Inguinal and scrotal hernia in men and boys - Causes, symptoms and treatment. MF.

The inguinal and scrotal hernia is the prolapse of the internal organs to the scrotum, due to the failure of the connective tissue of the inner or outer inguinal ring, which are natural openings in the abdominal wall.

Causes of inguinal and scrotal hernia

It is impossible to identify the causes of this disease. There are many factors that in some way contribute to a decrease in the tone of the inguinal rings and the loss of internal organs in the bag formed by the fold of the peritoneum.

Most often, hernias develop in men older than 50 years, when the connective tissue loses its natural elasticity. Promotes the development of hernia physical work, which leads to increased pressure inside the abdominal cavity. In addition, contributing factors can be considered excessive body weight and diseases of internal organs. Among the latter, it is necessary to single out liver pathologies, which are accompanied by ascites, that is, accumulation of fluid inside the abdominal cavity. This is the same as the physical load leads to an increase in peritoneal pressure and protrusion of the peritoneum through the physiological and pathological openings.

It is also necessary to distinguish congenital inguinal and scrotal hernia in boys, developing due to embryogenesis disorders, when in the process of development the testicle does not completely descend from the abdominal cavity to the scrotum.

Symptoms of inguinal and scrotal hernia

Men with inguinal and scrotal hernia, as a rule, complain of a tumor-like formation in one of the inguinal areas. If the hernia is not impaired, then education is painless.

Inguinal-scrotal hernia

In the case of infringement of the latter, there is a sharp soreness and redness of the skin over the tumor. When the hernial bag is lowered into the scrotum, the latter grows in size and becomes sharply painful. There are practically no limits for scrotal enlargement. There are clinical cases when almost the entire intestine with hernial sac went into the scrotum, and it became the size of several soccer balls.

Symptoms of the disease also depend on the organ that enters the hernial sac. Most often, it is a small intestine or a large omentum. If you get into the hernia of a large omentum of patients, only soreness in the area of ​​the hernial sac worries. In case of infringement of the intestines, the symptoms of intestinal obstruction are also added to the pain: lack of stool, bad gas leakage, bloating and hernial sac, nausea, vomiting with intestinal contents.

Infringement of the intestine in the hernial sac

If a man sees a tumor-like formation in his groin, he should immediately go to a surgeon or urologist so that they can assess his clinical condition and suggest the correct method of treatment.

Diagnosis of inguinal and scrotal hernia

As a rule, clinical examination is enough to accurately determine the diagnosis of inguinal and scrotal hernia. In order to find out whether the hernial ring is impaired or not, check the symptom of a "cough push".A hand is put on the hernial sac and the patient is asked to cough. If a cough shock is transmitted to the hernial sac, then this indicates that there is not an infringed inguinal hernia. If the hernia does not bulge with coughing movements, then the diagnosis of the strangled inguinal hernia is exposed. Such differential diagnosis is very important, since it completely determines the tactics of surgical treatment.

In some cases, for example, with a small hernia size, it can be difficult to diagnose and additional research methods must be used. Thus, ultrasound can provide more accurate information about the origin of tumor-like formation in the inguinal region.

Also used contrast radiography of the abdominal organs in order to determine the presence in the hernial sac of the loops of the small or large intestine.

In rare cases, a puncture of the hernial sac may be used for diagnosis. As a rule, it is performed in cases of suspected cyst of the spermatic cord, which can reach large sizes and mimic an inguinal hernia. Histological examination of the puncture material gives an accurate conclusion about the origin of the formation.

Treatment of inguinal and scrotal hernia

Treatment of this disease can be carried out by conservative or operational methods. Conservative treatment is recommended in those cases when the operation is contraindicated. As a rule, this is the case in elderly patients or with serious diseases of internal organs in the stage of decompensation.

Conservative treatment of inguinal hernia involves the use of a special bandage, which prevents the infringement of the hernial sac. As a rule, the bandage has the appearance of elastic meltings, which fit tightly to the body and prevent internal organs from falling into the hernial sac.

A more common method of treatment of inguinal and scrotal hernias is surgery. In the case of infringement of the inguinal ring, the operation is performed according to vital indications, and in the absence of infringement - in the planned order. If it is a question of an injured hernia, when a loop of the small intestine has entered the hernial sac, it is necessary to check the latter for viability. With a normal pink color and active peristaltic movements of the organ, it is simply immersed in the abdominal cavity. If the gut is black or crimson, and also poorly contracted, it is removed, and anastomosis is placed between the ends of the intestine.

After the removal of the hernial sac, the plastic of the hernia gates is made. To date, a huge number of types of plastic surgery of the hernial gates have been developed, but the most popular is the hernia of Liechtenstein. To perform it, a special lavsan mesh is placed on the site of the hernia from the abdominal cavity, which is fixed to the surrounding tissues by separate sutures. The operation ends by layer wound suturing with the installation of rubber drainage for the evacuation of effusion and blood residues. In place of the seams, an aseptic dressing is applied to prevent infection of the wound.

Rehabilitation after illness

All patients after the operation undergoing it is recommended to wear elastic trunks that support the scrotum in its physiological position. This contributes to the correct and rapid healing of the wound, as well as prevents relapses of the disease.

As for medicines, in the postoperative period all patients are prescribed antibiotics of a wide spectrum of action for the prevention of secondary infection of the wound. Usually, two ceftriaxone tablets are sufficient for this purpose per day.

Features of nutrition and lifestyle

To date, there is not yet developed a special diet that could affect the healing of the wound or the early recovery of the patient after inguinal hernia. All patients are recommended a general dietary table for Pevzner № 15, which includes high-calorie foods with high protein content.

As for lifestyle, during the first two months after the operation, patients should refrain from strong physical work and constantly wear elastic trunks. Lifting of a large load in the first two weeks after the operation in most cases results in a discrepancy between the postoperative wound and the inevitable relapse of the disease.

Treatment with folk remedies

As any methods of treatment, even if traditional, which are not based on surgery, do not have a lasting positive effect on inguinal hernia, the effectiveness of folk methods of treatment can not be discussed.

Very often, patients turn to folk healers in case of infringement of the hernia, when they are disturbed by severe pain in the inguinal region. As a rule, healers, if it turns out, put inguinal hernia, which does not always have a good prognostic effect. If the intestine is pinched in the hernial ring for more than 12 hours, it will necessarily necrotic and if such an organ is placed in the abdominal cavity, that is, there is a very high probability that the patient will develop peritonitis. Therefore, with tenderness in the groin area, it is better to seek help not from folk healers, but in specialized medical institutions.

Complications of inguinal and scrotal hernia

The most frequent complication of a hernia, regardless of its location, is the infringement of the latter. With regard to inguinal and scrotal hernia, infringement is dangerous because the intestine can enter the hernial sac and the patient will develop signs of acute intestinal obstruction, and after peritonitis. In such a situation, an operation is needed that is not carried out through a small inguinal incision, but a mid-laparotomy, after which there is a scar more than a half-animal.

Another formidable complication of scrotal hernia, which is more common in young patients, is erectile dysfunction and infertility. The fact is that when a whole complex of organs falls into the scrotum, they exert significant pressure on the testicles and the vas deferens. Because of this, the latter simply cease to function and do not produce spermatozoa. If, after some time, to operate such a patient, then the chance that he will recover normal activity of the seminal gland remains minimal.

Prevention of inguinal and scrotal hernia

In principle, the inguinal and scrotal hernia is the result of inguinal hernia, because at first the hernial sac from the abdominal cavity enters the inguinal canal, and only then falls directly into the scrotum. And if at the first stage to conduct effective treatment, then the second can be avoided. To do this, you need to contact the surgeon on time and perform a small surgical intervention in a planned manner.

As for the primary prevention of inguinal and scrotal hernia, it is more complicated. Patients who are engaged in physical work, it is difficult to explain that their profession is the direct route to inguinal hernia. Probably, in such a situation, the most optimal are the annual preventive examinations for the surgeon to detect the disease in the early stages.

Also in order to prevent an increase in intra-abdominal pressure, which can also cause inguinal hernia, it is necessary to diagnose and treat liver diseases on time, which are often accompanied by this symptom.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov AN