Slanting inguinal hernia

This pathology has its own peculiarities of the clinic and the course - the diagnosis is established by the surgeon, to whom it is recommended to treat already with the initial symptoms of the disease.

The oblique inguinal hernia is a kind of hernial protrusion in the inguinal zone, which is manifested by discomfort and soreness of varying intensity.

Code on the ICD 10:

• Class XI - diseases of the digestive organs (K00 - K93)
  • Hernia (K40 - K46)
    • K40 - inguinal hernia (including bilateral, oblique, direct, indirect)

[1], [2], [3]

Causes of the oblique inguinal hernia

The oblique inguinal hernia often has an acquired character than an innate one. The formation of a hernia can be promoted by a defect in the uterine development - it is a deeper peritoneal depression near the lateral inguinal cavity, which is part of an incompletely overgrown vaginal process.

Another common cause is the peculiarity of the anatomical structure of the groin zone, which makes it unsuited to resisting pressure within the abdominal cavity.

Other reasons include:

• the presence of excess weight (or severe emaciation);
• frequent pregnancies;
• strong and sharp compression trauma of the abdomen;
• heavy physical activity;
• chronic constipation;
• heavy labor activity;
• chronic coughing, etc.

[4], [5], [6],

Pathogenesis

At the first stage of the formation of the hernial sac, when it only begins its advancement into the inguinal opening, visually protruding can be overlooked. Only during an attack of coughing or sneezing, with the help of a finger inserted into the hernia, one can feel a valve thrust.

At the next stage the defect is located inside the inguinal canal. Outwardly it looks like a small swelling, increasing with the tension of the abdomen and hiding in a state of rest.

The third stage is a complete protrusion that extends beyond the inguinal canal.

There is also a type of hernia defect, which is called a huge protrusion - this is an extremely neglected pathology, when a large part of the internal organs of the abdomen is placed in the bag. Do not notice such a protrusion is impossible: sometimes it falls on the hips and even lower.

Right-sided or left-sided oblique inguinal hernia is formed following the inguinal canal and further along the spermatic cord. Sometimes an obstruction arises across its development: in this case the path of the herniation deflects, penetrating into other layers of tissues. Thus, inter-wall defects are formed. What can serve as an obstacle:

• an egg that has not descended into the scrotum;
• narrow and dense outer inguinal opening;
• bandage cushion.

As a result, the hernial canal enters either the space between the muscles and the peritoneum, either simply between the muscle fibers, or between the muscle and the skin.

In the female body, the oblique inguinal hernia, when going beyond the inguinal opening, can move to the left or right large labia.

[7], [8], [9], [10]

Symptoms of the oblique inguinal hernia

First of all, even before the appearance of signs of discomfort, a slanting hernia can be detected during examination and palpation. Some of them are visible only in the vertical position of the patient, and some do not hide, even when the patient lies.

During palpation, one can feel a soft, consistent texture that continues into the abdominal cavity, through the inguinal-channel opening. The hernial sac itself can be gently adjusted - education is pliable enough.

If the hernia is of considerable size, then its repositioning may be difficult because of the large number of parts of the organs caught in the cavity of the sac.

The oblique inguinal hernia usually has an elongated configuration, an oblique arrangement and a tendency to descend into the scrotum. Most often it is found in childhood and adolescence, mainly on one side of the groin.

Congenital inguinal hernia is often a phenomenon, whereas a direct hernia is only acquired. An innate pathological defect in most cases develops as a result of a violation of the natural course of the testicle in the scrotum, which should occur during intrauterine development.

The first signs are observed already at an early age, but not always immediately after birth: more often the disease is noticed only when the baby begins to show motor activity, for example, crawl or walk.

Sometimes protrusion manifests itself during coughing, sneezing or straining the child. In this case, the penis can deviate in the opposite direction from the hernial sac.

Complications and consequences

Complications of oblique inguinal hernia may occur due to the lack of timely treatment:

• pinching hernial protrusion - this is the most common consequence, which is eliminated only with the use of surgical intervention;
• necrosis of organs trapped in the herniated sac - this may be intestinal loops, gland, bladder sections;
• Peritonitis is a dangerous and severe inflammatory reaction that spreads to all tissues of the abdominal cavity (can also appear as a result of infringement);
• acute attack of appendicitis - inflammation of the tissues in the appendix, which develops due to clamping of the vessels of the appendix in the inguinal ring;
• the symptomatic consequences of inguinal hernia may be disorders of the digestive process, disruption of the intestine, increased gas formation in the abdomen,

The most formidable and frequent complication is the infringement of the hernia - this situation requires urgent medical care, with the placement of the patient in the hospital and the conduct of urgent surgical intervention.

[11], [12], [13], [14]

Diagnostics of the oblique inguinal hernia

Usually the diagnosis is established based on the patient's complaints, as well as the results of the external examination. The palpation is carried out using the index finger: in the late stages of development of the oblique inguinal hernia, the tubercle is palpable easily, and in the initial stage and in small children it can be difficult to probe.

In children, in the process of examination, the doctor simultaneously determines the descent of testicles into the scrotum, their size and shape, and the absence of varicocele. It is mandatory to check the condition of the lymph nodes in the groin area.

Blood tests can be prescribed only to exclude the inflammatory process in the hernia. In some cases, stool analysis is prescribed.

The condition of the hernial sac is checked in the horizontal and vertical position of the patient.

Subsequently, instrumental diagnostics is assigned, which may include the following types of studies:

• 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 illuminated through the protrusion 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, hydrocele, varicocele, cystic formation, lipoma or malignant neoplasm.

[15], [16], [17], [18]

Differential diagnosis

What is the difference between oblique and straight inguinal hernias?

Anatomico-physiological and symptomatic differences of hernial defects consist in the following symptoms.

• A direct variant of the hernia leaves the abdominal cavity through the middle inguinal cavity. When performing surgical intervention after opening a bag-shaped protrusion, the doctor will be able to penetrate without difficulty into the abdominal cavity and feel the area of the anterior abdominal wall from the back side. If the pulsation is determined from the outside of the mouth of the hernial sac, then we can talk about a direct variant of a hernia. When the pulsation is determined from the inner surface, it is a sure sign of an oblique inguinal hernia. A direct hernia is usually located closer to the middle of the spermatic cord adjacent to the sac. It consists of a skin layer, subcutaneous fat, a superficial fascial layer, an aponeurosis of the external oblique muscle of the abdomen, a transverse fascia and a directly hernial sac, which in turn has two layers - peritoneal and transversal-fascial.
• With a direct hernia, the sac is spherical, it can appear from both sides, mainly in elderly patients.
• The inguinal inguinal hernia has a different structure, consisting of the skin layer, subcutaneous fat, the superficial fascial layer, the aponeurosis of the external oblique muscle of the abdomen, the inner seminal fascia and the hernial sac connected by a connective tissue ligament to a part of the spermatic cord. The pouch can have a different thickness of the walls, most often inside the bag are areas of the epiploon and small intestine.

The oblique hernia has an elongated shape, can appear in childhood or in utero, and in later stages of formation it passes into the inguinal and scrotal form.

Treatment of the oblique inguinal hernia

Cure inguinal hernia can only be performed surgically by surgical intervention. Operative treatment is called hernioplasty and can occur in several variants.

• Endoscopic hernioplasty is the minimal possible intervention, which is carried out with the help of an endoscope and several small punctures of the abdominal wall. The doctor cuts the hernial protrusion and sews the mesh material to support weakened tissues. The patient is in the hospital no more than 2-3 days, after which he is discharged home.
• Gernioplasty without prosthetics is performed with tissue suturing with their simultaneous tension, without setting the net.
• Operation by the method of Liechtenstein occurs in this way: the hernia is removed through a skin incision length of about 10 cm, after which the mesh is sewed to strengthen the damaged tissue.

The use of a special reticular reinforcing material reduces the risk of relapse by about 30%.

Conservative treatment is wearing a bandage belt, but this is a temporary measure, and still sooner or later one has to resort to surgery. The inguinal bandage only prevents the protrusion and holds the damaged tissue.

Alternative treatment for a hernia is the imposition of tight bandages, the application of metal objects, lotions, magnets, compresses. According to a common opinion of specialists, herbal treatment of inguinal hernia is an ineffective and useless occupation. Being engaged in such treatment, the patient loses precious time, which can lead to complications in the form of infringement of a hernia, and this condition requires 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 intervention can lead to serious complications, and in some situations even lethal consequences are not excluded.

Long-term experiments and observations have shown that the only proven and effective treatment of inguinal hernia is surgery. Without it, the healing of a tissue defect is impossible.

Prevention

The best option for preventing oblique inguinal hernia is regular exercise, morning exercises, swimming and active lifestyles. If you doubt the possibility of exercise, you can consult a doctor who will determine your physical abilities and choose the most appropriate exercises.

The benefits will come on foot, for 1-2 hours daily.

It is recommended to normalize the mode of the day. In your everyday routine, there must be time, both for work and leisure, which must be full and sufficient to restore the body.

There is no need for excessive physical exertion, excessive physical activity, heavy weight and overload of the anterior abdominal wall.

The lack of motor activity is an equally dangerous condition, which leads to a weakening of the musculoskeletal system and may eventually lead to the formation of a hernia. Therefore, doctors strongly recommend exercise (it can be slow, non-intensive, but regularly).

Do not overweight. If you have a tendency to fullness - stick to a low-calorie diet, with the predominant use of plant foods, and with the restriction of sweet, flour products, animal fats, spirits. In addition to excess weight, such food will allow us to adjust digestion, eliminate constipation, which is also a predisposing factor in the development of inguinal hernia.

[19], [20], [21], [22], [23], [24]

Forecast

Surgical treatment of a hernia usually has good prognostic significance. Compliance with the recommendations of the doctor in most cases guarantees a continued absence of relapse.

Life and work capacity of the patient is restored with time, and the person returns to the usual life course.

If there is no such treatment, then there can be various difficulties and negative situations. Unpredictable also can be considered treatment of advanced forms of the disease, giant hernias and pinched forms of pathology.

The inguinal inguinal hernia refers to diseases associated, first of all, with defects and weakness of the muscular corset. For this reason, to improve the condition of the anterior abdominal wall it is recommended to perform a special exercise complex exercise therapy. This will protect yourself from the re-development of the disease.

[25], [26], [27], [28]