Inguinal direct hernia (hernia)

　　Most inguinal direct hernias are acquired, with the main cause being incomplete development of the abdominal wall, weak muscles and fascia in the inguinal triangle area. In the elderly, muscle atrophy and degeneration make the inguinal canal gap wider. At the same time, the supporting and protective effects of the oblique abdominal muscle, transverse abdominal muscle, and conjoint tendons are weakened. When chronic cough, habitual constipation, or difficulty in urination lead to increased intra-abdominal pressure, the transversalis fascia is repeatedly subjected to the impact of intra-abdominal pressure, causing injury, thinning, and the abdominal viscera are gradually pushed forward and protrude to form a direct hernia. There is no congenital occurrence.

　　If inguinal direct hernia is not treated in time, it can lead to intestinal incarceration and intestinal strangulation, as follows:

　　1. Intestinal incarceration

　　Under normal circumstances, the contents of the hernia (usually the intestinal tract) can be pushed into the hernia sac under the action of intra-abdominal pressure through the hernia ring, and can be retracted into the abdominal cavity spontaneously (or by external force). When various reasons (such as friction, adhesion, etc.) cause the contents of the reducible hernia to suddenly be unable to be retracted, and the local mass increases, it indicates that intestinal incarceration has occurred. At this time, it is called incarcerated hernia. After intestinal incarceration, the main clinical manifestations are those of intestinal obstruction.

　　2. Intestinal strangulation

　　If incarcerated hernia persists and is not treated in time, the contents of the hernia (mainly the intestinal tract) may experience circulatory disorders, leading to intestinal obstruction, intestinal necrosis, and even intestinal perforation, resulting in strangulated hernia as a complication.

　　Inguinal direct hernia is more common in middle-aged and elderly people with weak bodies, generally without obvious symptoms, only with slight acid and胀 sensation when the hernia mass protrudes. Since the hernia directly protrudes at the apex of Hesselbach's triangle, the hernia ring is the vulnerable area of Hesselbach's triangle, which is relatively wide and large, without a明显 hernia sac neck, and rarely occurs with incarceration. Physical examination requires the patient to stand, and the hernia mass will protrude above the pubic tubercle, presenting a hemispherical bulge. After the hernia mass is retracted, pressing on the Hesselbach's triangle area can prevent the hernia mass from returning.

　　Inguinal direct hernia often occurs in the elderly and weak, mainly due to weak abdominal wall and increased abdominal intra-pressure. Therefore, actively preventing and treating diseases that cause increased abdominal intra-pressure, such as chronic bronchitis, urinary retention, chronic constipation, etc., is an effective method to prevent and relapse of direct hernia.

　　Most inguinal direct hernias can be diagnosed based on the patient's clinical symptoms and the doctor's physical examination. If the hernia is small and not typical, it can be basically diagnosed by ultrasound.

　　In addition to surgical treatment, inguinal direct hernia can also be relieved by dietary therapy, as follows:

　　1, 120 grams of pork, wutong tree root, August melon root, and 10 grams of Xanthium sibiricum. Boil and take once a day.

　　2, 15 grams of fennel, 4 grams of salt, 2 duck eggs with green peel. Roast and grind the fennel and salt together, mix with the beaten eggs in the bowl, fry into an omelet in the oil, take it with warm rice wine before going to bed every night, and take it as a course of treatment every 4 days.

　　3, 50 grams of Eucommia ulmoides, salt-fried and ground into powder, add 25 grams of black sesame, take 9 grams each time, twice a day.

　　4, 20 grams of garlic skin, boil water, take several times a day. Garlic skin is the skin attached to the garlic meat, about 1000 grams of garlic can peel off 20 grams of skin.

　　Patients with inguinal direct hernia should, in principle, undergo surgical treatment if there are no contraindications. In view of the fact that direct hernia rarely occurs in incarceration, for the elderly and weak or those with other chronic diseases who cannot tolerate surgery, a hernia belt can be used to alleviate symptoms.

　　Since direct hernia has no obvious hernial sac neck and sac, it is only necessary to excise the relaxed protruding peritoneum during surgery. Sometimes it can be converted into an indirect hernia and ligated high up. The repair can be done using the Madden method to enhance the strength of the transversalis fascia, or the Bassini or Halsted method can be used to enhance the posterior wall of the inguinal canal. It must be pointed out that for large direct hernias, the McVay method should be used instead of the Madden method.