Inguinal Hernia Flashcards
def
abnormal protrusion of a peritoneal sac through a weakness in the inguinal region
what types of inguinal hernias are there
indirect (60%)
direct (35%)
‘pantaloon’ (5%)
where do direct hernias emerge from
emerge through hesselbachs triangle
- medially the lateral border of the rectus
- laterally the inferior epigastric vessels
- inferiorly the inguinal ligament
how can hernias be described
reducible
irreducible (incarcerated)
strangulated
def of direct inguinal hernia
protrusion of the hernial sac occurring directly through the transversalis fascia + posterior wall of the inguinal canal, medial to the inferior epigastric vessels
def of indirect inguinal hernia
protrusion of the hernial sac, through a deep inguinal ring with coverings of the spermatic cord, following the path of the inguinal canal
aetiology
1 congenital
-persistant processus vaginalis
2 acquired
-increased intra-abdominal pressure + muscle + transversalis fascia weakness
associations/risk factors
1 male 2 increasing age 3 raised intra-abdominal pressure -cough -constipation -bladder outflow obstruction
epi
common 1 congenital indirect inguinal hernias - 4% of male births 2 acquired -55-85yrs -men:women is 9:1
history
1 asymptomatic
2 lump or swelling in groin
3 pain or discomfort
examination
1 groin lump which may extend to scrotum
2 may be cough impulse associated with hernia when standing
3 auscultation may reveal bowel sounds from within the hernia
4 irreducible if incarcerated
5 tender if strangulated
how would inguinal + femoral hernias be distinguished
inguinal hernias emerge above + medial to the pubic tubercle
investigations
if acute with painful irreducible hernia 1 bloods -FBC, UEs, CRP, clotting -ABG may show bowel ischaemia within hernia (metabolic acidosis + high lactate) 2 imaging -erect CXR + AXR in emergency -USS for diagnosis + exclusion
management
1 conservative
-if patient unfit for surgery, managed with an inguinal truss (a belt which stops the hernia protruding)
2 surgery
-elective repair for uncomplicated hernias
-mesh (lichtenstein) repair - most common
-laparoscopic mesh repair
when is laparoscopic mesh repair commonly used
bilateral + recurrent hernias
