Inguinal hernias are the most common type of hernia (87–90%).
Etiology, pathogenesis of inguinal hernia
Contributing factors are: Nezar – schenie processus vaginalis of the peritoneum, atrophy of the fatty tissue in the inguinal canal with a decrease in body weight, muscle degeneration in obesity in old age. Passage to the embryonic period of development (6-8 months of pregnancy) through the inguinal canal of the descending testicle, spermatic cord in men and the round ligament of the uterus in women creates anatomical conditions that, if there are predisposing and producing causes, can lead to the development of a hernia. By the 7th month of life, a complete overgrowth of the vaginal process occurs in 35% of cases, by 12 months – in 41%, and in adults – in 90%. With a congenital hernia, the elements of the spermatic cord are spread over the hernial sac (its posterior wall) and are intimately connected with it, the testicle lies in the wall of the hernial sac and its own membrane stands in the lumen of the sac.
It leaves the abdominal cavity through the internal inguinal fossa, has a direct passage, wide gates, a short canal, a semicircular shape, does not descend into the scrotum, the spermatic cord lies outwards from the sac.
It exits through the external inguinal fossa, has an oblique direction, descends into the scrotum, the hernial sac lies inward from the membranes of the spermatic cord, on its inner surface.
The size of the initial hernia is distinguished – the hernial sac is only felt in the depth of the inguinal canal; incomplete – the hernial sac does not come out of the external opening of the inguinal canal; complete – hernial space is located outside the inguinal canal; inguinal-scrotal, descending into the scrotum; large – the hernial sac descends, pulling the scrotum down to the middle third of the thigh or to the knee joint.
Inguinal hernia clinic
With a correctable hernia, the tumor-like formation is felt in a typical place, appears with tension and disappears in the supine position and with pressure; a hernial ring is palpated in the abdominal wall; transmission of a cough impulse is noted; when leaving the hernia sac of the intestine over the protrusion, tympanitis is determined. With an irreducible hernia, the hernial protrusion does not adjust and has a localization typical of a hernia . Often, a tumor-like formation increases with straining . From the anamnesis it is known that in the past it was easily adjusted. When a finger is inserted into the inguinal canal after the hernia is repositioned, the expanded hernial gates are oval or triangular in shape. On palpation during straining , the outgoing hernial contents are determined. The diagnosis is not very difficult. Incomplete hernias are determined only by inserting a finger into the inguinal canal. The corrected hernia must be differentiated with the nipple , the expansion of the veins of the spermatic cord, and the irreducible hernia with the tumor and dropsy of the testicle.
Inguinal hernia in children
Inguinal hernia is the release of organs of the abdominal cavity (mainly the intestines) into non-growing vaginal peritoneum.
Incidence of inguinal hernias
Inguinal hernias are found mainly in boys (due to the lowering of the testicle), mostly unilateral, more often on the right). Injured inguinal hernias occupy third place in terms of specific prevalence among acute surgical diseases of childhood.
Inguinal hernia classification
1. Inguinal hernia. 2. Inguinal- Kalitkov hernia: a) testicular , b) cords (90% of inguinal hernias). The contents of the hernial sac are loops of the small intestine, omentum, in girls, in addition, ovaries, fallopian tubes.
Causes of inguinal hernias
Inheritance of the disease, deficiency of hormones of the mother and fetus, adverse environmental factors.
Clinic and diagnosis of inguinal hernia
Painless protrusion of a round or oval shape in the groin, which increases with a scream, elastic consistency. On palpation – a characteristic rumbling. Symptom “push” when coughing a child. Injury of an inguinal hernia. Sudden pain in the inguinal region, symptoms of irreversible hernia. Vomiting, intestinal obstruction. In the external opening of the inguinal canal there is a painful hernial protrusion.
Differential diagnosis of inguinal hernia
Differential diagnosis is carried out with testicular dropsy, cryptorchidism, testicular ectopia, enlarged lymph nodes, and in girls – Nukke cyst .
Inguinal hernia treatment
Conservative In case of numbness in the inguinal hernia – antispasmodics (atropine), painkillers ( promedol ), warm bath, horizontal position of the child with a raised pelvis. Prompt. Duhamel’s operation is cutting off the hernial sac without opening it and duct plastic. Operation Krasnobaev – cutting off the hernial sac with plastic inguinal canal without opening the front wall. Martinov’s operation is rarely used – cutting off the hernial sac with plastic of the inguinal canal with the opening of the front wall.