inguinal hernia
Introduction
Introduction to inguinal hernia Inguinal hernia refers to the formation of sputum from the abdominal cavity through the defect of the groin, commonly known as "helium", is the most common abdominal hernia, accounting for 90% of all abdominal hernia. According to the relationship between the ankle ring and the inferior epigastric artery, the inguinal hernia is divided into the inguinal hernia and the inguinal hernia. The oblique hernia protrudes from the inner ring of the inguinal canal located outside the inferior epigastric artery, inward and downward, obliquely through the inguinal canal, and then through the inguinal ring, which can enter the scrotum, accounting for 95%. The sacral trochanteric triangle from the inside of the inferior epigastric artery directly protrudes from the posterior and posterior, and does not enter the scrotum without the inner ring, accounting for only 5%. Inguinal hernias occur in males. The ratio of male to female incidence is 15:1, and the right side is more common than the left side. The incidence of sputum in elderly patients has increased, but it is still more common. basic knowledge The proportion of illness: 0.025% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal pain, constipation, sexual dysfunction
Cause
Inguinal hernia
Causes
There are many causes of inguinal hernia, mainly due to decreased abdominal strength and increased intra-abdominal pressure. Older muscles are atrophy, the abdominal wall is weak, and the groin area is weaker, coupled with the passage of blood vessels, spermatic cords or uterine round ligaments, providing a channel for the formation of sputum. In addition, the elderly have many diseases such as cough, constipation, and dysuria caused by benign prostatic hyperplasia, which causes the abdominal pressure to rise, providing a driving force for the formation of sputum. If there is a reversible mass in the groin area, that is, when standing, walking, coughing, or labor, and disappearing when lying down, you should consider the possibility of inguinal hernia.
Pathogenesis
Inguinal hernia
Most of the inguinal hernias are acquired, the main cause is the development of the abdominal wall is not perfect, the muscles and fascia of the inguinal triangle are weak. The elderly are degraded by muscle atrophy, which makes the gap of the inguinal canal wide, and the supportive protective effect of the intra-abdominal oblique muscle, the transverse abdominis muscle and the combined tendon is also weakened. When there is chronic cough, habitual constipation or difficulty in urinating, the intra-abdominal When the pressure is increased, the transverse fascia is repeatedly subjected to the impact of intra-abdominal pressure, causing damage and thinning, and the abdominal viscera is gradually pushed forward and protrudes to form a straight iliac crest. There is no innate occurrence.
Inguinal hernia
In the early stage of the embryo, the testis is located in the second to third lumbar vertebrae of the retroperitoneum, and then gradually declines. At the same time, in the future inguinal canal, the peritoneum, the transverse fascia and the muscles of each layer of the inguinal canal are gradually moved down, and the skin is pushed to form a scrotum. The peritoneum that moves down then forms a sheath, and the testicles cling to the posterior wall of the sheath. Shortly after the birth of the baby, except for the scrotum part, which becomes the testis intrinsic sheath, the rest is self-atrophic and atresia leaving a fiber cord. If the ring is not closed, congenital oblique hernia can be formed, and the unclosed sheath is a congenital oblique hernia. Sometimes, the patented uncinate process is only a very small tube, and it is not clinically manifested as a hernia. It only forms a traffic testicular hydrocele. If the lower segment of the sheath is closed and the upper segment is not closed, the oblique sputum can also be induced; if the two ends are locked and the middle segment is not closed, it is clinically characterized as spermatic hydrocele. The testicular drop on the right side is slightly later than the left side, and the occlusion of the sheath is also late. Therefore, the right inguinal hernia is more common.
Acquired oblique hernia is more than congenital, and its pathogenesis is completely different. At this point, the peritoneal sheath has been occluded, and another new sac is formed, which is caused by the groin. It is caused by anatomical defects in the inguinal region, that is, the inguinal canal area is a weak area of the abdominal wall, and the spermatic cord passes through and causes the local abdominal wall strength to weaken, but mainly the dysplasia or weak abdominal muscles and the transverse abdominis and abdomen The internal oblique muscles weakened the inner ring and the inferior oblique ligament of the transverse abdomen (or combined tendon) could not be close to the inguinal ligament, and induced inferior oblique sacral.
Prevention
Inguinal hernia prevention
Avoid the following factors that may cause paralysis:
1. Avoid lifting heavy objects;
2, try to smoke less or not smoke, the cough of the smoker may accelerate the development or deterioration of hernia, give up smoking can improve blood, accelerate the recovery of hernia;
3, eat less food that is easy to cause constipation and abdominal flatulence (especially cooked eggs, sweet potatoes, peanuts, beans, beer, carbonated bubble drinks, etc.), eat a high-fiber diet, including grains, grains, bran, and Raw fruits and vegetables;
4. Drinking at least eight glasses of water a day can help relieve constipation;
5, to avoid, reduce sneezing;
Deep breathing can help alleviate chronic cough.
Strengthen exercise to reduce seizures
The incidence of suffocation in the elderly is high, mainly because the abdominal muscles and tendons of the elderly are degenerated, the strength is reduced, and obesity or long-term bed-ridden factors can easily lead to atrophy of the abdominal wall muscles, resulting in the small intestine or omentum protruding from the weaker abdominal wall. In severe cases, I have to rely on surgery to solve the problem. Therefore, the elderly should consciously strengthen the abdominal muscles, increase muscle strength, and avoid the occurrence of hernia.
1. Lying on the bed, arms flat on both sides of the body, legs and raised up 30 to 90 degrees, and then flattened, preferably slightly suspended, generally repeated 30 times. Then put your hands on your chest and do sit-ups and repeat 8 to 10 times.
2. Sitting on the bed flat, the legs stretch forward, the upper body is straight, the arms are flat on the side of the body, and the palms are down. Use a long towel on the soles of the feet, inhale, bend and stretch the legs, lift off the bed, lean back, straighten your arms, and pull the ends of the towel to form a "V" on the body and legs. Exhale, tighten your abdomen, balance your body, straighten your back, try to maintain this position, breathe naturally, then slowly put your legs and torso back to the bed. Repeat 3 to 6 times.
3. Lying in bed, do 3 to 5 minutes of deep breathing, while the palm of the hand in the affected part to do a gentle circle massage, and then relax the body for 10 to 15 minutes.
Complication
Inguinal hernia complications Complications, abdominal pain, constipation, dysfunction
Hernia first affects the patient's digestive system, resulting in symptoms such as lower abdominal bulge, abdominal distension, abdominal pain, constipation, poor nutrient absorption, fatigue, and decreased constitution.
Because the inguinal region is adjacent to the genitourinary system, elderly patients are prone to bladder or prostate diseases such as frequent urination, urgency, and nocturia. Children can affect the normal development of the testes due to the compression of hernia; while young and middle-aged patients Easy to cause sexual dysfunction.
Also, because the intestinal tract or omentum in the hernia sac is easily subjected to inflammatory swelling due to squeezing or collision, it is difficult to return the hernia, resulting in incarceration of hernia, as well as dangerous conditions such as intestinal obstruction, intestinal necrosis, and severe abdominal pain.
Symptom
Inguinal hernia symptoms Common symptoms In the groin area, the rupture of the mass of the lumps or the swelling of the lateral thigh
Clinical symptoms may vary depending on the size of the hernia or the presence or absence of complications. The basic symptom is that there is a reversible mass in the inguinal region. The initial mass is small. It only appears when the patient is standing, working, walking, running, coughing or crying. When lying down or pressing by hand, the swollen body can return itself. Disappear. Generally no special discomfort, only occasionally with local pain and pain. As the disease progresses, the mass can gradually increase, from the groin to the scrotum or the labia majora, inconvenient walking and affect labor. The mass is in the shape of a pear with a pedicle, the upper end is narrow and the lower end is wide.
Inguinal hernia
Mainly for the inguinal area of reversible mass. Located above the pubic tuberosity, it is hemispherical, with no pain or other discomfort. When standing, the crotch appears immediately and disappears when lying down. The lumps do not enter the scrotum, and because of the wide neck, there is very little incarceration. After the sputum, the abdominal wall defect can be directly rubbed in the inguinal triangle area, and the fingertip has a swelling impact when coughing. Use your fingers to press the inner ring outside the abdominal wall to allow the patient to stand up and cough. There are still sputum blocks that can be identified with the sputum. Bilateral straight iliac crests and crotch blocks are often close to each other on both sides of the midline.
Inguinal hernia
Clinical symptoms may vary depending on the size of the hernia or the presence or absence of complications. The basic symptom is that there is a reversible mass in the inguinal region. The initial mass is small. It only appears when the patient is standing, working, walking, running, coughing or crying. When lying down or pressing by hand, the swollen body can return itself. Disappear. Generally no special discomfort, only occasionally with local pain and pain. As the disease progresses, the mass can gradually increase, from the groin to the scrotum or the labia majora, inconvenient walking and affect labor. The mass is in the shape of a pear with a pedicle, the upper end is narrow and the lower end is wide.
During the examination, the patient is lying on his back, and the lump can disappear by himself or gently push the mass outward and upward by the hand, and return to the abdominal cavity to disappear. The hearing is often heard because the contents are small intestine. After the sputum is returned, the examiner can use the tip of the index finger to gently extend through the scrotal skin along the spermatic cord into the enlarged outer ring. If the patient coughs, the fingertip has a shock. Some occult inguinal hernias can be determined by this test. The examiner pressed the inner ring of the inguinal canal with his fingers, and then the patient coughed and the lumps of the sputum did not appear. If the finger was removed, the bulge was seen from the midpoint of the groin. This compression inner loop test can be used to identify the oblique and straight sputum. The latter can still appear when the patient is coughing with the finger after pressing the inner ring.
The above is the clinical features of reversible hernia. If the contents of the sputum are intestinal sputum, the lumps are soft, the surface is smooth, and the sputum is drum sound. When returning, there is often resistance first; once the return is started, the mass disappears faster, and often snoring as the intestinal fistula enters the abdominal cavity. If the content is a large omentum, the mass is tough and inelastic, and the sputum is dull and the return is slow.
Difficult to remove sputum in the clinical performance in addition to slightly heavier pain. Its main feature is that the block cannot be completely returned.
Sliding slanting tendons tend to be large and difficult to fully retract. The cecum that slides out of the abdominal cavity often adheres to the anterior wall of the hernia sac. Clinically, in addition to the tumor can not be completely returned, there are still "dyspepsia" and constipation and other symptoms. Sliding sputum is more common on the right side, and the ratio of left and right incidence is about 1:6. This particular type of sputum should be recognized in clinical work, otherwise the cecal or sigmoid that slipped out may be mistaken for a part of the sac and cut when surgically repaired.
Incarcerated sputum often occurs when there is a sudden increase in intra-abdominal pressure, such as strong labor or defecation. Clinically, it is often manifested by a sudden increase in the mass of the sputum, accompanied by significant pain. Lying in the flat or by hand can not be returned. The mass is tight and stiff and has obvious tenderness. The incarcerated content is the omentum, local pain is often mild; if it is intestinal fistula, not only local pain, but also accompanied by paroxysmal abdominal cramps, nausea, vomiting, constipation, abdominal distension and other mechanical intestinal obstruction Disease image. Once incarcerated, the chance of self-return is small; the symptoms of most patients gradually increase, and if not treated in time, it will eventually become a strangulated sputum. When the intestinal wall is incarcerated, because the local mass is not obvious, it does not necessarily have intestinal obstruction and is easily ignored.
The clinical symptoms of strangulated hernia are more serious. Abdominal pain was severe and persistent; vomiting was frequent, vomit contained coffee-like blood or bloody stools; asymmetric abdominal distension, peritoneal irritation, bowel sounds weakened or disappeared; abdominal puncture or lavage was bloody effusion; Isolated swollen intestinal mixed or tumor-like shadow; body temperature, pulse rate, white blood cell count gradually increased, and even signs of shock.
Examine
Inguinal hernia examination
The vast majority of inguinal hernia can be diagnosed according to the patient's clinical symptoms and the doctor's physical examination. If the hernia is relatively small, the performance is not typical, and it can be confirmed by B-ultrasound.
During the examination, the patient is lying on his back, and the lump can disappear by himself or gently push the mass outward and upward by the hand, and return to the abdominal cavity to disappear. The hearing is often heard because the contents are small intestine. After the sputum is returned, the examiner can use the tip of the index finger to gently extend through the scrotal skin along the spermatic cord into the enlarged outer ring. If the patient coughs, the fingertip has a shock. Some occult inguinal hernias can be determined by this test. The examiner pressed the inner ring of the inguinal canal with his fingers, and then the patient coughed and the lumps of the sputum did not appear. If the finger was removed, the bulge was seen from the midpoint of the groin. This compression inner loop test can be used to identify the oblique and straight sputum. The latter can still appear when the patient is coughing with the finger after pressing the inner ring.
The above is the clinical features of reversible hernia. If the contents of the sputum are intestinal sputum, the lumps are soft, the surface is smooth, and the sputum is drum sound. When returning, there is often resistance first; once the return is started, the mass disappears faster, and often snoring as the intestinal fistula enters the abdominal cavity. If the content is a large omentum, the mass is tough and inelastic, and the sputum is dull and the return is slow.
Difficult to remove sputum in the clinical performance in addition to slightly heavier pain. Its main feature is that the block cannot be completely returned.
Sliding slanting tendons tend to be large and difficult to fully retract. The cecum that slides out of the abdominal cavity often adheres to the anterior wall of the hernia sac. Clinically, in addition to the tumor can not be completely returned, there are still "dyspepsia" and constipation and other symptoms. Sliding sputum is more common on the right side, and the ratio of left and right incidence is about 1:6. This particular type of sputum should be recognized in clinical work, otherwise the cecal or sigmoid that slipped out may be mistaken for a part of the sac and cut when surgically repaired.
Incarcerated sputum often occurs when there is a sudden increase in intra-abdominal pressure, such as strong labor or defecation. Clinically, it is often manifested by a sudden increase in the mass of the sputum, accompanied by significant pain. Lying in the flat or by hand can not be returned. The mass is tight and stiff and has obvious tenderness. The incarcerated content is the omentum, local pain is often mild; if it is intestinal fistula, not only local pain, but also accompanied by paroxysmal abdominal cramps, nausea, vomiting, constipation, abdominal distension and other mechanical intestinal obstruction Disease image. Once incarcerated, the chance of self-return is small; the symptoms of most patients gradually increase, and if not treated in time, it will eventually become a strangulated sputum. When the intestinal wall is incarcerated, because the local mass is not obvious, it does not necessarily have intestinal obstruction and is easily ignored.
Diagnosis
Diagnosis and differentiation of inguinal hernia
Diagnosis can be based on the cause, symptoms and related tests.
