What is dangerous strangulated inguinal hernia
A strangulated inguinal hernia is a dangerous complication of hernial pathology, which is closely associated with a gross violation of the function of an organ located in the hernial sac. To begin with, you should explain about the disease itself. A hernia is a disease that is characterized by pathological protrusion of an organ from its natural cavity with the surrounding space.
So, with a stable course of the disease, the organ or part of it maintains its function. The organ does not lose its working capacity, and if it does, then partially. Incarcerated inguinal hernia is said to be when the structures in the hernial sac are suddenly pinched due to some factors.
A pinched inguinal hernia is an acute condition that requires immediate first aid and further surgical intervention to restore the functioning of the strangulated organs.
Anatomical reference
A hernia in the groin is a defect in the peritoneum, namely in the inguinal region. The abdomen is lined from the inside with an inner sheet - the peritoneum - a thin film consisting of connective tissue.
The task of this sheet is to “envelop” the inner walls and organs that are in the stomach. The peritoneum is another barrier after the skin and muscles, the purpose of which is to protect the internal organs.
Between the groin and the peritoneum is the inguinal canal, through which, during fetal development, they descend along the spermatic cord in boys, and in girls - the uterine ligament. Under the influence of some genetic factors, the inguinal canal does not close, which should do so almost immediately after birth. This channel originates in a part of the abdominal cavity, then goes down. With an increase in intra-abdominal pressure, part of the peritoneum, certain organs, or the omentum may descend through the inguinal canal, forming an inguinal hernia.
A strangulated inguinal hernia often comes on suddenly, like any other complication.
Causes of infringement in the groin:
- weakness of the inguinal muscles;
- a sharp increase in intra-abdominal pressure due to a heavy load on the body, coughing, sneezing, vomiting, or accumulation of gases;
- previous injuries;
- period of gestation;
- age and gender: infringement of an inguinal hernia in men and boys occurs much more often than in women; also, the likelihood of developing this complication increases when a person reaches a young and mature age (from 25 years or more).
It is worth noting that a strangulated inguinal hernia in a newborn is just as common, but it is formed in a child during pregnancy.
Types of strangulated inguinal hernia
There are four types of strangulated inguinal hernia:
1.Elastic infringement.
This type of complication occurs when there is a strong and sudden increase in pressure inside the abdominal cavity. Causes include: coughing, strong sneezing, sharp turns of the torso to the side, work with weights, constipation.
Elastic infringement is characterized by the fact that usually a larger number of organs and other structures enter the area of the hernial sac than with a conventional hernia. The structures that have come out cannot be repositioned, since the hernial ring behind the sac is too narrow, its diameter is not able to pass volumetric structures.
In this state, local ischemia develops - a lack of oxygen, since local arteries and veins are clamped along with the organs. Thus, a prolonged absence of oxygen will sooner or later lead to tissue death and irreversible changes in organs.
2. Fecal infringement.
This is one of the types of pinched inguinal hernia, which occurs against the background of a weakening of intestinal motility. This condition usually occurs when a person follows a low-acid diet. In the intestinal tract, a large amount of feces accumulates, which are transported to the hernial sac. So, the pressure in the hernia sac increases, and the pressure in the hernial ring also increases. This condition is accompanied by a violation of local blood circulation. Necrosis may occur.
Often, fecal infringement is observed in old people. It should also be remembered that a long stay of feces can provoke purulent inflammation.
3. Infringement of the retrograde type.
This variant of the complication is formed when in the region of the hernial ring there is not one loop of the intestine, but several. Part of the digestive tract is exposed to ischemia.
4. Wall infringement.
This type occurs when a certain part of the intestinal wall, which is attached to the mesentery, lends itself to infringement. This condition is accompanied by impaired blood and lymph circulation, which leads to ischemia and further tissue necrosis. It is complicated by perforation - a condition when a "hole" has formed in the intestinal wall, through which the intestinal contents enter the abdominal cavity. One of the rarest infringement options.
Location type:
- left-sided: occur with a probability of no more than 30%;
- right-sided: fixed in 60% of all cases;
- bilateral: the frequency of occurrence is approximately 10%.
Symptoms of strangulated inguinal hernia
Usually the infringement speaks about itself immediately. In this case, the patient should fix his painful condition as soon as possible and contact a specialist for urgent medical help.
Signs of strangulated inguinal hernia:
- The bulge formed earlier begins to hurt a lot. In general, pain syndrome is the leading sign that a part of the organ has been pinched. The pain most often spreads to nearby areas, that is, to the groin area and lower abdomen.
- After the intestine has been restrained, the person will immediately feel the severity of the condition. His body temperature will rise, a severe headache will appear, the person will complain of a general malaise in the body, and the pulse will increase. Outwardly, such people look anxious, confused. People predisposed to hypochondria can fall into a state of panic.
- The clinical picture also includes nausea and vomiting, often constipation.
- When taking a horizontal position, the pain does not disappear, outwardly the hernia does not become smaller.
- The hernia goes into a state of irreducibility.
- Absence of cough. With a stable flow, if you put the patient on their back and press the area of the inguinal canal with the thumb, you can feel how the finger is pushed out. This does not happen when it gets worse.
In men, the symptoms are almost the same as inguinal hernia in women, except for some points:
- inguinal hernia in men may be accompanied by a strong lowering of the scrotum down;
- in women, this condition is associated with a visible increase in the labia majora.
Strangulated inguinal hernia in children
When such a condition appears, the baby begins to worry, the child begins to cry, he vomits. Body temperature does not rise, which can confuse parents. Among the vomit, one can notice yellowish impurities of bile, a little later - intestinal contents. The stool is also delayed, gases are not released.
In the later stages of an inguinal hernia, the child's temperature rises sharply, signs of an intoxication syndrome appear. When forming an inguinal hernia in children in the groin area with hands and fingers, you can feel a roundish and hard formation.
Diagnostics for inguinal hernia
It is important for the patient to know that if a number of symptoms appear, it is extremely important to call an ambulance, and painkillers should not be taken. Anesthetic drugs erase and smooth the clinical picture. This makes it much more difficult for doctors to make a diagnosis.
During an objective examination, the specialist detects severe pain, increased bulging, swelling and redness of the skin. First of all, the doctor will check the symptom of a cough shock. If it is not there, the risk that the organs are infringed increases.
After the initial examination, the patient is sent to the hospital, where he later falls under the supervision of a surgeon, who alone can make a final diagnosis. The final diagnosis is based on ultrasound.
Urgent Care
First aid consists in a list of items that should not be done in any case:
- Do not try to self-diagnose and give the patient medication.
- You can not set and somehow manipulate the hernia.
- It is contraindicated to take baths, use painkillers and antispasmodics, and cold or heat should not be applied to the affected area.
A relative, friend or relative should immediately take the patient to the hospital, while trying to interfere as little as possible in his condition.
Treatment
With a restrained inguinal pathology, treatment is carried out only surgically. A common operation is an emergency hernia repair. Unlike other conditions, there is no hernia repair performed here. Before surgery, the patient usually empties the intestines and bladder. Anesthesia is most commonly used as an anesthetic.
The main goal of the intervention is the elimination of an acute condition by removing the pinching and its consequences. The organ that is infringed is subject to release and reduction.
In the course of opening the hernial sac, antiseptic measures are taken, since there is always the possibility of microbial flora or any other infection joining. After the liquidation of the unstable condition, specialists carry out the plastic surgery of the hernial ring. Further treatment is determined by the general condition of the patient.
Forecast
As a rule, after a successful operation, the prognosis for a full recovery is favorable. Further adherence to preventive measures prevents the recurrence of not only complications, but also the hernia itself.
