Inguinal Hernia Flashcards
Definition
Protrusion of abdominal/pelvic contents through a dilated internal inguinal ring or attenuated inguinal floor into the inguinal canal & out of the external inguinal ring causing a visible or easily palpable bulge.
Types of inguinal hernia
Direct: hernia sac comes through the inguinal floor medial to the inferior epigastric artery & the deep inguinal ring
Indirect: Hernia sac comes through the internal (deep) inguinal ring lateral to the artery.
Causes
Congenital: Processus vaginalis fails to undergo regression
Familial/ hereditary (IH)
Connective tissue disorders
Acquired: Degeneration & fatty changes in wall of inguinal floor
Risk factors
Family history Connective tissue disorders Male Old age Smoking Prematurity Arterial aneurysm Prev. RLQ incision Defective transversalis fascia Chronic bronchitis/ emphysema Lathyrism Heavy lifting Pregnancy Ascites Obesity Cachexia Urethral stricture BPH Chronic bowel obstruction
Clinical presentation
Groin mass/bulge, groin discomfort, acute abdomen, constipation, N&V
Differentials
Undescended testis Lymphadenopathy Femoral hernia Femoral aneurysm Psoas abscess Saphena varix Hydrocele & spermatocele Encysted hydrocele or lipoma of spermatic cord
Investigations
Clinical Diagnosis
Consider: Groin USS/CT/MRI, herniography
Management
LEAVE: Watchful waiting, small asymptomatic hernia,
SURGERY: Open repair (irreducible, strangulated, obstructed, uncertain viability of bowel)
Large Hernia: Open mesh repair OR laproscopic inguinal herniography, truss
Prognosis
Improvement in QoL, tension-free mesh repair-low incidence of recurrence
Complications
Urinary retention post-op, scrotal haematoma, wound seroma, inguinal wound haematoma/infection, mesh rejection, division of vas, ischaemia
