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Abstract: This patient, a 54-year-old uncle, complained of a reversible swelling in the right inguinal region with no obvious cause six months ago, purchased a hernia belt on his own and used it for more than 2 months, and the swelling gradually increased in size in the last month, so he came to our hospital for consultation. He was diagnosed as inguinal hernia and underwent tension-free repair of right inguinal hernia under local anesthesia.
Basic information】Male, 54 years old
Type of disease】inguinal hernia
Hospital】Tianjin Fifth Central Hospital
Consultation time】April 2022
Treatment plan】Surgical treatment (tension-free repair of right inguinal hernia) + intravenous infusion (ceftriaxone sodium for injection)
Treatment period】3 days in hospital
Effectiveness of treatment] The abdominal swelling disappeared, the swelling in the right inguinal region subsided, and the condition improved.
I. Initial consultation
The patient complained that more than half a year ago a reducible swelling in the right inguinal region appeared without obvious cause, with a size of about 4×3 cm, accompanied by intermittent swelling, no redness, swelling and pain, and the swelling bulged after prolonged standing and walking without descending into the scrotum, and could be completely retracted into the abdominal cavity when lying down. The patient bought a hernia belt on her own and used it for more than 2 months. In the past 1 month, the swelling in the right inguinal region gradually increased in size, accompanied by right lower abdominal cramping and discomfort. Ultrasound suggested: right inguinal hernia. On examination: a mass of about 4×3 cm in size could be palpated in the right inguinal region, with a soft texture, not descending into the scrotum, without pressure pain, and could be returned to the abdominal cavity by pressure.
Figure 1 Ultrasound findings
II. Treatment history
Combining the patient’s symptoms, physical examination and ultrasound findings, the diagnosis of right inguinal hernia was made clearly, and preoperative laboratory tests were completed. The right inguinal hernia was repaired tension-free under local anesthesia, and the hernia sac was found during the operation, followed by separation of the hernia sac from the spermatic cord, dissection of the hernia sac, complete hemostasis of the distal hernia sac, freeing the proximal hernia sac to a high position, and the hernia sac was located on the lateral side of the subabdominal vessels, which was confirmed to be a hiatal hernia. The operation went smoothly. After the operation, the patient was given local pressure for 24 hours and restricted to bed for 48 hours, while the patient was given anti-infection treatment with ceftriaxone sodium for injection.
III. Treatment effect
After the operation, the patient’s inguinal swelling disappeared without pain and discomfort. Since the patient was operated under local anesthesia, the patient’s diet was not affected after the operation and he could eat normally without oral medication. The surgical wound was 4 cm long, with intradermal sutures, and no suture removal was required. After 3 days of hospitalization, the patient’s incision was initially healed without infection, and the patient was discharged without adverse reactions during medication treatment.
IV. Notes
We are glad that after surgical treatment, the patient’s inguinal hernia repair was perfected. Tension-free repair requires built-in artificial patch to repair the defect, and it takes some time for the patch and tissue to adhere after the repair, and the local stimulation of the operated area needs to be reduced during the adduction phase, with the following main attention
1.Basic daily activities are not affected, but avoid cycling and repeated squatting for 3 months, and minimize factors that increase abdominal pressure in daily life, such as constipation, difficulty in urination, heavy lifting and long-term coughing, etc., and treat any of the above conditions promptly.
2, pay attention to keep the incision dry and clean, 1 month after surgery routine outpatient review, check the recovery, patch repair surgery effect is exact, very few recurrence after surgery, discomfort follow-up.
V. Personal insight
The patient in this case is a middle-aged male and belongs to the population with a high prevalence of inguinal hernia. The formation of inguinal hernia is age-related, and as the structure of the inguinal canal tends to relax with age, the intra-abdominal tissues are more likely to herniate, which increases the prevalence of hernia. Inguinal hernia usually presents as a reversible swelling in the inguinal region, i.e., a protrusion in the standing position that disappears when lying down, and the accompanying symptoms may be cramping and swelling as in the patient in this article.
Once formed, an inguinal hernia cannot heal itself and will gradually increase in size over time, and once stuck pressure occurs and cannot be recovered, an incarcerated hernia can occur, which is characterized by significant pain and a swelling that does not disappear after lying down. It can lead to intestinal necrosis with serious consequences, therefore, inguinal hernia should be treated early once diagnosed.