Incarcerated inguinal hernia

Introduction to incarcerated inguinal hernia Incarcerated indirect inguinal hernia (incarcerated indirectated hernia) is called "incarcerated hernia" (incarerated hernia) refers to the abdominal organ into the hernia sac, because the outer ring is narrow, can not reset by itself and stay in the hernia sac, and then blood circulation disorders, This is a common complication of inguinal hernia. If it is not treated properly in time, it often causes strangulated intestinal obstruction and intestinal necrosis, which causes serious consequences. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: intestinal obstruction, acute diffuse peritonitis

Incarcerated inguinal hernia

Stress factor (35%):

Mostly caused by sudden increase in intra-abdominal pressure, such as intense labor, severe coughing or defecation, and children crying. The increase of intra-abdominal pressure forces more abdominal organs to expand the ankle ring and enter the sac. When the intra-abdominal pressure is temporarily reduced, the ankle ring elastically retracts, preventing the sputum content from being reset and incarcerated. It can cause local pain, which can cause reflexive muscle spasm in the abdominal wall and increase incarceration.

Disease factors (55%):

The initial sputum or small baby's sac is thinner, the outer ring is narrower, and the incarceration is easy to occur. After the organ that enters the sac is incarcerated, the blood circulation is blocked, the venous return is blocked, congestion, edema, and sac in the sac. Exudate, if the content of the sputum is intestinal tube, intestinal obstruction can occur after incarceration, the incarceration time is more than 24 ~ 48h, a few severe cases can be necrotic necrosis in 4h, intestinal tube or mesenteric fistula in the sac, edema or flaky Hemorrhage, ischemic necrosis in the late intestinal wall, perforation, intestinal contents spillage, intracapsular infection, followed by cover of various layers of acute cellulitis or abscess, infection extended to the peritoneum can cause acute diffuse peritonitis.

Secondary factors (10%):

In infants with incarcerated sputum, due to prolonged compression of the spermatic vessels, testicular infarction can be complicated, and the incidence rate is reported to be 2.3% to 15%.

Incarcerated inguinal hernia prevention

1, early diagnosis, early treatment, and cultivate a good lifestyle.

2, to maintain smooth stool: constipation is one of the important reasons for the increase in abdominal pressure, so keeping the stool smooth is an effective way to prevent inguinal hernia.

3, actively prevent and treat diseases that promote increased intra-abdominal pressure, such as chronic bronchitis, emphysema, prostatic hypertrophy and so on.

Incarcerated inguinal hernia complications Complications, intestinal obstruction, acute diffuse peritonitis

Streasing of the abdominal organs is the main complication of incarcerated sputum, can not be treated in time, can develop intestinal obstruction, intestinal necrosis, intestinal rupture, acute diffuse peritonitis and toxic shock, etc., can cause death.

Incarcerated inguinal hernia symptoms Common symptoms Abdominal wall incision at the site of a prominent bulge, nausea, cessation of exhaust shock, blood in the groin area, reversible mass toxemia

Symptom

A painful mass that cannot be repaid is a characteristic manifestation of incarcerated hernia.

(1) Painful mass: When the inguinal hernia is incarcerated, painful masses appear in the groin and scrotum, or the original sacral mass increases, hardens, and can not refill the abdominal cavity. The pain is obviously intensified and persistent. There is tenderness, and the child can be expressed as sudden crying or a finger indicating pain to the mass.

(2) Intestinal obstruction symptoms: When the incarcerated contents are intestines, abdominal cramps, nausea, vomiting, and blood in the stool may occur. If not treated in time, defecation, exhaustion stops, and abdominal distension is obviously aggravated.

The contents of the inguinal hernia are often ovarian and fallopian tubes, and incarceration can also occur, because the symptoms of intestinal obstruction are easily ignored.

(3) Toxic performance: sputum incarceration occurs, patients may have elevated body temperature, pulse speed, and even toxic shock.

(4) Severe water, electrolytes and acid-base disorders.

(5) local inflammation: local swelling of the inguinal mass, pain and so on.

2. Signs

Physical examination revealed a swelling of the inguinal region, hard, red skin, tenderness, partial impulsiveness when coughing, and the contents of the sputum could not be included in the abdominal cavity.

Incarcerated inguinal hernia

1.B-ultrasound

Color Doppler can detect bilateral inferior epigastric artery in patients with inguinal hernia, and according to the sac neck and hernia sac located in the medial or lateral inferior epigastric artery, it is identified as straight and oblique, and the blood supply of sputum contents can also be observed. Blood flow velocity to see if there is strangulation and necrosis.

2. Standing X-ray film

In the case of incarcerated inguinal hernia, showing flatulence, stepped gas-liquid equal intestinal obstruction signs, help to confirm the diagnosis.

3. Digital rectal examination

During the incarceration, the finger can touch the intestine through the abdominal cavity through the inner ring into the inguinal canal. The examination should be compared with the healthy side. The rectal examination combined with abdominal percussion is of great value in identifying infants and young children.

Diagnosis and identification of incarcerated inguinal hernia

diagnosis

The diagnosis of typical incarcerated inguinal hernia is not difficult. When there is a painful mass that cannot be self-resetting in the groin or scrotum, the incarcerated hernia should be considered first. If there is a history of inguinal hernia, the diagnosis is more certain.

Differential diagnosis

There are several diseases that are clinically confused with incarcerated hernia:

Hydrocele

When the sick child is crying and uneasy, the mass in the groin is often found by the parents and mistakenly thought to be at the same time as crying, so it is difficult to rule out the incarceration from the medical history, when the hydrocele is rapidly increased. When infected, or repeated manual reduction, causing local skin redness and tenderness, it is more difficult to identify with incarcerated hernia.

2. Cryptorchidism and spermatic cord twist

Some of the sick children have reflex vomiting due to severe pain. When the body is examined, it is found that there is a mass in the inguinal region, which is easily misdiagnosed as incarcerated sputum. The testicle is located in the groin, which is a solid mass, the scrotum of the affected side is dysplasia, and there is no testicle in the scrotum. Helps identify.

3. Acute inguinal lymphadenitis

The early mass was hard, the border was unclear, the local skin was red and swollen, and it was tender, much like a small incarcerated sputum. In some cases, there was fever and vomiting, which was more easily confused with incarcerated sputum, but no intestinal obstruction.

4. Intestinal obstruction

Some patients have only symptoms and signs of intestinal obstruction. They are often misdiagnosed as intestinal obstruction for conservative treatment without sputum history. This occurs mostly in obese people and infants. Because of the thicker subcutaneous fat and smaller lumps, the inguinal mass is not obvious. If the examiner only pays attention to the X-ray examination, it is satisfied with the gas-liquid surface of the intestine in the abdominal cavity, neglecting the examination of the inguinal part and the gas-liquid surface in the intestinal fistula of the part, which is easy to be misdiagnosed. The examination of the anus examination is easy to identify, and the finger can be incarcerated when incarcerated. Touching the intestine that enters the inguinal canal from the abdominal cavity through the inner ring, it can be clearly detected in comparison with the healthy side.

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