Inguinal hernia is a mass formed by intra-abdominal organs or tissues pushing and squeezing the abdominal wall and protruding to the body surface through the weak points or pores of the abdominal wall.
I. Etiology Clinical manifestations
1. Congenital inguinal hernia
During embryonic development, in the early embryonic stage, the testis is located behind the peritoneum next to the 2nd-3rd lumbar vertebrae, and then it gradually moves downward, pushing the peritoneum forward near the inguinal ring and forming the sheath, with the testis immediately behind the peritoneal sheath and gradually descending to the scrotum. Under normal development, the sphincter begins to atrophy shortly after birth, except for the formation of the intrinsic sheath near the testis, and the rest of the sphincter is completely closed to form a strip of tissue. The right testis descends slightly later than the left and the sphincter is also closed later. Therefore, right inguinal hernia is more common.
2. Acquired inguinal hernia
The pathogenesis is completely different than that of congenital ones, when the peritoneal sphincter is already atretic and a new hernial sac is formed via the groin.
The main manifestation is the appearance of a reducible mass in the inguinal region soon after birth, mostly at 2-3 months of age, but also as late as 1 to 2 years of age, usually when the patient is standing, walking, coughing or crying, sometimes extending to the scrotum or labia. The main feature of refractory hiatal hernia is that the mass cannot be completely retracted. The cecum that slips out of the abdominal cavity often adheres to the anterior wall of the hernia sac. In addition to incomplete retraction of the hernia mass, clinical symptoms such as dyspepsia and constipation also occur.
Treatment options
Surgery is the basic method of treatment for pediatric inguinal hernia. Pediatric inguinal hernia is caused by incomplete closure of the sphincter, and there is still a chance of delayed closure of the sphincter within 6 months, so it is generally advisable for children with inguinal hernia to be operated after 6 months. Therefore, children with inguinal hernia should be operated after 6 months.
2. Non-surgical treatment can be done by hernia belt if serious diseases are not suitable for surgical treatment, but the position of the belt should be adjusted at any time during the treatment to prevent the hernia contents from dislodging under the belt and becoming entrapped. The hernia belt is not recommended for infants and children (it can cause damage to the spermatic cord). Injection treatment methods are not recommended due to the high number of complications.
Contraindications:
1, children with chronic coughing abdominal tumors ascites and constipation causing increased abdominal pressure should be treated for the primary disease before surgical treatment of inguinal hernia.
2. Hernia belt treatment may be considered if the child has severe congenital malformations that cannot tolerate surgery. Intussusception hernia: In principle, an intussusception hernia should be operated urgently to prevent necrosis of the intestinal canal, but in a few cases:
(1) For example, if the incarcerated hernia is short within 3-5 hours, the local pressure pain is not obvious, there is no abdominal pressure pain and peritoneal irritation symptoms, it is estimated that strangulation is still formed, especially in children, because the tissue around the hernia ring is elastic, it can be tried to reset.
(2) A huge hernia with a long history is estimated to have a large abdominal wall defect and a relaxed hernia ring. After retraction, repeated close observation for 24 hours should be made to note the presence of abdominal pain, abdominal muscle tension and blood in the stool, and also to note whether the intestinal obstruction has been lifted.
Drug treatment
Pre-operative medication, scopolamine is injected 30 minutes before surgery to prepare for anesthesia, and it is normal to have a flushed face, rapid heart rate, dry mouth and lips after injection.
Postoperative precautions
1. Keep the bed sheet and cover clean and dry. Keep the incision clean and dry, and do not touch the incision with your hands. Pay attention to the change of body temperature if there is fever and report to the nurse in time.
2, diet, diet should avoid spicy stimulation, light and easy to digest, avoid fried flatulent food, eat more high-protein, high vitamin, rich nutritious food, eat more fresh vegetables and fruits, promote intestinal peristalsis, prevent constipation such as bloating constipation should use lactulose or the use of open cork, help defecation. Three activities and rest, lying flat for 7-10 days after surgery, if necessary, use diapers or dingus to hold up the scrotum, do not sit up or stand up too early, so as not to swell the scrotum or affect the healing of the incision, swelling should be reported to the doctor to avoid increasing abdominal pressure, keep the bowels open, prevent colds and coughs, avoid strenuous crying, avoid strenuous activities for 3 months.