Inguinal hernia in men
- Classification of inguinal hernia in men
- Causes of inguinal hernia in men
- Injury of inguinal hernia
- Clinical manifestations of inguinal hernia in men
- Diagnosis of inguinal hernia in men
- Treatment of inguinal hernia in men
Hernia is the emergence of an organ, its part, or at once a group of organs through existing normally or pathologically formed openings. In this case, all the shells covering the organ remain intact.
The most common are hernia of the anterior abdominal wall, as this is a very large area of the human body, which has many weaknesses and is under pressure of a large mass of organs.
In any hernia, several elements are distinguished:
- hernial gates - an opening (natural or pathological) through which the contents of the cavity protrude;
- the hernial sac is part of the peritoneum that emerges through the hernial gates;
- hernial contents are all organs or parts of them that go beyond the limits of their natural stay and are contained in a hernial sac.
Inguinal hernia - protrusion of the peritoneum into the inguinal canal area. They accounted for the most of the total number of hernias of the anterior abdominal wall. In men, this pathology occurs 9 times more often than in women, which is due to the difference in the structure of male and female organisms. Due to the features of the structure of the pelvis, femoral hernia is much more likely in women.
The inguinal canal is one of the weak areas of the anterior abdominal wall. Normally, there is a gap between the anatomical formations, in which men undergo a spermatic cord and women have a round ligament of the uterus. Passes the canal from the deep inguinal ring to the superficial inguinal ring - the entrance and exit from the canal. It is through these rings under certain conditions that the abdominal cavity can protrude.
Classification of inguinal hernia in men
Depending on the origin of the hernia there are:
- congenital - are formed in the intrauterine period and are present in the child at the time of birth (they account for a small number of all inguinal hernias);
- acquired - are formed in the process of life activity due to the influence of a number of factors.
According to the clinical course of the hernia of the anterior abdominal wall there are:
- primary - the first arising hernia;
- relapse - occurs after the physicians have performed an operation to eliminate the protrusion of organs, in the same place;
- postoperative - occurs after surgery on the abdominal organs (doctors have to make a cut of tissues, which creates an additional weak spot on the front abdominal wall).
Also inguinal hernia, depending on the way through which ring of the inguinal canal it leaves, happens:
- oblique - passes through the inner ring and is sent obliquely downward;
- straight - leaves through the outer inguinal ring.
The hernia can also be expressed in different degrees:
- initial - is characterized only by the first manifestations, when the hernial sac already exits through the inguinal ring;
- canal - the hernial sac moves along the inguinal canal and does not go beyond it;
- the inguinal groin itself becomes larger and extends beyond the inguinal canal;
- the inguinal and scrotal hernia is the latest stage of hernia development, when its contents descend even lower and fall along the spermatic cord into the scrotum.
Causes of inguinal hernia in men
All the factors leading to the appearance of hernias are divided into two groups:
- predisposing - presence in the muscular aponeurotic layer of the abdominal wall of weak sites;
- producing - all the effects, which result in increased pressure in the abdominal cavity.
In the case of inguinal hernia, a predisposing factor is the presence of deep and superficial inguinal rings. Almost everywhere the abdominal wall is alternating layers of muscles and fascia, which ensures its maximum strength. A deep inguinal ring is formed as a result of passage through the abdominal wall of the testicle during the development of the organism. This ensures the formation of a "natural defect", through which a hernial sac can subsequently pass through with its contents. In the outer ring area aponeurosis of the abdominal muscle diverges, which also weakens the abdominal wall.
Also, some people have congenital or acquired (appears with age) weakening of the abdominal wall due to the ligament cleavage.
- Excess body weight ensures the presence of constantly increased intra-abdominal pressure.
- Lifting weights is always accompanied by tension in the muscles of the abdomen, which leads to increased pressure in the abdominal cavity. If the loads are too heavy, and the pressure increase is noted systematically, then there is a high probability that sooner or later the weak points will not survive and a hernia will form.
- Problems with digestion, accompanied by constipation, force patients to make great efforts to evacuate the intestines. This also leads to increased strain on the weak points of the anterior abdominal wall.
- Cough is a harmless at first glance symptom of many diseases, which everyone notes several times a year. However, a persistent and strongly pronounced cough that does not bring relief and lasts for hours, weeks, or even months (chronic bronchitis in smokers), combined with a weakening of the fasciae and muscles can easily lead to the development of a hernia.
Injury of inguinal hernia
Hernia can for years not bother its "owner", even with impressive dimensions. In most cases, the contents of the hernial sac are the loops of the intestines, through which the contents of the digestive tract constantly progress. Usually they do not squeeze in the gates of the hernia and calmly contract, pushing food or stool masses forward. Patients can calmly fix the hernia in the abdominal cavity, often the loops themselves return there with the horizontal position of the body.
However, in some cases, a complication develops in the form of infringement.
- The most frequent cause of infringement is a sharp increase in intra-abdominal pressure, as a result of which extra hinge loops enter the hernial sac. The diameter of the hernia gates is not enough to ensure that there are all the organs leaving them calmly. Consequently, the intestines simply squeeze, which leads to a violation of their nutrition (the vessels of the mesentery can not pass the right amount of blood).
- Slightly infringement develops as a result of accumulation in the hernia of fecal masses, which gradually exert increasing pressure on the wall of the intestine and provoke infringement.
Specific forms of infringement
- Retrograde - in the hernial sac enter the loops of the intestine, which, with their contractions, gradually squeeze the vessels of that intestine that is located inside the abdominal cavity. As a result, the surgeon during the operation on the infringement can erroneously think that the contents of the hernia are all right. In fact, the strangulated intestine can erode, tear and subsequently cause severe peritonitis.
- Pristenochnoe infringement - in the hernia gates infringed only one wall of the intestine. As a result, the clinical manifestations of the disease are weak, the patency of intestinal contents is not compromised. The patient may feel a minor pain for several days and do not attach any importance to this. During this time, the site of the intestinal wall will wither away and an opening will be formed through which intestinal contents enter the abdominal cavity and cause peritonitis.
Symptoms of inguinal hernia in men
How does inguinal hernia in men look like you can see in the photo on the right.
Symptoms of the restrained and not restrained inguinal hernia are radically different, therefore they will be described separately.
Symptoms of not restrained hernia
- Presence of protrusion in the lower abdomen, in the pubic region. In some cases, the contents of the hernia penetrate into the scrotum and cause an increase in her on one side. The protrusion rarely hurts, it can often self-correct with the horizontal position of the body.
- Seldom the patient is disturbed by insignificant pains in the field of a hernia. They quickly pass and do not attract attention.
- Frequent urination develops when the hernia in any way affects the organs of the genitourinary system or the nerves responsible for their functioning.
- Constipation, eructation, flatulence - all these manifestations are rare and do not bring the patient anxiety.
A relatively favorable course is due to the fact that patients rarely turn to specialists for help themselves. As a result, they often "wait" for infringement of a hernia and go to treatment in an emergency.
Symptoms of strangulated hernia
- Pain in the area of protrusion on the anterior abdominal wall. It arises from the development of ischemia of the injured organs and can be so strongly pronounced that the patient loses consciousness or is in a state of shock.
- The hernial sac at palpation is strained, it hurts. If you ask the patient to cough, then cough jolts are not transmitted to the hernia, which is not characteristic for the not restrained hernia.
- Vomiting, which does not bring relief, can develop either as a reflex, or as a result of the development of intestinal obstruction and the accumulation of large amounts of fecal matter in the intestine.
- The hernia does not fit into the abdominal cavity when the patient is in a horizontal position. In no case should attempts be made to correct the hernia on its own, since it is possible to achieve a rupture of the organ and provoke severe peritonitis.
- The abdomen becomes asymmetrical due to the accumulation of a large amount of intestinal contents.
- If in healthy men the stomach actively participates in the act of breathing, then if there is an infringement, this is either not observed, or its movements become less pronounced.
- A firm stomach is a sign of irritation of the peritoneum. It can be noted with many pathologies of the digestive system.
Diagnosis of inguinal hernia in men
Since the pathology is visible to the naked eye, the general examination becomes very informative. For an experienced doctor, it is not difficult to diagnose with high probability after the examination. When preparing for treatment, the patient is examined using some instrumental methods.
- Ultrasound examination of the contents of the hernial sac and abdominal cavity. It allows you to find out exactly what is inside, how many loops there are and how they are located.
- Irrigoscopy - the introduction through the anus of the patient into the intestine of a special solution, which is visible under X-rays. Getting into the hernial sac, this solution allows you to estimate what is inside the hernia, in what quantity. What are the dimensions of the gate, etc.?
If suspicion of infringement is suspected, differential diagnosis is performed with uncommitted hernia. In this case, all the symptoms are evaluated, especially the "cough push symptom", which was mentioned above.
Treatment of inguinal hernia in men
To cure an inguinal hernia now it is possible only surgically. Many authors at different stages of the development of medical science offered various methods of treating hernias. Many methods are currently practically not used, because after them there is a high probability of recurrence, and have only historical significance. New technologies allow to save men from inguinal hernias with greater efficiency, less traumatism and less likely to develop relapse of the disease.
It makes no sense to list all the operations and their features, since for ordinary readers these terms will not carry any semantic load. In general, the operation for the removal of a hernia consists of several stages.
Planned hernia repair operation
- Anesthesia - Nowadays, conductive spinal anesthesia is increasingly used, when pulses are blocked below a certain segment of the spinal cord. The patient is not exposed to the anesthetic throughout the body and remains conscious during the intervention. Also, this method of anesthesia provides fewer side effects.
- Operative access - the surgeon sequentially opens the soft tissues of the anterior abdominal wall until it reaches the peritoneum with the organs contained in it.
- The hernial sac, up to the neck, stands out from the surrounding tissues.
- In the region of the bottom, the hernial sac is opened and all of its contents gently pushes into the abdominal cavity.
- The neck of the hernial sac is stitched in the area of its gates and bandaged.
- Excess of the peritoneum, which went beyond the abdominal cavity and covered the contents of the hernia, is cut off.
- Plastic surgery of the hernial gates (their removal and strengthening of the abdominal wall).
Earlier, operations were actively used to strengthen the anterior wall of the inguinal canal to prevent the development of relapse. At the same time, muscles and ligaments were placed on top of each other, located side by side. Currently, the "gold standard" of plastic surgery of the hernial gate is the Liechtenstein method.
- After excision of the excess of the peritoneum of the plastic gate the hernia is performed with the help of a special net, which is made for this purpose and does not cause a reaction of rejection by the body. This mesh is superimposed on the place where the hernia used to be, and is gently sewn to the surrounding tissues (this prevents its displacement at the first time after the operation).
- Gradually the body is restored and all the injuries that were inflicted by the surgeon during the operation are overgrown. Through the cells of the net, connective tissue grows, which ensures its reliable fixation and prevents recurrence of the hernia.
Laparoscopic treatment of hernias
Laparoscopic technique allows you to penetrate the abdominal cavity of the patient with special manipulators through small punctures in the anterior abdominal wall. The advantage of the operation is that after it there are no scars left, and at the time of execution small damages are caused to the tissues.
- At the initial stage, the patient is anesthetized. Intervention is performed under general anesthesia (anesthesia).
- Carbon dioxide is injected into the abdominal cavity, so that the anterior abdominal wall rises like a dome, and conditions for the work of surgeons are created.
- The hernial sac with its contents returns back to the abdominal cavity.
- From the inside, the mesh is sewn to the abdominal wall. As a result, it more effectively retains the abdominal organs and prevents them from going beyond it. Gradually it grows and reliably fixes in its place.
Thanks to a number of advantages, laparoscopic methods of treating hernias gradually gain popularity. However, if the protrusion is large, then surgeons prefer to work in traditional ways, since it is technically easier to perform the intervention. Therefore, it is necessary to contact the doctors as soon as possible for help and receive treatment with the most modern methods.
Emergency intervention with strangulated hernia
- Anesthesia is only local. General anesthesia is accompanied by relaxation of the muscles of the anterior abdominal wall, which weakens the infringement and the contents of the hernial sac with a high probability of being able to be directed into the abdominal cavity. If we take into account the fact that by the time of the intervention the gut may die, a high risk of peritonitis develops, which can lead to the death of the patient.
- The soft tissues are dissected to the hernial sac, which completely separates to the cervix.
- The hernial sac is opened and all organs in it are securely fixed.
- The hernial gates are opened, which allows to achieve removal of infringement.
- The condition of the injured organ is assessed after the blood flow in it is renewed. If the gut becomes pink and pulsation is clearly visible, then the doctors guide it into the abdominal cavity. If the organ has time to die, the patient is transferred to general anesthesia and performs a resection of the dead region with restoration of the integrity of the digestive tract by applying an anastomosis.
- After all the actions duplicate those that are performed during planned intervention.
It is enough to get acquainted with the list of reasons leading to the formation of a hernia in order to draw the right conclusions and prevent its development. If a large intervention is performed on the abdominal organs, it is necessary to wear a special bandage, which will help the weakened anterior abdominal wall to cope with the load falling on it and will not allow the formation of a hernia.
If the hernia only began to form - immediately it is worth turning to the doctors. If there is no possibility to go to the doctor right away and it is necessary to wait a little, it is also better to use a bandage that will not allow an increase in the hernia, the release of a large number of organs beyond the abdominal cavity and the development of infringement.
- Pain in the groin in the men's right, left: causes
- Herniated belly
- Herniation of the lumbosacral spine