Inguinal Hernia Flashcards
Define a hernia
The abnormal exit of tissue or organ through the wall of the cavity in which it normally resides
Where do inguinal hernias occur?
Protrusion of abdominal contents through the inguinal canal
What are the types of inguinal hernia?
- Direct
- Indirect
What type of inguinal hernia is most common in children?
Indirect
What “congenital abnormality” underlies most inguinal hernias in children?
Patent processus vaginalis
What does a patent processus vaginalis allow for?
Emergence of bowel through deep inguinal ring into the inguinal canal
In what group of children are direct inguinal hernias more common?
Premature babies
Why are direct inguinal hernias more common in one group of children?
Premature babies have more weak and friable tissue
Weakness in what area leads to a direct inguinal hernia?
Hesselbach’s Triangle
What are the risk factors for inguinal hernia in children?
- Male gender
- Prematurity
What is the typical presentation of an inguinal hernia?
Groin lump - potentially extending into the scrotum/labia
What can exaggerate a hernia?
Increased intra-abdominal pressure
What can cause increased intra-abdominal pressure?
- Crying
- Straining
- Coughing
What may cause a hernia lump to disappear?
If the child relaxes and lies down
Are inguinal hernias symptomatic or asymptomatic generally?
Asymptomatic
If there is a scrotal hernia, is transillumination possible?
No
How are inguinal hernias diagnosed?
Clinical diagnosis
What is a differential for an inguinal hernia?
Hydrocoele (for scrotal hernias)
How can most inguinal hernias be managed immediately?
‘Taxis’ - the hernia is gently compressed through the inguinal canal under good analgesia
What is the benefit of performing reduction by taxis?
Surgery can be planned once any oedema has settled down and the child is well
What should happen whilst waiting for surgery?
Educate the parents about signs of incarceration
If reduction is not possible what may be required?
Emergency surgery
What does surgical repair involve?
Ligation and division of the processus vaginalis
What are the complications of inguinal hernia?
- Incarceration
- Strangulation
- Bowel obstruction
- Damage to the testis
What are the symptoms of incarceration +/- strangulation?
- Tenderness of the lump
- Vomiting
- Irritability
In which age group is strangulation more common?
Infants
