Left-sided inguinal hernia in men: causes, symptoms and treatment

Causes of pathology

In rare cases, the pathology develops in early childhood and is a consequence of congenital anomalies.

☝ More often it bothers adult men and is formed against the background of connective tissue defects.

Causes of left-sided inguinal hernia in men:

• age-related changes associated with the aging of all tissues of the body;
• previous operations on the peritoneal organs - the risk increases due to incorrect tactics when applying sutures or the individual characteristics of the patient;
• sedentary lifestyle;
• obesity;
• physical labor associated with heavy lifting;
• chronic constipation.

Operations for inguinal hernia

At GMS Hospital, operations for inguinal hernias are performed using the non-tension hernioplasty technique, which makes it possible to efficiently eliminate the pathology, without complications or relapse of the disease. All operations, regardless of access technique, are performed using modern mesh endoprostheses (including 3D meshes).

Thanks to the use of modern surgical techniques and materials, you can end a hernia in just an hour and return to your normal lifestyle in just two weeks. Hernioplasty operations at the Hernia Treatment Center at GMS Hospital are performed by leading surgeons with many years of experience in successfully treating inguinal hernias, including complicated ones.

Clinical picture

❗ A characteristic symptom of a left-sided inguinal hernia in men is a round or oval formation in the left part of the groin area. It resembles a bump, but is soft to the touch. It may not cause discomfort or be accompanied by pain of varying degrees of intensity.

As a rule, discomfort increases with straining, prolonged coughing, and physical activity. Pain is associated with the presence of peritoneal organs in an anatomically incorrect position, as well as pinched nerve endings or squeezing blood vessels.

Additional symptoms of an inguinal hernia:

• frequent constipation;
• nausea, vomiting;
• heartburn, belching;
• gas formation;
• increased urge to urinate;
• burning in the groin area;
• swelling of the scrotum.

Classification of pathology

The division into types is based on the shape of the protrusion and its location. Doctors distinguish four groups, but a combination of several is possible.

1. Straight. Does not exceed 5-10 cm and does not affect the spermatic cord. It is rarely complicated.
2. Oblique. Reaches 30-40 cm. Captures the spermatic cord. Localized in the groin area and scrotum.
3. Supravesical. Small, rarely accompanied by pain. Formed directly above the pubic bone.
4. Sliding. A fragment of an organ, such as part of the bladder or intestines, passes through the opening of the connective tissue.

Advantages of tension-free hernioplasty

The indisputable advantage of tension-free hernioplasty is low trauma and complete elimination of the hernia without recurrence of the disease. The mesh implant is sutured under the aponeurosis so that the surrounding tissues and fascia are not injured. The advantages of the technique include:

• No trauma to surrounding tissues.
• There are no circulatory disorders in the mesh implantation area.
• No pain or discomfort when moving.
• Minimal recovery time.
• Hospital stay is 1-3 days.

The operation does not require long preparation and can be performed under any anesthesia (local, general).

Choice of treatment tactics

The approach to the treatment of left-sided inguinal hernia in men depends on the shape and stage of the protrusion.

1. Reducible . The initial stage when the protrusion can be eliminated on its own. The adhesive process has not begun. The pain doesn't bother me.
2. Irreversible . The hernial sac is connected to a layer of fatty tissue, so it cannot be reduced manually, but periodically changes in size.
3. Disadvantaged . The patient complains of sharp pain and feels tension in the hernia area.

With reducible protrusion, a wait-and-see approach is possible.

⚠ In other cases, surgery is needed - planned if you feel well or emergency if there is sudden pinching and complications.

Cost of treatment of inguinal hernia

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

Dear Clients! Each case is individual and the final cost of your treatment can only be found out after an in-person visit to a GMS Hospital doctor. Prices for the most popular services are indicated with a 30% discount, which is valid when paying in cash or by credit card. You can be served under a VHI policy, pay separately for each visit, sign an agreement for an annual medical program, or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge additional payments according to the current price list. Services are provided on the basis of a concluded contract.

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Treatment options

In the early stages, if there is a small painless protrusion, conservative treatment is possible, but it will not lead to a reduction in the size of the hernia, but will only slow down the rate of its development. Elimination of the bulge is only possible through surgery.

Conservative approach

Your doctor may recommend wearing a bandage to secure the abdominal organs. A compression bandage will help with physical activity or severe pain, but you cannot wear it all the time.

In addition to the bandage, moderate physical activity is indicated - exercise therapy, swimming, walking, as well as a diet that normalizes digestion.

It is necessary to exclude from the diet all foods that cause constipation and increased gas formation - legumes, cabbage, grapes, milk.

Surgical approach

Surgery for left-sided inguinal hernia in men is performed in two ways - open and laparoscopic. In both cases, general anesthesia is used.

✅ During hernioplasty, protruding fragments are not excised, but returned to the correct position. Only the area of ​​connective tissue with the defect and part of the subcutaneous fatty tissue must be removed.

Full name: Age: 05/25/1950 Marital status: single. Profession and place of work: ShPZ, turner. Address: Referred by: Date of admission to the clinic: Diagnosis of the referring preventive medical institution: inguinal hernia. Diagnosis upon admission: left-sided inguinal hernia. Clinical diagnosis: left-sided direct reducible inguinal hernia.

2. Subjective data.

Patient's complaints.

The patient complains of pain in the left groin area, as well as discomfort when walking.

History of the present illness.

He considers himself sick for about 4 years, when protrusions began to appear during physical activity in a vertical position of the patient and were reduced in a horizontal position. Notes the sudden onset of a hernia at the time of physical activity and its gradual development. Two weeks before hospitalization, he had a consultation with a surgeon at the 32nd city clinic and was sent for treatment to the hospital of the 9th City Clinical Hospital. Anamnesis of life.

Among the past diseases, acute respiratory infections will be noted. Denies any history of chronic diseases. Denies tuberculosis, diabetes mellitus, viral hepatitis, and venous diseases. He does not note any surgeries, injuries, or blood transfusions in the past. There is no allergic history. Hereditary history is not burdened. Occupational hazards: work involves heavy physical activity (lifting and moving heavy objects). Bad habits: smokes for about 30 years. Living conditions are satisfactory.

Conclusions from the anamnesis.

Based on the analysis of anamnesis data, predisposing factors to the development of an inguinal hernia can be detected: characteristic complaints, medical history, occupational hazards.

3. Objective research data.

General status.

The general condition of the patient is satisfactory, the position is active, conscious, clear, nutrition is normal. Body type is normosthenic, height 170 cm, weight 70 kg.

Skin and mucous membranes accessible to inspection.

The color of the skin and visible mucous membranes is pale pink, there is no pastiness or swelling. The hair is gray, brittle, hair growth is male-type. Nails unchanged. Skin turgor is within age norms. The degree of development of subcutaneous fat is moderate. There are no wounds, ulcers, or scars on the skin.

Lymphatic regional lymph nodes.

Regional lymph nodes with a diameter of 0.5 cm, are soft, painless, mobile, not fused with surrounding organs or with each other, as well as with the skin. The skin color over them is normal. Lymphatic vessels are normal.

Muscular system.

Muscle development is moderate, tone is good, muscle strength is within age norms, palpation and movement are painless. There is no atrophy.

Osteoarticular system.

Full range of joint movements, active and passive, painless. There is no deformation or deformation of the joints. The color and temperature of the skin over the joints is normal. There is no pain on palpation. The bones are painless on palpation, there is no curvature or deformation of the bones.

Neck area.

There are no pathological changes in the neck area. The thyroid gland is not palpable; upon palpation, the area of ​​the thyroid gland is painless.

Rib cage.

The chest is normosthenic, there is no chest deformation. Both halves of the chest are symmetrical, evenly participate in the act of breathing, auxiliary muscles do not participate in the act of breathing. There are no visible changes.

Respiratory system.

Abdominal breathing type. Breathing is rhythmic 16 times per minute. With comparative percussion of the lungs, sound is heard over all fields of the lungs. With topographic percussion, the boundaries of the lungs are within age norms. On comparative auscultation: vesicular breathing.

Circulatory organs.

The pulse in the radial, carotid, femoral, popliteal, posterior tibial and dorsal arteries of the foot is 76 times per minute, rhythmic, of moderate filling and tension, the same in symmetrical areas. Blood pressure in both arms is 130\90. There are no pathological pulsations of arteries and veins. “Caratida dance” and there is no venous pulse. Percussion borders of the heart are within normal limits. The auscultatory picture is unchanged.

Digestive organs.

There is no swelling or bleeding of the gums. Teeth sanitized. The tongue is wet and pink. The mucous membrane of the mouth and pharynx are pink, the tonsils are loose without purulent plugs or plaque, do not extend beyond the palatine arches, the mucous membrane of the pharynx is pink, the act of swallowing is not disturbed. The abdomen is of normal shape, not enlarged in volume, symmetrical. The subcutaneous vein network is not visible. The muscle tone of the abdominal wall is normal. On superficial palpation of the abdomen: the abdomen is soft and painless. There is no free fluid in the abdominal cavity. No pathology was found on deep palpation. On auscultation of the abdomen, peristalsis is normal. A chair is formed once a day. There are no visible protrusions in the area of ​​the liver and spleen. The liver and spleen are not palpable. Percussion examination of the borders of the liver and spleen is normal.

Genitourinary system.

The lumbar region is symmetrical, there is no swelling. The kidneys are not palpable, there is no pain on palpation. On percussion, the borders of the kidneys are normal. Pasternatsky's symptom is negative on both sides. The bladder does not rise above the womb and is not palpable. There is no swelling.

Nervous system.

The patient's consciousness is clear, behavior is adequate to the situation, the patient's orientation in space is not impaired.

Local status.

In the left groin area there is a hernial protrusion 2 by 3 cm, painless, reducible into the abdominal cavity. The external inguinal ring on the left is widened to 1.5 cm. On palpation, the hernial contents have an elastic consistency. The symptom of cough impulse is positive. Data from special research methods.

General blood test dated October 16, 2008 Red blood cells 4.2*1012\l. Hemoglobin 140 g/l. Leukocytes 9*109\l. band 1% segmented 69% lymphocytes 26% monocytes 2% eosinophils 2% Platelets 225*109\l. ESR 7 mm/hour Blood clotting 3 minutes. Blood group test dated November 1, 2008 Blood group B(III) Ph+

Biochemical blood test dated November 1, 2008 Protein 76 g/l Urea 3.7 mmol/l Bilirubin total 9 mmol/l ALT 14 mmol/l AST 26 mmol/l Na+ 146 mmol/l Ca+ 1.04 mmol/l K+ 4.9 mmol/l Cl+ 108 mmol/l General urine analysis dated 10/15/2008 Color – light yellow Specific gravity – 1010 Transparency – turbid Reaction – acidic Epithelium – single Leukocytes – single Salts – phosphates +++ Sugar – no Protein – no ECG dated 10/15/2008 Conclusion : sinus rhythm. ECG dated November 1, 2008 Conclusion: mild myocardial changes in the posterolateral region of the left ventricle. Stool analysis dated October 15, 2008 No eggworm was detected. Data from laboratory and instrumental studies are within normal limits.

4. Clinical picture.

The patient's main complaints were pain in the left groin area during physical activity, walking, as well as protrusion in the left groin area. Upon examination, there is a hernial protrusion of 2 by 3 cm in the left inguinal region, the external inguinal ring on the left is widened to 1.5 cm. Upon percussion of the hernial protrusion, a tympanic sound is detected (there is an intestine in the hernial sac). On palpation, the consistency of the hernial contents is elastic. In a horizontal position of the patient, we determine the reducibility of the hernia - the hernia is reducible. Possible complications: strangulated hernia.

5. Diagnosis, its rationale and differential diagnosis.

Based on the patient’s complaints, the collected medical history, and objective examination data, a diagnosis can be made: left-sided direct reducible inguinal hernia. A direct inguinal hernia should be differentiated from an oblique inguinal hernia, hydrocele, varicocele, and femoral hernia. An oblique inguinal hernia, unlike a direct one, is more common in childhood and middle age; it usually descends towards the scrotum and is one-sided. With an oblique inguinal hernia, the posterior wall of the inguinal canal is well defined, the direction of the cough impulse is felt from the side of the deep opening of the inguinal canal. The hernial sac passes through the elements of the spermatic cord, therefore, upon objective examination, thickening of the spermatic cord on the side of the hernia is noted. An irreducible inguinal hernia, causing an enlargement of the scrotum, becomes similar to a hydrocele. In this case, fluid accumulates between the layers of the testicular membrane and, as a result, the size of the scrotum increases. The difference between a hydrocele and an irreducible inguinal-scrotal hernia is that it has a round or oval rather than pear-shaped shape, a densely elastic consistency, and a smooth surface. The palpable formation cannot be distinguished from the testicle and its appendages. A large hydrocele, reaching the external opening of the inguinal canal, can be clearly separated from it by palpation. On percussion, the sound above the hydrocele is dull; above the hernia it can be tympanic. An important method of differential diagnosis is diaphanoscopy (transillumination). It is performed in a dark room using a flashlight held tightly to the surface of the scrotum. If the palpable formation contains a clear liquid, then it will have a red color when examined. The intestinal loops and omentum located in the hernial sac do not allow light rays to pass through. A varicocele is similar to an inguinal hernia, in which when the patient is in an upright position, dull arching pain appears in the scrotum and a slight increase in its size is noted. Upon palpation, you can detect a serpentine dilatation of the veins of the spermatic cord. Dilated veins easily collapse when pressure is applied to them or when the scrotum is lifted upward. It should be borne in mind that varicocele can occur when the testicular vein is compressed by a tumor of the lower pole of the kidney. Femoral hernias are the most commonly reported hernia that exits the abdominal cavity through the femoral ring. The hernial sac pushes the preperitoneal tissue and the Pirogov-Rosenmüller lymph node forward. Coming out from under the inguinal ligament, the hernia is located in the oval fossa medially from the femoral vein. Less commonly, a femoral hernia emerges between the femoral artery and vein. Femoral hernias are rarely large and are prone to strangulation.

6. Etiology and pathogenesis. Factors contributing to the formation of hernias can be divided into predisposing and producing. Predisposing factors include heredity, age (weak abdominal wall in children, atrophy of abdominal wall tissue in old people), gender (structural features of the pelvis and large size of the femoral ring in women, weakness of the groin area and the formation of the inguinal canal in men), degree of fatness ( rapid weight loss), abdominal wall trauma, postoperative scars, paralysis of the nerves innervating the abdominal wall. These factors contribute to weakening of the abdominal wall. Producing factors cause an increase in intra-abdominal pressure; these include heavy physical labor, difficult childbirth, difficulty urinating, constipation, and prolonged cough. An increase that contributes to an increase in intra-abdominal pressure may be single and sudden (heavy lifting) or frequent (cough). With acquired hernias, the hernial sac and internal organs exit through the internal opening of the canal, then through the external one (femoral canal, inguinal canal).

7. Treatment.

The main treatment method is surgery. The main purpose of the operation is plastic surgery of the inguinal canal. In case of direct hernias, plastic surgery of the posterior wall of the inguinal canal should be performed. This patient underwent surgery on November 2, 2008: hernia repair, Shouldes plastic surgery. After the operation, painkillers and antimicrobial agents were prescribed: Rp.: Sol. Analgini 50% 2.0 DS: intramuscularly 3 times a day.

Rp.: Sol. Papaverini 2% 2.0 DS: intramuscularly 3 times a day.

Rp.: Tab. Doxiclini 2 DS: 2 times a day.

8. Indications for surgery.

The presence of a left-sided hernia in a patient of significant size, a pronounced expansion of the external inguinal ring, the possibility of its strangulation, all of these are indications for surgical treatment of the hernia.

9. Selection and justification of the method of pain relief.

For this operation, the optimal method of pain relief is local anesthesia. The method of local neuroleptoanalgesia is used, which allows achieving sufficient pain relief and muscle relaxation in the area of ​​the surgical field, and also allows keeping the patient conscious during the operation.

10. Description of the operation. Operation No. 2275 02.11.2008 920-1040 Full name: Krainik Nikolai Konstantinovich Age: 53\56 years Gender: husband Operator: Second assistant: Type of anesthesia: local Diagnosis before surgery: left-sided inguinal hernia Diagnosis after surgery: left-sided direct reducible inguinal hernia Name of operation : Hernia repair. Plastic surgery according to Shouldis. Description of the operation: an incision was made above and parallel to the inguinal ligament to open the inguinal canal. The hernial sac was isolated, opened, bandaged, and cut off at the neck. Plastic surgery of the inguinal canal according to Shouldis. Layer-by-layer sutures, leaving a rubber graduate, bandage.

11. Disease prevention.

Adults need regular physical education and sports to strengthen both the muscles and the body as a whole. It is also necessary to limit physical activity, treat chronic diseases of the respiratory system, and stop smoking. Early identification of people suffering from hernias and performing operations before complications develop are of great importance.

12. Forecast.

The general prognosis for the patient’s life, health, and ability to work is satisfactory.

13. Course of the disease.

2.11.2008 Complaints of pain in the left groin area. The condition is satisfactory. Pulmo: normal. Pulse 70 per minute, rhythmic. Cor: normal. Hell 130\90. Stool and diuresis are normal. Purpose: Rp.: Sol. Analgini 50% 2.0 DS: intramuscularly 3 times a day.

Rp.: Sol. Papaverini 2% 2.0 DS: intramuscularly 3 times a day.

Rp.: Tab. Doxiclini 2 DS: 2 times a day.

4.11.2008 Condition is satisfactory. No complaints. Pulmo: normal. Pulse 70 per minute, rhythmic. Cor: normal. Hell 130\90. The abdomen is painless. Stool and diuresis are normal. Purpose: the same. 5.11.2008 Condition is satisfactory. No complaints. Pulmo: normal. Pulse 70 per minute, rhythmic. Cor: normal. Hell 130\90. The abdomen is painless. Stool and diuresis are normal. Purpose: the same.

14. Epicrisis.

Krainik Nikolay Konstantinovich, born in 1950\1953, entered the 9th City Clinical Hospital on November 1, 2008, 935-955, as planned. Diagnosis of the referral medical preventive institution: inguinal hernia. The patient underwent all the necessary laboratory and instrumental studies, the data of which were within the age norm. Based on the patient’s complaints, the collected medical history, and objective examination data, a diagnosis can be made: left-sided direct reducible inguinal hernia. Treatment was carried out: on November 2, 2008, an operation was performed: hernia repair, Shouldes plastic surgery, as well as drug therapy (analgin, papaverine, doxycycline). Discharged on November 8, 2008 with improvement. Recommendations are given: regular physical education and sports are necessary to strengthen both the muscles and the body as a whole. It is also necessary to limit physical activity, treat chronic diseases of the respiratory system, and stop smoking.

Bibliography.

1. Surgical diseases (Moscow 1995, M.I. Kuzina). 2. Practical guide to surgical diseases (Minsk 2003, V.G. Astapenko, N.N. Malinovsky). 3. Fundamentals of practical surgery (Minsk 20088, G.V. Maksimenya).