GI - Inguinal Hernia

Question 1

Definition

Answer 1

Inguinal hernias present with a soft lump in the inguinal region (in the groin). There are two types:

• Indirect inguinal hernia
• Direct inguinal hernia

Question 2

Pathophysiology

Answer 2

Indirect hernia (MC in children)
- Abdominal contents protrude through the deep inguinal ring into the inguinal canal and through the superficial inguinal ring into the groin.
This is due to the incomplete closure of an outpouring of the peritoneum = processes vaginalis after the descent of the testes in utero
Direct hernia (MC in adults)
- weakness of the posterior wall of the inguinal canal. Herniation directly thought the abdominal wall = HESSELBACH’S TRIANGLE - Hessebach’s triangle borders are (RIP):
R – Rectus abdominis muscle – medial border
I – Inferior epigastric vessels – superior / lateral border
P – Poupart’s ligament (inguinal ligament) – inferior border

Question 3

Risk factors

Answer 3

Prematurity
Male
Family Hx

Question 4

Signs and symptoms

Answer 4

Groin swelling
Nausea
Vomiting
Constipation
Abdo pain or discomfort
Strangulation

Question 5

Differential diagnosis

Answer 5

Hydrocele = possible to ‘get above’ a hydrocele, transilluminates, non-tender
Varicose = scrotal heaviness, non-tender, ‘bag-of-worms’ sensation on palpation

Question 6

Diagnosis

Answer 6

Clinical diagnosis
USS/CT scan

Question 7

Management

Answer 7

Surgical repair

Question 8

Complications

Answer 8

Recurrence
Strangulation
Incarceration
Bowel obstruction