Chapter 35: Hernias- Indirect Inguinal Hernia

Question 1

What is it?

Answer 1

Hernia through the internal ring of the inguinal canal, traveling down toward the external ring; it may enter the scrotum upon exiting the external ring (i.e., if complete); think of the hernia sac traveling indirectly through the abdominal wall from the internal ring to the external ring

Question 2

What is the cause?

Answer 2

Patent processus vaginalis (i.e., congenital)

Question 3

What is the incidence?

Answer 3

≈5% of all men; most common hernia in both men and women

Question 4

How is an inguinal hernia diagnosed?

Answer 4

Relies mainly on history and physical exam with index finger invaginated into the external ring and palpation of hernia; examine the patient standing up if diagnosis is not obvious

(Note: if swelling occurs below the inguinal ligament, it is possibly a femoral hernia)

Question 5

What is the differential diagnosis of an inguinal hernia?

Answer 5

• Lymphadenopathy
• psoas abscess
• ectopic testis
• hydrocele of the cord
• saphenous varix
• lipoma
• varicocele
• testicular torsion
• femoral artery aneurysm
• abscess

Question 6

What is the risk of strangulation?

Answer 6

Higher with indirect than direct inguinal hernia, but highest in femoral hernias

Question 7

What is the treatment?

Answer 7

Emergent herniorrhaphy is indicated if strangulation is suspected or acute incarceration is present; otherwise, elective herniorrhaphy is indicated to prevent the chance of incarceration/strangulation