Inguinal hernias

Question 1

What is an inguinal hernia?

Answer 1

• = protrusion of an organ through a weakness in the lower abdominal wall, into the groin region

Question 2

Which side more common: left or right?

Answer 2

Right

Question 3

Risk factors for inguinal hernia

Answer 3

• Male gender
• Premature birth/low birth weight
• Immediate FHx of inguinal hernia as a baby
• Other urological problems e.g. undescended testes

Question 4

Direct vs indirect inguinal hernia

Answer 4

• Indirect: through inguinal canal, can pass through scrotum
○ In a girl, common for ovary to pass through too - not painful, and the ovary should be mobile as it is attached to a mesentery
• Direct: bulge from posterior wall of canal, can’t pass through scrotum

Question 5

Risk with irreducible inguinal hernia

Answer 5

bowel cannot move back into abdomen, and at risk of avascular necrosis -> infertility

Question 6

When is risk of incarceration highest?

Answer 6

In babies

Question 7

Why is there a weakness in the lower abdominal wall?

Answer 7

• Weakness in lower abdominal wall caused by development of testes
  • Testes travel through inguinal canal to scrotum at 7m pregnancy
  • Canal should fuse before birth, but sometimes muscles don’t cover opening completely

Question 8

What are the features of a reducible inguinal hernia?

Answer 8

• is usually painless (but there may be some mild discomfort)
• is soft and smooth intexture
• may disappear or reduce in size when baby is relaxed and lying flat
• may appear or increase in size when baby is crying, coughing or straining

Question 9

Clinical features of irreducible hernia

Answer 9

• Unwell child
• pain in the groin +++
• nausea and vomiting
• bloating or full abdomen
• fever
• Swelling: firm, tender, red/dusky, doesn’t change in size when crying

Question 10

Definitive Mx of inguinal hernia

Answer 10

• = surgical repair via herniotomy, even if reducible

- Reduces risk of returning and potential incarceration