Scrotal hernia is a pathological protrusion of various abdominal organs into the inguinal canal and scrotum. The disease affects males aged 50 to 55 years. But hernias also form in children. Most often, the folds of the visceral peritoneum or the bladder exit through the hernial orifice.
Etiopathogenesis of hernia and its types
The mechanism of occurrence and development is the non-obliteration of the blind protrusion of the peritoneum. The vaginal process appears in the fetus in the womb at the 12th week of development. It is a protrusion of a thin serous membrane covering the internal walls of the abdominal cavity instead of the internal inguinal ring. By the end of the early fetal period, the process of the peritoneum moves with the testicle into the scrotum through the inguinal canal. By the beginning of the neonatal period, the process is overgrown in 75% of children.
Sometimes the explication or length of the closure of the protrusion of the serous membrane is incomplete. Inguinal-scrotal hernia in childhood is a consequence of a non-overgrown vaginal process.
There are 2 subspecies of scrotal protrusion.
- Congenital testicular - hernial content extends all the way to the testicle and scrotal floor.
- Funicular, or cord - obliteration of the peritoneum is partial in the distal part. This type accounts for about 90% of inguinal bulges in children.
The article presents photos of a scrotal hernia in a child (X-ray) and an adult.
Reason for development
There are a lot of conditions that contribute to the formation of an inguinal protrusion. Causes are conditionally divided into pathogenetic and external.
Physiological mechanisms that determine the formation of scrotal hernia:
- Congenital pathological protrusion of organs.
- Hereditary tendency.
- Individual features of anatomy.
- Diseases that increase intra-abdominal pressure: pancreatic necrosis, colitis, peritonitis, irritable bowel syndrome.
- Stagnation of intestinal contents as a result of developed pathologies: helminthic invasions, intestinal diverticula, tumor processes.
- Weakening of the muscular apparatus of the abdominal wall.
- Reduced muscle tone due to paralysis.
- When the abdominal wall is in the anterior position, it experiences strong pressure, which contributes to the development of a hernia.
External causes.
- Regular hard physical activity.
- Sedentary lifestyle.
- Overweight.
- Abdominal surgery.
- Abdominal injury.
Swith age, there is a weakening of the abdominal wall, muscle tone, this is also a predisposing factor in the formation of protrusion.
Symptoms
The main characteristic manifestations are observed at the site of the pathology. But some symptoms may be a sign of other pathologies developing in the groin or abdominal cavity. Therefore, for any manifestations, you should seek the advice of a medical expert.
- One of the main signs of a scrotal hernia in men is the presence of swelling in the groin, which disappears with manual reduction or during the supine position.
- Non-disappearing swelling in places typical for the formation of a protrusion.
- When pressing on the localization site or coughing, a loud, drum-like sound is heard.
- Pain in the area of the hernia, especially when lifting weights.
- Urinary disorders.
Patients often complain of belching, bloating, and nausea. When a hernia is incarcerated, the abdominal and groin areas can become inflamed. Also, with such a clinic, intestinal obstruction and fecal stasis with intestinal blockage (coprostasis) often develop.
Diagnostic methods
Due to the fact that an inguinal-scrotal hernia in a child occurs in the womb, a surgeon must examine him even in the maternity hospital. Children with pathology are registered and monitored for their condition. With a stable course of the disease without complications, small patients are operated on.
If symptoms of a scrotal hernia occur, men should see a urologist. With the help of information obtained by questioning and visual assessment, the doctor establishes a preliminary conclusion. Additional diagnostic measures are taken to confirm the diagnosis.
- Visually determine the size of the scrotum, the degree of prolapse, asymmetry.
- Evaluate the possibility of manual insertion.
- Listen to the sound at the location of the hernia, which occurs when you press on the affected area.
- The hernia sac is felt.
- When palpation reveals the presence of enlarged lymph nodes.
Additional information is obtained using instrumental diagnostic methods:
- Ultrasound examination of the scrotum.
- X-ray with barium of the abdominal organs. Examination reveals adhesions, cicatricial modifications of the walls of the hernial sac and intestinal loops.
- Puncture of the hernial sac is performed if a cyst of the spermatic cord is suspected.
Scrotal hernia in children
In boys, the residual phenomenon of the transfer of the testicle into the scrotum (the vaginal process of the peritoneum) covers the inguinal canal from the inside. In girls, such an education in medicine is called Nook's diverticulum. By the time the child is born, the process closes due to tissue overgrowth (obliteration). In some cases, infection of the abdominal organ does not occur completely. This is how various pathologies develop: funicolocele, dropsy of the testicle, inguinal and scrotal hernia. Thus, most of the inguinalprotrusions in children - congenital defects in the formation.
All inguinal and scrotal hernias in young patients are divided depending on the complex of clinical symptoms:
- Uncomplicated. Hernias are not very large in size, do not have a predisposition to infringement, they are operated on according to planned indications, after the child reaches two years of age. Large protrusions and peritoneal organs prone to squeezing are treated with surgery after 6 months.
- Irreducible are characteristic of girls under 1 year old. The operation is carried out according to urgent indicators.
- Injured. The main manifestation of such a hernia is insufficient blood supply to the abdominal organ in the hernial orifice, which can cause necrosis of intestinal tissues.
Recently, doctors have been using the laparoscopic method to treat inguinal-scrotal hernias.
Effectiveness of conservative therapy
Surgical operation of scrotal hernia is replaced by conservative treatment only in certain localizations, the patient refuses it. Also, surgery is not performed if there are contraindications.
- Early childhood.
- Presence of infections.
- Dermatitis.
- Cavernous pulmonary tuberculosis.
- Malignant tumors.
With senile infirmity, the expediency of a surgical operation is often not justified. Conservative treatment includes: use of drugs that reduce symptoms, wearing a bandage, injections of a sclerosing solution.
Surgical treatment
Herniorrhaphy is the only effective method of treating pathological protrusion of organs. The only, but rather serious, complication after inguinal-scrotal hernia surgery is the development of pain in the lower part of the abdominal region adjacent to the thigh.
Surgical strategy is determined based on the stage of the disease, anatomical features and individual wishes. The operation is performed mainly under local anesthesia. The algorithm of the surgeon's actions is almost the same as in any operations of inguinal hernias. The only difference in the manipulation around the spermatic cord is that damage to it threatens infertility.
Recovery period
The specifics of the course of the rehabilitation period after scrotal hernia surgery depends on the nature of the surgical intervention, the likelihood and degree of complications, and the patient's well-being after anesthesia. The terms of stay in the hospital are different: some patients are discharged after a week, others after 14 days. But usually patients are observed in a medical institution for at least five days. This time is sufficient for the postoperative course of antibiotics, assessment of the dynamics of recovery. 24-hour medical supervision allows you to quickly respond to complications.
After discharge, in order to avoid relapse and unpleasant consequences, men must follow certain recommendations:
- Exclude sports.
- Restrictions on physical activity.
- Abstinence from sexual activity. The duration of this period is determined by the doctor.
- Prevention and, if necessary, treatment of diseases associated with difficult and insufficient bowel movements or prolonged cough.
- Following a weight-loss diet.
- If a man smokes, it is advisable to give up this addiction.
Special exercises for the lower abdominal muscles contribute to rapid recovery. Effectively fixes the muscles of the abdominal wall wearing a bandage. It is invisible to others and avoids unwanted manifestations. The bandage is worn after surgery and for preventive purposes.
Forecast
The results of timely treatment of scrotal hernia in men are favorable in most cases. Lethal outcomes in this clinic of pathology are quite rare and amount to 0.04%. The number of complications after surgery is also not high and according to statistics does not exceed 4.9%. However, scrotal protrusions cannot be considered a benign disease, since approximately 19.5% of them are infringed. Patients are limited in physical activity, sports.
After hernia repair, patients are considered disabled for 30 calendar days. If the operation was carried out at the conclusion of the medical advisory commission, people are limited in their ability to work for a period of six months. If these recommendations are not followed, there is a risk of relapse. Men of military age receive a deferment from the army for the period of treatment andrehabilitation.
Traditional medicine
When treated by any method other than surgery, there is a risk of infringement of the inguinal-scrotal hernia in men. Therefore, the effectiveness of the use of alternative methods of treatment is rather doubtful.
The use of various untested folk remedies can lead to the development of intestinal necrosis. Also, a rather dangerous method is the manual reduction of a hernia by healers. Almost all of these people have no medical education. Due to their incompetence, their actions can lead to serious complications.
Prevention measures
In order not to have to treat a scrotal hernia, it is necessary to carry out the prevention of the disease. Scheduled examinations are of great importance - early detection of pathological protrusion allows non-surgical therapy.
Therapeutic physical training complex, which includes exercises for the limbs and trunk, is prescribed not only for the purpose of prevention, but already the next day after hernia repair.
Inguinal-scrotal hernias can be treated, the main thing is to consult a doctor in a timely manner. After eliminating the pathological protrusion in the inguinal region, men continue to live their usual lives.
