direct inguinal hernia
Introduction
Introduction to the inguinal hernia The viscera of the ventral viscera directly from the inguinal triangle (Hesselbach triangle) on the inside of the inferior epigastric artery is called the inguinal hernia. Occurs in middle-aged and elderly people, and is associated with many factors such as muscle and fascia dysplasia, muscle atrophy, and increased intra-abdominal pressure in the sacral triangle. The giant sacral spurs significantly weaken or lack the strength of the posterior wall of the inguinal canal. It can also be straightforward. basic knowledge The proportion of sickness: 0.2-0.5% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction
Cause
Inguinal hernia
Muscular dysplasia (35%)
In the inguinal region, there is an inguinal canal through which the testis and spermatic cord pass. There is a vascular cavity and a femoral sheath for the lower extremity vessels to pass through, and a weak region of the abdominal wall is formed above and behind the inguinal ligament, and has the following characteristics: external oblique muscle The layer is a decidual structure, and even the decidua is lacking in the shallow ring; the lower edge of the oblique inferior oblique and transverse abdominis muscles and the medial half of the inguinal ligament contain the spermatic cord (uterus ligament) and its inner layer, the middle layer The gap between the capsules and thus the lack of protection. If the lower edge of the two muscles can not reach the upper edge of the spermatic cord and the spermatic membrane, the weakness is more obvious. Anson believes that the good development of the two muscles can prevent only 26% and 62% of the muscles of the straight muscle. One of the dysplasias or the upper edge of the spermatic cord could not be reached, and 12% could not provide support. The point of attachment of the intra-abdominal oblique muscle was high, and the gap was not closed when the contraction was reached, which was 36.8%. Direct cause; the medial development of the inferior oblique muscle and the lower abdominis muscle is variable. If the left and right lower muscles both terminate in front of the rectus abdominis, the lateral iliac crest of the rectus abdominis is only composed of the transverse fascia. Protection; the transverse abdominis aponeurosis and transverse fascia are attached The pubic ligament becomes the posterior wall of the inguinal canal, and the transverse fascia can also be thickened in the inguinal region, but these structures are not as strong as the muscle and diaphragm, the transverse fascia and constitute the deep loop of the inguinal canal; The oblique internal oblique muscle protection, the back of the shallow ring is all decidual or fascial components, and the protection is weaker.
Self-enclosure mechanism barrier (20%)
The anatomical defect of the inguinal region can be compensated by the defensive effect of the contraction of the internal oblique muscle and the transverse abdominis muscle. The first is the sphincter action, that is, when the abdominal wall movement or abdominal pressure is increased, the abdominal oblique muscle and the transverse abdominis contraction will pull the concave ligament. Lifting outwards, tightening the inner ring to resist increased intra-abdominal pressure, and secondly, embedding function. Under normal circumstances, the intra-abdominal oblique muscle and the transverse abdominis muscle form a convex bow on the inguinal canal, and Corresponding in between the inguinal ligaments, there is a distance of 0.5 ~ 2.0cm, the muscle contraction bow edge is flattened to the inguinal ligament, and close to the pubic symphysis and inguinal ligament, the gap is closed, the posterior wall of the inguinal canal is strengthened, and the transverse fascia is compensated. In the weak point, the above functions play an important role in preventing the occurrence of inguinal hernia. If the intercondylar ligament, the pubic symphysis relaxation, the intra-abdominal oblique muscle and the transverse abdominis dysplasia do not constitute a complete arched edge, and various causes Muscle atrophy, decreased contractility, etc. can cause weakening or loss of sphing and embedding.
Increased intra-abdominal pressure (10%)
Any disease that causes an increase in intra-abdominal pressure may induce inguinal hernia, including obesity, chronic bronchitis, enlarged prostate, constipation, ascites, and pregnancy.
Other factors (10%)
Abdominal trauma, age, obesity, multiple pregnancies, and lack of exercise are all associated with the disease.
Prevention
Inguinal hernia prevention
1. Change bad habits and cultivate a healthy lifestyle.
(1) Smoking cessation: smoking can not only cause chronic cough, leading to increased intra-abdominal pressure, but also inhibit the synthesis of collagen fibers and promote the degeneration of abdominal muscles. It is one of the important predisposing factors for the elderly inguinal hernia, so the elderly are best. Do not smoke or reduce the amount of smoking.
(2) Keeping the stool smooth: constipation is one of the important reasons for the increase of abdominal pressure. Therefore, keeping the stool unobstructed is an effective way to prevent inguinal hernia. The elderly should eat more vegetables, fruits, quantitative drinking water, and develop the habit of regular bowel movements. .
2. Actively prevent and treat diseases that promote increased intra-abdominal pressure, such as chronic bronchitis, emphysema, and enlarged prostate.
Complication
Inguinal hernia complications Complications, intestinal obstruction
Common complications include intestinal tube incarceration and intestinal tube narrowing.
Symptom
Inguinal hernia symptoms Common symptoms Lower abdominal mass triangle area tenderness left lower abdomen can be touched... Lower abdomen dull pain and soreness
1. The hemispherical reversible mass appearing on the outside of the pubic symphysis, appears when standing upright, disappears when lying down; does not require manual reduction, rarely occurs incarceration (sacral neck wide), more common in the elderly, rarely occurs In women and children.
2. The mass of the mass is wide and rarely falls into the scrotum.
3. After the tumor returns, press the inner ring.
4. The straight triangle can reach the obvious abdominal wall defect.
5. If part of the bladder wall forms part of a sliding sputum, bladder irritation may occur.
Examine
Examination of the inguinal hernia
The diagnosis and differential diagnosis of inguinal hernia are mainly based on clinical manifestations and physical examination, and imaging examination is performed in some special cases.
1. Digestive tract angiography or barium enema examination : Intestinal shadows in the groin area can be found, especially the sputum.
2. Intravenous pyelography and cystography: Observe whether sputum affects the relationship between the genitourinary system, such as the genital warts and the bladder.
3. Phlegm angiography : In 1967, Ducharme injected contrast agent into the abdominal cavity to observe the presence or absence of the peritoneum, also known as peritoneal angiography Perineal sputum, obturator, etc., especially in the case of suspected inguinal hernia repair, can be confirmed by this method.
4. CT: Observe the location, shape, size of the sac and the contents of the sputum . When the bladder is filled with contrast agent, it can be observed whether the sacral sputum affects the bladder.
5. Ultrasound examination : This method is ideal for the diagnosis of sputum. It can be found that tiny sputum, especially obese patients, can clearly show the shape of the inguinal hernia, the adjacent relationship, the size of the sac and the contents of the sputum, especially the patient taking a certain These positions can be observed dynamically when deep breathing or deep breathing, and can be differentiated from inguinal lymph nodes, hydrocele, lipoma, hematoma, etc.
6. Laparoscopy: In recent years, laparoscopy can be used for the diagnosis of inguinal hernia, as well as for treatment, with satisfactory results.
Diagnosis
Diagnosis and differentiation of inguinal hernia
Diagnose based on
1. A reversible hemispherical mass that appears above the pubic tuberosity.
2. After the tumor is returned, the internal pressure of the finger pressure and the increase of the abdominal pressure mass may still appear.
3. It was confirmed that the hernia sac was located inside the inferior epigastric artery.
Differential diagnosis
1. Half-moon line: The lower half-moon line is easy to be confused with the inguinal hernia. The main point of identification is that the inguinal hernia is prominent through the straight triangle, and its position is relatively low relative to the half-moon line, while the half-moon line passes through the abdomen. The transverse fascia arch protrudes.
2. Upper and lower bladder: There are half globular masses on the outer edge of the rectus abdominis muscle. When standing, the lying position disappears, often accompanied by different degrees of pain, but the incarceration rarely occurs. The disease is similar to the groin. Some patients even have a direct inguinal hernia, which should be distinguished.
3. Inguinal hernia: the identification of straight and oblique.
