Inguinal Hernias Flashcards
Define Inguinal Hernia?
The abnormal protrusion of a peritoneal sac through a weakness of the abdominal wall in the inguinal region
What are the two types of Inguinal Hernias?
Direct Inguinal Hernia
Indirect Inguinal Hernia
What are the characteristics of Direct Inguinal Hernias?
Protrusion of the hernial sac directly through a weakness in the transversalis fascia and posterior wall of the inguinal canal
Arises medial to the inferior epigastric vessels
Appear through Hesselbach’s triangle
What are the borders of Hesselbach’s Triangle?
Lateral border of rectus abdominiis
Inferior epigastric veseels
Inguinal ligament
What are the characteristics of Indirect Inguinal Hernias?
Protrusion of the hernial sac through the deep inguinal ring, following the path of the inguinal canal
What do you call it if indirect and direct Inguinal Hernia coexist?
Pantaloon hernia
What is the congenital aetiology of Inguinal Hernias?
Abdominal contents enter the inguinal canal through a patent processus vaginalis
What is the acquired aetiology of Inguinal Hernias?
Due to increased intra-abdominal pressure along with muscle and transversalis fasica weakness
What are the risk factors for Inguinal Hernias?
Male Prematurity Age Obesity Raised intra-abdominal pressure (e.g. chronic cough) Constipation Bladder outflow obstruction Intraperitoneal fluid (e.g. ascites)
What is the epidemiology of Inguinal Hernias?
COMMON
Peak age in adults: 55-85 yrs
9x more common in males
What are the presenting symptoms of Inguinal Hernias?
May be asymptomatic
Patient notices a ‘lump in the groin’
May cause discomfort and pain
May be irreducible
May present because it has increased in size
May present because of complications (e.g. bowel obstruction)
What are the signs of Inguinal Hernias on physical examination?
Groin lumps that extends to the scrotum (males) or labia (women)
Check for cough impulse
Indirect hernias can be reduced and controlled by applying pressure over the deep inguinal ring
Herenia may be irreducible
Tenderness if strangulated
Signs of complications
Bowel obstruction and systemic upset (pyrexia, tachycardia etc. )
How do you distinguish between inguinal and femoral hernias?
Inguinal - superior and medial to the pubic tubercle
Femoral - inferior and lateral to the pubic tubercle
What can you hear upon auscultation of Inguinal Hernias?
There may be bowel sounds over the hernia
When do we investigate Inguinal Hernias?
If acute with painful irreducible hernia
What bloods do you do for Inguinal Hernias?
FBC U&Es CRP Clotting Group and save (if operation is likely) ABGs - may show lactic acidosis from bowel ischaemia
What imaging would you do for Inguinal Hernias?
Erect CXR - check for perforation
USS - exclude other causes of groin lump
AXR - check for obstruction
What is the surgical management plan for Inguinal Hernias?
Usually elective repair of uncomplicated hernias
Mesh Repair
Laparoscopic Mesh Repair
What’s involved in Mesh Repair treatment of Inguinal Hernias?
The hernias is surgically reduced and a mesh is inserted to reinforce the defect in the transversalis fascia
What do you do in an emergency to manage Inguinal Hernias?
If obstructed or strangulated
Laparotomy with bowel resection may be indicated if the bowel is gangrenous
What are the complications of Inguinal Hernias?
Incarceration Strangulation Bowel Obstruction Maydl's hernia Richter's Hernia
What is Maydl’s Hernia?
Strangulated W-shaped loop of small bowel
What is Richter’s Hernia?
Strangulation of only part of the bowel circumference
What are the complications of Surgery for Inguinal Hernias?
Pain Wound infection Haematoma Penile/scrotal oedema Mesh infection Testicular ischaemia
What is the prognosis for patients with Inguinal Hernias?
Slowly enlarge if left alone
Surgical mesh repair has a GOOD outcome
