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Abstract: An inguinal hernia is a mass of abdominal organs protruding outward through a defect in the inguinal region. In this case, the patient came to the clinic with a reducible mass in the left inguinal region, and the diagnosis of inguinal hernia was confirmed after physical examination and imaging. After inpatient surgery and pharmacological treatment, the patient was discharged in good general condition, resumed normal diet, the incision healed well, and the mass in the left inguinal region disappeared.
Basic information】Male, 64 years old
Type of disease】inguinal hernia
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】June 2021
Treatment plan】Surgical treatment (high ligation of hernia sac under combined lumbar and rigid anesthesia + tension-free hernia repair) + medication (Ceftriaxone sodium for injection, glucose injection, cefuroxime tablets)
Treatment period】7 days of inpatient treatment, 3 months of postoperative outpatient review
Results】The patient is in good general condition, resumed normal diet, the incision is healing well, and the swelling in the left groin area disappeared
I. Initial interview
The patient is an elderly male, 64 years old, with a reversible left inguinal swelling for 2 years, and a swelling in the left inguinal region, about the size of a “fingernail”, was found after physical labor 2 years ago. Afterwards, the swelling appeared intermittently and gradually increased in size, and now it is about the size of a “ping-pong ball”, which can descend into the scrotum at times. The patient underwent a specialist examination, and a 3.0 cm x 1.5 cm sized swelling was seen in the left inguinal region after increasing abdominal pressure, with no redness or swelling around the swelling, no fluctuating sensation, soft texture, no pressure pain, and the swelling disappeared after lying down. There was no pressure pain in the whole abdomen, no rebound pain and muscle tension, drum sound on percussion of the whole abdomen, and 4-5 bowel sounds/min on auscultation. Through the patient’s symptoms and physical examination, a preliminary diagnosis of inguinal hernia was made, and hospitalization for imaging and surgical treatment was recommended.
II. Treatment history
The patient was admitted to the hospital for routine history questioning and physical examination, and was informed that the patient had no history of heart disease, hypertension, diabetes mellitus, and no history of acute or chronic infectious diseases such as hepatitis, typhoid, tuberculosis, etc. After that, routine blood, urine, electrocardiogram and orthopantomogram and inguinal ultrasound were performed for the patient. After the patient and her family agreed, a high ligation of the hernia sac + tension-free hernia repair was performed under combined lumbar and rigid anesthesia. The patient was fasted from food and water before the operation, and the operation was performed prophylactically with ceftriaxone sodium for injection 0.5 hours before the operation. The patient was sandbagged and pressurized at the incision, and returned to the ward for 6 hours postoperatively, with glucose infusion for rehydration and cefuroxime tablets for anti-inflammatory treatment. The incision was changed 2 days after surgery, and slight redness and exudate were found in the incision. The patient was in good general condition 7 days after surgery, resumed normal diet, the incision healed well, and the swelling in the left inguinal region disappeared, and was discharged from the hospital.
III. Treatment effect
After 7 days of hospitalization, the patient’s incision was well aligned, without redness, oozing, cracking and large subcutaneous bruises, resumed normal diet, good healing of the incision and disappearance of the swelling in the left inguinal region, and met the discharge criteria, so he was discharged from the hospital. Since the wound was closed with absorbable sutures, no stitch removal was required, and the patient was instructed to review the wound on an outpatient basis for 3 months after surgery.
IV. Notes
We are glad that the patient was cured after treatment, but after discharge, the patient should pay attention to the following points.
1. Avoid heavy physical labor and standing for a long time, avoid lifting heavy objects, and try to reduce the factors that increase intra-abdominal pressure, because the increase in abdominal pressure may easily lead to the onset of inguinal hernia.
2, pay attention to dietary regimen, pay attention to eat more food rich in dietary fiber, keep the bowels open, reduce the pressure in the abdominal cavity.
If you find a swelling in your groin, it may be a recurrence of inguinal hernia, and you should seek medical attention for a clear diagnosis in time.
V. Doctor’s insight
In this case, the patient was relatively old and stressed, and her attitude towards treatment was not very positive at the initial consultation, and her bad mood was gradually relieved only after the family and doctor’s guidance. In fact, inguinal hernia is a common disease and is not very serious, so patients should not avoid treatment. The most direct cause of this disease is the weakening of the abdominal wall muscles or the increase of pressure in the abdominal cavity due to various reasons, such as prolonged constipation, lifting heavy objects, etc., which causes the contents of the abdominal cavity to bulge out through the weakness of the abdominal muscle and form an inguinal hernia, which requires surgery to heal.