdominal cavity increases, which is why antiseptic and aseptic agents are used during the operation.
During the operation, men take into account the proximity of the spermatic cord and the vas deferens and the further ability of the man to conceive depends on the surgeon's qualification.
In women, the decision to plasticate the hernial gates is taken already in the process of surgical intervention.
In childhood there are peculiarities of infringement - a weak pressure of the hernial opening, high elasticity of blood vessels, improved blood flow in the intestine. Therefore, cases where the infringement of a hernia in children, including newborns, are manually infiltrated are not uncommon. This requires complete rest, which will help relax the muscles and remove the spasm of the hernial opening. However, in case of infringement, girls need urgent surgery, since with a strangulated ovary or fallopian tube, the risk of necrosis and infertility is increased in the future.
Boys usually in the first hours are prescribed conservative treatment (trimeperidine, atropine), if such treatment is not effective, an urgent surgery is prescribed.
Medications
There are no special medicinal products from the injured inguinal hernia, in this case the only method of treatment is surgery, exceptions are children and contraindications to the operation. In such cases, the hernia is attempted to be adjusted with hands, but on the condition that, after infringement, no more than 2 hours have passed. Before manipulating the patient, antispasmodics (atropine) are introduced, the bladder is emptied, an enema is made, and the stomach is emptied.
Alternative treatment
With the weakened inguinal hernia, alternative medicine recommends that the patient be seduced into a bath with warm water, which will relax the muscles and remove spasms, and also clean the intestines of the contents with an enema. In the water, you can try to return the fallen organs to the abdominal cavity.
If a person is disturbed by severe vomiting, you can give him to swallow a small piece of ice, and from severe pain will help get rid of the ice warmer.
It should be noted that giving any laxatives is strictly prohibited.
Operative treatment
Surgery for the removal of a hernia is done in several ways, the choice of which depends on the type of strangulated hernia.
When the small intestine is infringed, geriatolaparatomy is performed, with an extensive adhesive process in the abdominal cavity, which prevents return to the normal position of the strangulated loop, with phlegmon, diffuse peritonitis, an additional median incision is made in the anterior abdominal wall.
Before the operation, it is desirable for the patient to empty the bladder, intestine, stomach, but if these events delay the operation, they are missed.
More information of the treatment
Forecast
The prognosis for infringement of an inguinal hernia is favorable only in the event that operation is timely spent. The longer an operation is delayed or the person does not seek help, the higher the probability of a fatal outcome.
Incompatible inguinal hernia is a serious complication, which, without treatment, leads to terrible consequences. More men and boys are susceptible to the formation of a hernia. In women, the disease is less common and mostly in adulthood.
Treatment of pathology is mostly operational, with rare exceptions, when for various reasons the operation can not be performed, the restrained organs are attempted to return to the abdominal cavity manually.