Extra-abdominal hernias that occur in the inguinal region are collectively known as inguinal hernias and are the most common type of hernia. Inguinal hernias can be distinguished from straight and hiatal hernias. A straight hernia protrudes from the straight hernia triangle. Oblique hernias protrude from the inguinal canal.
I. Diagnosis
1. Clinical manifestations
(1) The earliest manifestation is a feeling of swelling in the inguinal region, accompanied by a lump that appears from time to time in this region. The mass is characterized by the appearance of the mass when the abdominal pressure increases and its disappearance after lying down or after manual rejection.
(2) Afterwards, the mass in the inguinal region gradually increases in size and may enter the scrotum. The mass disappears after lying down or after manual retraction.
(3) Further development may result in pain in the inguinal region.
2.Signs
(1) The swelling can be palpated in the inguinal region. In the early stage, the swelling is small, and the patient can cough and feel the impact at the swelling.
(2) When the swelling is large, it can be returned manually.
(3) When the swelling cannot be retracted, there may be pressure pain in this area.
3.Auxiliary examination
(1) Laboratory examination: generally, there is no specific performance.
(2) B-type ultrasound examination: hernial sac and hernial contents can be detected in the inguinal region, and fluid can be seen with traffic syringomyelia.
(3) CT examination: hernia sac and hernia contents can be detected in the inguinal region, and fluid can be seen in the presence of a communicating syringomyelia.
(4) Peritoneal imaging: for smaller hernias or occult hernias, the hernial sac and or hernial contents can be seen in the inguinal region on peritoneal imaging.
II. Diagnostic points
1. The earliest manifestation in the medical history is a feeling of swelling in the inguinal region, accompanied by a lump that appears from time to time in this region. The mass is characterized by the appearance of the mass when it is enlarged by standing, and disappears after lying down or after manual rejection.
2. In patients with a long history, the mass in the inguinal region gradually increases in size and may enter the scrotum. The mass disappears after lying down or after manual retraction, and in some cases it cannot be retracted and becomes a difficult hernia.
3. If the pain in the inguinal region is accompanied by acute abdominal manifestations, and the mass does not disappear after flat lying or manual retraction, then intussusception occurs, paying particular attention to history taking and inguinal region examination in case of acute abdomen.
4. For inguinal masses that cannot be identified, B-type ultrasound examination, CT examination and peritoneal imaging are used to clarify the diagnosis.
Differential diagnosis
1. Testicular syringomyelia
This disease mainly manifests as a mass in the scrotum that cannot be returned, and its upper boundary can be clearly palpated in the scrotum. Most of the testes are surrounded by fluid in the sphincter and the parenchymal testes cannot be palpated. The transillumination test is positive.
2.Traffic sphingomyelomeningocele
The shape of the mass is similar to that of testicular syringomyelia, and the transillumination test is also positive. The biliary effusion mass does not exist in the morning when waking up, and slowly appears after a period of activity, and the mass gradually shrinks again when lying down or squeezing the mass.
3.Spermatic sphincter effusion
The mass is usually small, located in the inguinal canal, smooth and cystic to touch, without coughing and shocking sensation, and the characteristic performance is that the mass moves when pulling the ipsilateral testicle.
4.Cryptorchidism
The mass is located in the inguinal region, and is a testicle with incomplete descent, with no shocking sensation on palpation.
5. Acute intestinal obstruction
An incarcerated hernia can be accompanied by acute intestinal obstruction, but the diagnosis of intestinal obstruction should not be satisfied and the presence of the hernia should not be ignored.
6.Differentiation between straight hernia and hiatal hernia
(1) Direct hernia: Most commonly seen in the elderly. The herniated triangle does not protrude into the scrotum and has a wide hemispherical base.
(2) Hiatal hernia: mostly seen in adolescents. The herniated hernia may enter the scrotum by protruding from the inguinal canal, is elliptical or pear-shaped with a stalked upper part, and the returned hernia mass does not protrude from the deep ring mass.