Inguinal and Femoral hernias

Question 1

Describe an inguinal hernia?

Answer 1

In inguinal hernia enters the deep inguinal ring and descends within the covering of the spermatic cord so that it can pass on down into the scrotum.

Question 2

What is the clinical presentation of an inguinal hernia?

Answer 2

(takes months to years to develop so may not have any symptoms)

• dragging discomfort in the groin
• particularly during lifting or straining or at end of day
• visible when patient stands and is asked to cough

Question 3

How do you differentiate between an inguinal and femoral hernia?

Answer 3

• inguinal hernia passes into the scrotum, passes above and medial to the pubic tubercle.
• femoral hernia bulges below and lateral to the pubic tubercle.

Question 4

Describe a direct inguinal hernia?

Answer 4

Direct inguinal hernia is due to a weakness in the abdo wall and can be precipitated by increases in intra abdo pressure.
The hernia protrudes through the transversalis fascia in the posterior wall of the inguinal canal.

Question 5

What are the boundaries of a direct inguinal hernia?

Answer 5

Hesselbach’s triangle.
Direct inguinal hernia is bounded by conjoint tendon above, inguinal ligament below and laterally by the inferior epigastric vessels.

Question 6

/What type of hernia is bounded by hesselbach’s triangle

Answer 6

Direct inguinal hernia

• conjoint tendon above
• inguinal ligament below
• inferior epigastric vessels laterally

Question 7

What are the clinical features of a direct hernia?

Answer 7

bulge in the medial part of inguinal canal.

doesn’t descend into scrotum.

Question 8

What is the difference between indirect and direct hernias?

Answer 8

Indirect hernias go through the deep inguinal ring and lies lateral to the inferior epigastric vessels.

Direct hernia are due to a weakness in the abdo wall and lie medial to the inferior epigastric vessels.

Question 9

What is the management of an inguinal hernia?

Answer 9

if symptomatic then laproscopic mesh repair.

Question 10

What is a femoral hernia?

Answer 10

a femoral hernia is bowel that protrudes through the femoral ring and goes into the femoral canal.
The ring is bound laterally by the femoral vein, superiorly by the inguinal ligament, inferiorly by the superior ramus of the pubis and medially by the lacunar ligament.

Question 11

What are the clinical features of the femoral hernia?

Answer 11

bulge in upper inner aspect of thigh.

groin pain related to exercise.

Question 12

% of groin hernias:

• indirect inguinal
• direct inguinal
• femoral

Answer 12

• indirect = 60%
• direct = 25%
• femoral = 15%