Scrotum hernia is a pathological exit of various abdominal organs into the inguinal canal and scrotum. The disease affects males aged 50 to 55 years. But hernias are formed in children. Most often, folds of the visceral peritoneum or bladder exit through the hernia gate.
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 bulging of a thin serous membrane covering the inner walls of the abdominal cavity instead of the inner inguinal ring. By the end of the early fetal period, the peritoneal process moves with the testicle into the scrotum through the inguinal canal. By the beginning of the neonatal period, the process overgrows in 75% of children.
Sometimes the explication or the length of the closure of the protrusion of the serous membrane is incomplete. Inguinal-scrotal hernia in childhood is a consequence of an overgrown vaginal process.
There are 2 subspecies of scrotal protrusion.
- Congenital testicular - hernial contents extend right up to the testicle and the bottom of the scrotum.
- Funicular, or funicular - partial peritoneal obliteration in the distal part. This species makes up about 90% of inguinal bulges in children.
The article presents photos of a scrotal hernia in a child (x-ray) and an adult.
Development reasons
There are a lot of conditions conducive to the formation of inguinal protrusion. The reasons are conditionally divided into pathogenetic and external.
Physiological mechanisms that determine the formation of scrotal hernia:
- Congenital abnormal discharge of organs.
- Hereditary addiction.
- 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.
- Muscle tone reduction due to paralysis.
- With the front location of the abdominal wall, it experiences strong pressure, which contributes to the development of a hernia.
External causes.
- Regular heavy physical exertion.
- Passive lifestyle.
- Overweight.
- Surgery on the abdomen.
- Abdominal injuries.
With 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 scrotal hernia in men is the presence of swelling in the groin, which disappears when manually repaired or while taking a lying position.
- Non-disappearing swelling in places typical for the formation of protrusion.
- When you press down on the site of localization or coughing, a loud sound resembling a blow to the drum is heard.
- Pain in the area of hernia exit, especially when lifting weights.
- Urination disorders.
Patients often complain of belching, bloating, and nausea. With infringement of the hernia, the abdominal and inguinal areas can become inflamed. Also, with such a clinic, intestinal obstruction and fecal congestion with intestinal obstruction (coprostasis) often develops.
Diagnostic Methods
Due to the fact that the inguinal-scrotal hernia in a child occurs in the womb, the surgeon examines it in the maternity hospital without fail. 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 occur characteristic of a scrotal hernia, men should visit a urologist. Using the information obtained through a survey and visual assessment, the doctor establishes a preliminary conclusion. To confirm the diagnosis, additional diagnostic measures are performed.
- Visually determine the size of the scrotum, the degree of omission, asymmetry.
- Evaluate the possibility of manual adjustments.
- Listen to the sound at the location of the hernia that occurs when you click on the affected area.
- Feel the hernial sac.
- On palpation, the presence of enlarged lymph nodes is detected.
Additional information is obtained using instrumental diagnostic methods:
- Ultrasound examination of the scrotum.
- X-ray with barium of the abdominal organs. The examination reveals adhesions, cicatricial modifications of the walls of the hernial sac and intestinal loops.
- Puncture of a hernial sac is performed if a cyst of the spermatic cord is suspected.
Scrotum hernia in children
In boys, the residual phenomenon of the testicle moving into the scrotum (vaginal process of the peritoneum) covers the inguinal canal from the inside. In girls, such an education in medicine is called the Nuka diverticulum. By the time a child is born, the process closes due to tissue overgrowth (obliteration). In some cases, infection of the abdominal organ does not occur completely. Thus, various pathologies develop: funicularis, dropsy of the testicle, inguinal and scrotal hernia. Thus, most of the inguinal protrusions in children are congenital defects of the formation.
All inguinal and scrotal hernias in small patients are divided depending on the complex of clinical symptoms:
- Uncomplicated. Hernias are not very large in size, having no predisposition to infringement, operate on planned indications, after the child reaches two years. Large protrusions and prone to compression of the peritoneal organs are treated surgically after 6 months.
- The irreducible are peculiar to girls under 1 year old. The operation is carried out according to urgent indicators.
- Restrained. The main manifestation of such a hernia is an insufficient blood supply to the abdominal organ in the hernia gate, which can cause necrosis of the intestinal tissues.
Recently, doctors have used the laparoscopic method to treat inguinal-scrotal hernias.
The effectiveness of conservative therapy
Surgical operation of scrotal hernia is replaced by conservative treatment only at certain locations, the patient refuses it. Also, surgery is not performed if there are contraindications.
- Early childhood.
- The presence of infections.
- Dermatitis.
- Cavernous pulmonary tuberculosis.
- Malignant tumors.
With senility, the feasibility of a surgical operation is often not justified. Conservative treatment includes: the use of drugs that reduce symptoms, wearing a bandage, injecting a sclerotherapy solution.
Surgical treatment
Gernioraphia 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 abdominal region adjacent to the thigh.
The surgical strategy is determined based on the stage of the disease, anatomical features and individual wishes. The operation is carried out mainly under local anesthesia. The surgeon’s action algorithm is almost the same as with any inguinal hernia surgery. The only difference in manipulation around the spermatic cord is that its damage 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. Duration of hospital stay is different: some patients are discharged after a week, others - after 14 days. But usually patients are observed in a medical facility for at least five days. This time is enough for the postoperative course of taking antibiotics, assessing the dynamics of recovery. 24-hour medical monitoring allows you to quickly respond to complications.
After discharge, in order to avoid relapse and unpleasant consequences, men should follow certain recommendations:
- Exclusion of sports.
- Limitations of 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 obstructed and insufficient bowel movements or prolonged coughing.
- Compliance with a diet that helps to get rid of extra pounds.
- If a man smokes, it is advisable to give up this addiction.
Quick recovery is facilitated by special exercises on the lower abdominal muscles. Effectively fixes the muscles of the abdominal wall wearing a bandage. It is invisible to others and avoids undesirable manifestations. The bandage is worn after surgery and for preventive purposes.
Forecast
The results of timely treatment of scrotal hernia in men are in most cases favorable. Lethal outcomes at this pathology clinic are quite rare and make up 0.04%. The number of complications after surgery is also not large and, according to statistics, does not exceed 4.9%. However, scrotal protrusions cannot be considered a non-dangerous disease, since approximately 19.5% of them are infringed. Patients are limited in physical activity, sports.
After hernia repair, patients are considered incapacitated for 30 calendar days. If the operation was carried out at the conclusion of a medical advisory commission, people are limited in working capacity for a period of six months. If these recommendations are not followed, there is a risk of relapse. Men of military age receive a reprieve from the army for the period of treatment and rehabilitation.
ethnoscience
When treating by any method other than surgical intervention, there is a risk of infringement of the inguinal-scrotal hernia in men. Therefore, the effectiveness of alternative treatment methods 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 incompetence, their actions can lead to serious complications.
Preventive actions
In order not to have to treat scrotal hernia, it is necessary to prevent the disease. Scheduled examinations are of great importance - early detection of pathological protrusion allows for non-surgical therapy.
Therapeutic physical training complex, which includes exercises for the limbs and torso, is prescribed not only for the purpose of prevention, but already the day after hernia repair.
Inguinal-scrotal hernias are amenable to therapy, most importantly, consult a doctor in a timely manner. After eliminating the pathological protrusion in the inguinal region, men continue to live a familiar life.