Indirect Inguinal Hernia

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Indirect Inguinal Hernia
Body Parts: Lower Limbs Abdomen
Medical Subjects: Children's Health
Overview

What Is Indirect Inguinal Hernia?

Indirect inguinal hernia is formed when abdominal organs are squeezed into the unclosed sheath process under the condition of increased intra-abdominal pressure, just like a bulge grows in the child's groin or scrotum, commonly known as hernia or small intestine hernia. It is the most common pediatric surgical disease.

One can imagine an unclosed sheath in a child's groin as a sock, with the contents of the hernia corresponding to the foot extending into the sock, the neck of the hernia corresponding to the sock entrance, and the outer shoe corresponding to the hernia outer covering.

An indirect hernia consists of a hernial sac, the contents of the hernia, the outer covering of the hernia, and so on. Hernial sac is an open, sheath-like process that consists of a hernial sac neck and a hernial sac body, where the hernial sac neck is located.

Which children suffer from indirect inguinal hernia easily?

Indirect inguinal hernia in infants and young children is more common in boys than in girls and occurs more on the right groin than on the left.

What is an incarcerated indirect inguinal hernia?

It refers to that the organs in the abdominal cavity cannot reset themselves and stay in the hernial sac after falling into the hernial sac. This is a common complication of indirect inguinal hernia in children. If not handled in time, intestinal necrosis, intestinal perforation and other serious consequences can occur, even life-threatening.

Cause

What Is The Cause Of Indirect Inguinal Hernia?

Is indirect inguinal hernia caused by cough or cold?

Indirect inguinal hernia in children is a congenital disease. Increased intra-abdominal pressure (cough, crying, severe activity, constipation, lower urinary tract obstruction, etc.) is only the inducing factor, while the non-closure of the sheathing process is the real reason.

It can be imagined that the foot can extend into the sock. The most fundamental reason is that the sock has an opening. The act of extending the foot into the sock can be interpreted as an increase in intra-abdominal pressure. When the foot is pushed down hard, it is easier to extend into the sock.

Why is there blood in the stool when incarcerated inguinal hernia?

This is a very serious situation.

In case of incarcerated indirect hernia, for example, the content is intestine, the intestinal wall and its mesentery can be compressed at the neck of hernial sac, which will firstly obstruct venous return and cause congestion and edema of intestinal wall. Continuous aggravation of compression can reduce arterial blood flow, which finally leads to complete occlusion and intestinal necrosis, and bloody stool will appear.

As you can imagine, the foot stuck in the sock has been tightly bridled at the mouth of the sock, and the blood in the foot cannot flow out, but at this time the blood outside can also flow in some, the foot becomes a bluish purple and looks swollen.

Finally le more and more tight, even the blood flow outside, that this section of the intestine will become black, necrosis. As a result, the intestinal things slowly discharge, became blood.

Symptom

What Is The Symptoms Of Indirect Inguinal Hernia?

How to preliminarily judge indirect inguinal hernia.

Inguinal or scrotal can be pushed back to disappear in situ, soft mass, and when the child crying, stool force, quiet can disappear, general preliminary judgment is indirect hernia.

What are the types of indirect inguinal hernia?

Testicular hernia: The entire sheathing process is not closed, and the contents of the hernia can fall into the scrotum, in the same sheathing cavity as the testis. Testis can be imagined as originally in the inside of the socks a worm, feet directly in contact with the worms, pin the worms.

Spermatic cord hernia: The sheathing process is partially atretic near the testis, but the spermatic cord near the abdominal end is not atretic, has not yet entered the scrotum, or is not in a sheathing cavity with the testis. Testes can be imagined as bugs wrapped in cloth in socks, with the feet just touching the cloth.

Sliding hernia: The cecum (including the appendix) or the unsupported descending sigmoid colon that becomes part of the wall of the hernial sac.

Is there mild or severe indirect inguinal hernia?

Indirect inguinal hernia is divided into oblique inguinal hernia and incarcerated indirect inguinal hernia according to whether the contents of the hernia can be reduced by oneself. Indirect inguinal hernias generally do not have serious consequences, but incarcerated indirect inguinal hernias can be life-threatening if not treated in a timely manner.

What are the manifestations of incarcerated indirect inguinal hernia?

  • For children with a history of indirect inguinal hernia, a large, firm lump can be felt immediately on the scrotum of men or on the lower abdomen of women near the perineum and at the base of the thigh, and severe pain can be felt at the touch.
  • The children presented with persistent crying, vomiting, and non-defecation and non-exhaust through the anus.
  • Later there will be fever, dehydration, poor spirit, blood in the stool, etc.
Detect

How To Check Indirect Inguinal Hernia?

What examinations do I need to do for indirect inguinal hernia?

The majority of indirect inguinal hernia can be diagnosed according to the clinical symptoms and physical examination in children. If the hernia is small in size, a B-scan of the groin can confirm the diagnosis.

What diseases need to be differentiated from indirect inguinal hernia?

It is mainly distinguished from hydrocele of tunica vaginalis. Depending on the size of the opening in the patent sheath, a hernia is defined if the contents of the abdominal cavity, such as the bowel, can be passed through. If the opening is small enough to allow only fluid to pass through, it is called hydrocele. The average doctor can judge by physical examination or B-scan of groin.

Which department should I go to for incarcerated inguinal hernia?

General pediatric surgery is preferred in areas with specialist hospitals once an incarcerated indirect hernia is identified. If there is no children's hospital, general surgery in a general hospital is preferred.

Prevention

How To Prevent Indirect Inguinal Hernia?

How to prevent the recurrence of indirect inguinal hernia after surgery?

The recurrence of indirect inguinal hernia is mainly associated with an increase in intra-abdominal pressure. The hernia operation is like tying an open hosiery. If the child suffers from constipation, repeated cough and strenuous exercise, the tied hosiery may be re-opened. Avoiding these factors can greatly reduce the recurrence of indirect hernia.

Treatment

How To Treat Indirect Inguinal Hernia?

Clinically, there are a very few cases that can recover from themselves, and they are only found in children with very small internal repatriations. Therefore, children with indirect inguinal hernia should be treated surgically unless there are clear contraindications, such as severe congenital heart disease.

When is the most appropriate operation for indirect inguinal hernia?

When a diagnosis of indirect inguinal hernia is made, surgery can be performed in a child who is in good general condition and does not have other underlying conditions. However, if the hernia frequently falls into the scrotum, early surgery is required, even in the neonatal period.

Is general anesthesia necessary for indirect inguinal hernia surgery? Will general anesthesia affect children's intelligence?

Surgery does require general anesthesia. Anesthesia is risky, but the probability of complications is very low. For children without underlying diseases (congenital heart disease, respiratory diseases, etc.), normal anesthesia will not affect their intelligence.

Can indirect inguinal hernia be treated with medication?

At present, there is no medicine to treat indirect inguinal hernia. Children's families should not listen to rumors and take chances. They should cooperate with doctors when they need to operate.

Can indirect inguinal hernia be treated with a hernia belt?

Indirect inguinal hernias cannot be treated with a colic band. Colic zone just put what fell into the scrotum back to the stomach, but the congenital hole still exists, just like we will foot back in the pants, or can be extended into the socks, only by surgery to sew up the socks mouth. It is no longer recommended for children.

What operation method does inguinal indirect hernia have?

  • Traditional surgery: high ligation of hernial sac (+repair), which can be imagined as sewing a circle around the mouth of the sock, and the foot cannot be extended. Repair can be understood as, sometimes you need to sew the socks and then add a few needles to reinforce it.
  • Laparoscopic high ligation of hernial sac: a less invasive treatment that operates on a similar principle to conventional surgery.

Which is better, traditional surgery or laparoscopic surgery for indirect inguinal hernia?

Laparoscopic surgery is generally preferred when both options are available, as laparoscopic surgery can explore the possibility of a hernia in both sides of the child.

If present, they can be treated surgically together with a small surgical incision and less trauma. The chances of recurrence after the two surgeries are similar, about 2/1000.

Is the operation method of indirect inguinal hernia in children and adults the same?

Not the same. Pediatric hernia generally only requires high ligation of the hernial sac neck (like tying open sock mouth). Preschool children and large hernias can be treated according to modified surgical methods for adults (strengthening the anterior wall of the inguinal canal and making repairs).

What preparations need to be done before indirect inguinal hernia surgery?

Routine preparations before surgery require relevant examinations, including blood tests (routine blood tests, liver and kidney functions, blood glucose, coagulation functions, and a complete set of hepatitis B), routine urination and defecation, chest radiograph, electrocardiogram, groin and scrotal B-scan. For children under one year old, cardiac B-scan is also recommended.

Does infantile hernia postoperative need use antibiotic?

Antibiotics are not normally required.

Antibiotics can be used prophylactically once for hernias. In the case of an incarcerated hernia, the physician must decide which grade of antibiotic to use based on the damage to the hernia contents.

Is it necessary to have an operation immediately if an incarcerated inguinal hernia occurs?

It is generally believed that manual reduction can be considered only if there is no manifestation of intestinal necrosis within 4–6 hours after the operation is performed. Elective surgery can be performed 2–3 days after the successful reduction. Emergency surgical treatment should be performed after 4–6 hours or if manual reduction fails.

When an incarcerated inguinal hernia occurs, which conditions require immediate surgical treatment?

  • The incarceration time exceed 4 to 6 hours.
  • The child was obviously in poor spirit, with fever, hematochezia, and dehydration.
  • Neonatal incarcerated hernia: The exact time of onset cannot be clarified, and the intestinal necrosis rate of neonatal incarcerated hernia is high.
  • Female incarcerated hernia: The incarceration of ovary and fallopian tube is not easy to reset.
  • Intestinal injury or perforation cannot be ruled out in children with unsuccessful manual reduction or after multiple manual reductions.

Can incarcerated inguinal hernia undergo minimally invasive abdominal surgery?

It should be judged according to the specific situation of the child. The laparoscope can observe under direct view that the contents of the hernial sac are pushed back into the abdomen, and can more clearly see whether there is necrosis, perforation, etc. in the intestine. For intestinal resection, the intestine can be removed by lifting the intestine out of the abdominal cavity through the incision made in the arc shape of the navel.

Can recurrent indirect inguinal hernia still undergo laparoscopic surgery?

The answer is yes. However, it is still necessary to ask the doctor to comprehensively consider the specific situation and specific analysis in combination with the age of the child and the size of the hernia.

Life

What Should Patients With Indirect Inguinal Hernia Pay Attention To In Life?

Will indirect inguinal hernia affect fertility?

General indirect inguinal hernia does not affect fertility.

However, if the indirect inguinal hernia progresses to an incarcerated hernia, fertility will be affected when the contents of the hernia in girls are ovaries, and testicular necrosis may occur in boys, which also affects fertility.

You can imagine, just like your feet in your socks, your ankles will become tighter and tighter. The feet in your socks and the things that are crushed by your feet may all die.

Can you move normally after indirect inguinal hernia surgery?

You can move normally after the operation. Children's daily activities are generally not affected, but strenuous activities (such as running, high jump, diving, etc.) should be avoided for 3 months.

What are the precautions for indirect inguinal hernia after surgery?

Postoperative care should be taken to reduce the factors that increase the intra-abdominal pressure, such as chronic cough, constipation, and lower urinary tract obstruction, which should be treated and controlled in time.

Can you eat immediately after reduction of an incarcerated inguinal hernia?

Generally do not take food immediately (including drinking water). Observe for at least 6–8 hours after manual reduction. Pay special attention to the presence of abdominal pain and abdominal stiffness. If there is no water available and no discomfort, take food to avoid delayed intestinal perforation and intestinal necrosis.

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