Oblique inguinal hernia

This pathology has its own clinical and course characteristics - the diagnosis is established by a surgeon, whom it is recommended to contact already at the initial symptoms of the disease.

An oblique inguinal hernia is a type of hernial protrusion in the groin area that manifests itself as discomfort and pain of varying intensity.

ICD 10 code:

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

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Causes oblique inguinal hernia

An oblique inguinal hernia is more often acquired than congenital. The formation of a hernia can be facilitated by a defect in intrauterine development - this 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 area, which makes it unsuitable to withstand the pressure inside the abdominal cavity.

Other reasons include:

• being overweight (or losing weight rapidly);
• frequent pregnancies;
• severe and sharp compression injury to the abdominal area;
• heavy physical activity;
• chronic constipation;
• difficult labor;
• chronic hacking cough, etc.

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Pathogenesis

At the first stage of the formation of the hernial sac, when it only begins its movement into the inguinal opening, the protrusion may not be visually noticeable. Only during a coughing or sneezing attack, with the help of a finger inserted into the hernia area, can you feel the valve push.

At the next stage, the defect is located within the borders of the inguinal canal. Externally, it looks like a small swelling that increases with abdominal tension and hides at rest.

The third stage is complete protrusion, which extends beyond the inguinal canal.

There is also a type of hernial defect called a huge protrusion - this is an extremely advanced pathology, when a significant part of the internal organs of the abdomen is placed in the sac. It is impossible not to notice such a protrusion: sometimes it goes down to the hips and even lower.

A right- or left-sided oblique inguinal hernia is formed following the course of the inguinal canal and further along the spermatic cord. Sometimes an obstacle arises across its development: in this case, the path of the hernial formation deviates, penetrating into other layers of tissue. This is how interstitial defects are formed. What can serve as an obstacle:

• a testicle that has not descended into the scrotum;
• narrow and tight external inguinal opening;
• bandage pad.

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

In the female body, an oblique inguinal hernia, when it extends beyond the inguinal opening, can move into the left or right labia majora.

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Symptoms oblique inguinal hernia

First of all, even before the signs of discomfort appear, an oblique hernia can be detected by examination and palpation. Some of them are visible only in the patient's upright position, and some do not hide even when the patient is lying down.

During palpation, you can feel a soft formation that continues into the abdominal cavity through the inguinal canal opening. The hernial sac itself can be carefully repositioned - the formation is quite pliable.

If the hernia is of significant size, then its reduction may be difficult due to the large number of organ parts that are in the cavity of the sac.

An oblique inguinal hernia is usually elongated, obliquely located, and tends to descend into the scrotum. It is most often found in childhood and adolescence, usually on one side of the groin.

Congenital inguinal oblique hernia is a common occurrence, while direct hernia can only be acquired. Congenital pathological defect in most cases develops due to disruption of the natural passage of the testicle into the scrotum, which should occur during intrauterine development.

The first signs are observed 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, crawling or walking.

Sometimes the protrusion makes itself known during coughing, sneezing or straining of the child. In this case, the penis may deviate in the opposite direction from the hernial sac.

Complications and consequences

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

• strangulation of the hernial protrusion is the most common consequence, which can only be eliminated with the use of surgical intervention;
• necrosis of organs trapped in the pinched hernial sac - these may be intestinal loops, areas of the omentum, or the urinary bladder;
• peritonitis is a dangerous and severe inflammatory reaction that spreads to all tissues of the abdominal cavity (can also appear as a result of strangulation);
• acute attack of appendicitis – inflammation of the tissues in the appendix, which develops as a result of compression of the vessels of the appendix by the inguinal ring;
• Symptomatic consequences of an inguinal hernia may include digestive disorders, intestinal dysfunction, increased gas formation in the abdomen, etc.

The most serious and common complication is considered to be strangulation of the hernia - such a situation requires urgent medical care, with the patient being admitted to hospital and emergency surgery.

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Diagnostics oblique inguinal hernia

Usually the diagnosis is established based on the patient's complaints, as well as the results of an external examination. Palpation is carried out using the index finger: in the later stages of the development of an oblique inguinal hernia, the tubercle is easily palpated, but in the initial stage and in small children it can be quite difficult to palpate it.

In children, during the examination, 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.

Blood tests may be prescribed only to exclude an inflammatory process in the hernial area. In some cases, a stool test is prescribed.

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

Subsequently, instrumental diagnostics are prescribed, which may include the following types of studies:

• 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 protrusion without problems. A denser structure will not let the rays through, and the light will look dim or uneven.

Differential diagnosis is carried out with femoral hernia, hydrocele, varicocele, cystic formation, lipoma or malignant neoplasm.

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Differential diagnosis

What is the difference between an indirect and direct inguinal hernia?

The anatomical, physiological and symptomatic differences of hernial defects consist of the following signs.

• The direct type of hernia leaves the abdominal cavity through the median inguinal fossa. During surgery, after opening the saccular protrusion, the doctor will be able to freely insert a finger into the abdominal cavity and palpate the area of the anterior abdominal wall from the back. If pulsation is determined on the outer side from the mouth of the hernial sac, then we can talk about the direct type of hernia. When pulsation is determined from the inner surface, this 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, superficial fascial layer, aponeurosis of the external oblique abdominal muscle, transverse fascia and the hernial sac itself, which, in turn, has two layers - peritoneal and transverse fascial.
• In a direct hernia, the sac is spherical and can appear on both sides, mainly in elderly patients.
• An oblique inguinal hernia has a different structure, consisting of a skin layer, subcutaneous fat, superficial fascial layer, aponeurosis of the external oblique abdominal muscle, internal spermatic fascia and a hernial sac connected by a connective tissue ligament to part of the spermatic cord. The sac may have different wall thicknesses, most often the sac contains parts of the omentum and small intestine.

An oblique hernia has an elongated shape, can occur in childhood or in utero, and in the later stages of formation it turns into an inguinal-scrotal form.

Treatment oblique inguinal hernia

An inguinal hernia can only be treated surgically using surgical intervention. Surgical treatment is called hernioplasty and can take several forms.

• Endoscopic hernioplasty is the minimally invasive procedure performed using an endoscope and several small punctures in the abdominal wall. The doctor cuts off the hernial protrusion and sews in a mesh material to support the weakened tissue. The patient stays in the hospital for no more than 2-3 days, after which he is discharged home.
• Hernioplasty without prosthetics is performed with suturing of tissues with their simultaneous tension, without placing a mesh.
• The Lichtenstein method of surgery is performed as follows: the hernia is removed through a skin incision about 10 cm long, after which a mesh is sewn on to strengthen the damaged tissue.

The use of a special mesh reinforcing material reduces the risk of relapse by approximately 30%.

Conservative treatment involves wearing a bandage belt, but this is a temporary measure and sooner or later you will have to resort to surgery. The groin bandage only prevents protrusion and holds the damaged tissues.

Traditional treatment of hernia is the application of tight bandages, metal objects, lotions, magnets, compresses. According to the unanimous opinion of experts, herbal treatment of inguinal hernia is ineffective and useless. By engaging in such treatment, the patient loses precious time, which can lead to complications in the form of strangulation of the hernia, and this condition requires 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 not excluded.

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

Prevention

The best option for preventing an oblique inguinal hernia is regular exercise, morning exercises, swimming and an active lifestyle. If you doubt the possibility of physical activity, you can consult a doctor who will determine your physical capabilities and select the most suitable exercises.

Walking for 1-2 hours daily will be beneficial.

It is recommended to normalize your daily routine. Your daily routine should include time for both work and rest, which should be complete and sufficient for the body to recover.

There is no need for excessive physical exertion, excessive physical activity, carrying heavy objects or overloading the anterior abdominal wall.

Lack of physical activity is an equally dangerous condition, which leads to weakening of the muscular-ligamentous apparatus and over time can cause the formation of a hernia. Therefore, doctors strongly recommend doing physical exercises (it can be short-term, not intensive, but regular).

Do not allow excess weight to appear. If you have a tendency to be overweight, stick to a low-calorie diet, with predominant consumption of plant foods, and with limitation of sweets, flour products, animal fats, alcoholic beverages. In addition to excess weight, such a diet will improve digestion, eliminate constipation, which is also a predisposing factor to the development of inguinal hernia.

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Forecast

Surgical treatment of hernia usually has a good prognostic value. Compliance with the doctor's recommendations in most cases guarantees the absence of further relapses.

The patient's life and ability to work are restored over time, and the person returns to his normal life.

If there is no such treatment, various complications and negative situations may arise. Treatment of advanced forms of the disease, giant hernias and strangulated forms of pathology can also be considered unpredictable.

An oblique inguinal hernia is a disease associated primarily with defects and weakness of the muscular corset. For this reason, it is recommended to perform a special set of exercise therapy exercises to improve the condition of the anterior abdominal wall. This will protect you from the recurrence of the disease.

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