General: Inguinal Hernia

Question 1

Describe the pathophysiology of an inguinal hernia

Answer 1

Abdo contents enter the inguinal canal

DIRECT = bowel enters inguinal canal “directly” through a weakness in wall, Hesselbach’s triangle

INDIRECT = bowel enters the inguinal canal via the deep inguinal ring

Question 2

How can you differentiate between an indirect and direct inguinal hernia?

Answer 2

Indirect hernias will be lateral to the inferior epigastric vessel

Direct hernias will be medial to the inferior epigastric vessels

Question 3

What are the risk factors for an inguinal hernia?

Answer 3

Male

Increasing age

Raised intra-abdo pressure = chronic cough, heavy lifting, or chronic constipation

Obesity

Question 4

How does an inguinal hernia present?

Answer 4

Lump in groin = will disappear with minimal pressure

Discomfort which can worsen with activity or standing

Incarcerated = painful, tender, erythematous

Strangulated = pain out of proportion to clinical signs

Question 5

How should an inguinal hernia be investigated?

Answer 5

Exam = reduce hernia, place pressure over deep inguinal ring (mid-point of the inguinal ligament), before asking the patient to cough, protrusion = direct

Explorative surgery = definitive diagnosis

US = to exclude other pathology

Question 6

How can you differentiate between an inguinal and femoral hernia?

Answer 6

Location:

Inguinal = superomedial to the pubic tubercle

Femoral = inferolateral to the pubic tubercle

Question 7

How should an inguinal hernia be managed?

Answer 7

Surgical repair = open or laparoscopic

Question 8

What are the possible complications from an inguinal hernia?

Answer 8

Incarcerated hernia

Obstruction of bowel lumen

Strangulation of bowel = ischemia

Post op = pain, bruising, haematoma, recurrence, chronic pain, damage to vas deferens or testicular vessels