Indirect inguinal hernia
Introduction
Introduction to the inguinal hernia Where the hernia sac protrudes from the inner ring of the outside of the inferior epigastric artery, obliquely inward, downward, and forward through the inguinal canal, and then through the subcutaneous ring and into the scrotum is called the inguinal hernia. It is the most common abdominal hernia, and the incidence rate accounts for about 90% of all abdominal hernias, or 95% of inguinal hernias. Males account for the vast majority, and the right side is more common than the left side. Inguinal hernia is both congenital and acquired. The cause of the former is peritoneal sheath rupture, and the cause of the latter has a major role in the development of the inferior oblique muscle and the transverse abdominis muscle, except for the congenital defect in the inguinal region. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction abdominal pain shock
Cause
Cause of inguinal hernia
Congenital embryonic dysplasia (35%):
Related to embryonic development. During the human embryonic period, the testicles gradually descend from the lumbar vertebrae, and at the same time, part of the peritoneum, abdomen diaphragm and abdominal muscles are gradually moved down through the inguinal canal to form a scrotum. During the testicular decline, the peritoneum forms a peritoneal sheath. When the testicular decline is complete, the peritoneal sheath is self-shrinking. If the peritoneal sheath is not locked or incomplete, a hernia of the congenital inguinal hernia may form.
Anatomical defects in the groin (20%):
Associated with anatomical defects in the groin area. Under normal circumstances, the contraction of the transverse transverse fascia and the transverse abdominis muscles can close the deep groin of the groin, thereby preventing the formation of the oblique sac. If the transverse fascia or abdominis muscle is underdeveloped, and the increase of intra-abdominal pressure (such as labor, defecation, urination, ascites, crying, etc.), it can promote the deep peritoneum to protrude into the sac, intestinal tract, etc. The tissue also enters the hernia sac and forms an acquired inguinal hernia. When the contents of the sputum protrude from the sacral triangle (Hersey and Haha triangle) located inside the inferior epigastric artery, the nickname formed by the groin is straight. Inguinal hernia is more common in middle and old people, and is associated with weaker abdominal muscles in the elderly.
Prevention
Inguinal hernia prevention
Most hernias cannot be prevented, but it is possible to reduce the recurrence of hernias. The following suggestions can help reduce the recurrence of hernia:
1. Maintain a healthy weight.
2. Insist on strengthening abdominal muscle exercise.
3. Active prevention, control constipation, chronic cough.
Complication
Inguinal hernia complications Complications, intestinal obstruction, abdominal pain, shock
Common complications and clinical manifestations are:
(1) Intestinal incarceration: Under normal circumstances, the contents of the sputum (usually the intestine) can enter the sac through the ankle ring under the pressure of the abdominal cavity, and can be returned to the abdominal cavity by itself (or by external force). When various reasons (such as friction, adhesion, etc.) make the content of the reversible sputum suddenly unable to return, when the local lumps increase, it indicates that the intestinal incarceration is complicated, which is called incarcerated sputum, after the intestine is incarcerated The main clinical manifestations of intestinal obstruction.
(2) Intestinal tube strangulation: If the incarcerated sputum persists and cannot be treated and treated in time, the contents of the sputum (mainly the intestinal tract) have blood circulation disorders, intestinal obstruction, intestinal necrosis, and even intestinal perforation. , and concurrent with the strangulated hernia, the clinical manifestations of intestinal narrowing are:
1 paroxysmal, persistent, severe abdominal pain.
2 pulse increased, shortness of breath, increased white blood cell count and other shock performance.
2 peritoneal irritation (local tenderness, rebound tenderness, muscle tension, etc.).
4 The bowel sounds change from hyperthyroidism to weakening or disappearing, and you can smell the sound of gas over water.
5 hematemesis (or bloody fluid), blood in the stool.
6 Abdominal can be touched with obvious swelling, swelling and lump.
7X-ray examination showed that the isolated intestine or small intestine with expanded expansion in the abdomen changed, the intestinal lumen was widened, and there was abdominal fluid.
8 do abdominal puncture can draw hemorrhagic fluid.
Symptom
Inguinal hernia symptoms Common symptoms Inguinal pain involves pain constipation Abdominal wall incision has a mass protruding lower abdominal pain bloating
The presence of a reversible mass at the outer ring of the inguinal canal is the most important clinical manifestation. Initially, when standing, walking or coughing for a long time, the mass slanted along the inguinal canal to the outer ring. Later, the mass gradually enlarges and extends into the scrotum. The upper end of the mass is narrow, the lower end is wide, and the shape is like a pear, and it seems to have a handle that extends into the inguinal canal. When the mass protrudes, it has a falling or mild soreness.
Examine
Examination of inguinal hernia
an examination
Visual examination, routine laboratory examination and inguinal outer ring impact test.
The inguinal outer ring impact test is an auxiliary examination method for checking the normal position of the abdominal groin. After the sacral sac is returned to the abdominal cavity, the outer ring is enlarged by the tip of the finger through the scrotal skin. In general, the size of the outer ring is of little clinical significance. When the outer ring is enlarged, the fingertip can enter the groin smoothly. Tube, examination and understanding of the posterior wall of the inner ring and the inguinal canal have guiding significance for proposing appropriate surgical methods. Some occult oblique hernias can establish their existence through this test, but this method of examination causes great discomfort to the patient. It is felt that the diagnosis is not necessary for routine implementation.
Diagnosis
Diagnosis and differentiation of inguinal hernia
Combined with the anatomical features of the inguinal region and the above clinical manifestations, the diagnosis of inguinal hernia is not difficult, but must be identified with the following diseases:
1. Testicular hydrocele: The positive test of the light transmission of the tumor is a characteristic clinical manifestation of the disease. In addition, the tumor has a clear boundary, the upper part of which is not connected to the outer ring, and the testicle is wrapped by hydrocele. It is not easy to get rid of, the mass can not be returned, and there is no history of reversible disease. If the peritoneal sheath is not completely closed, when the traffic testicular hydrocele is formed, although the mass has reversible characteristics, it can be used for the light transmission test. Identification.
2. Uterine round ligament cyst: The mass is located in the inguinal canal, which is round or elliptical. It has a sexy capsule with clear boundary and high tension. Its upper end does not extend into the abdominal cavity, and it is generally not easy to be confused with sputum.
3. spermatic cyst or testicular insufficiency: the mass is located in the inguinal canal or spermatic testicular path, the boundary is clear, the former has a sac sexy, high tension, the scrotum can reach the ipsilateral testicle, the latter is tough, for the sense of substance, the scrotum The ipsilateral testis is absent.
In fact, the differential diagnosis is not difficult. The basic characteristics shared by the above diseases are: non-reversible masses, the upper boundary of the mass does not enter the outer ring or the inner ring, and there is no "bow handle", and there is no cough impact.
