Inguinal hernias

Question 1

Define inguinal hernia

Answer 1

Abnormal protrusion of peritoneal sac through a weakness of abdominal wall in the inguinal region

Question 2

Define direct inguinal hernia

3

Answer 2

Protrusion of hernial sac directly through a weakness in the transversalis fascia & posterior wall of the inguinal canal
Medial to the inferior epigastric vessels
Appear through Hesselbach’s triangle

Question 3

Define indirect inguinal hernia

Answer 3

Protrusion of hernial sac through the deep inguinal ring, following the path of the inguinal canal

Question 4

Borders of Hesselbach’s triangle

Answer 4

Lateral border of rectus abdominis
Inferior epigastric vessels
Inguinal ligament

Question 5

Define pantaloon hernia

Answer 5

indirect & direct hernias coexist

Question 6

Aetiology of inguinal hernias

congenital, acquired

Answer 6

Congenital - abdominal contents enter inguinal canal through a patent processus vaginalis

Acquired - due to increased intra-abdominal pressure along w/ muscle & transversalis fascia weakness

Question 7

Risk factors for inguinal hernia

8

Answer 7

Male
Prematurity
Age
Obesity
Raised intra-abdominal pressure
Constipation
Bladder outflow obstruction
Intraperitoneal fluid

Question 8

Epidemiology of inguinal hernias

prevalence, age, gender

Answer 8

COMMON
Peak age 55-85 yrs
9x more common in males

Question 9

Presenting symptoms of inguinal hernias

general, 4

Answer 9

Asymptomatic

Notice “lump in the groin”
May cause discomfort & pain
May be irreducible
May present due to increase in size or complications

Question 10

Signs of inguinal hernia on physical examination

6

Answer 10

Groin lump that extends to scrotum or labia
Check for cough impulse
Indirect hernias can be reduced & controlled by applying pressure over deep inguinal ring
or hernia may be irreducible
Auscultation - may be bowel sounds over hernia
Tenderness if strangulated
Check for signs of complications

Question 11

Location of inguinal & femoral hernias

Answer 11

Inguinal - superior & medial to the pubic tubercle

Femoral - inferior & lateral to the pubic tubercle

Question 12

Investigations for inguinal hernia

when + 2 types

Answer 12

If ACUTE with painful irreducible hernia

Bloods
Imaging

Question 13

Investigations for inguinal hernia - bloods

6

Answer 13

FBC
U&Es
CRP
Clotting
Group & save (if op likely)
ABGs - may show lactic acidosis from bowel ischaemia

Question 14

Investigations for inguinal hernia - imaging

3

Answer 14

Erect CXR - check for perforation
USS - exclude other causes of groin lump
AXR - check for obstruction

Question 15

Type of management of inguinal hernia

Answer 15

Surgical -

Usually elective repair of uncomplicated hernias

Question 16

Management of inguinal hernia

3

Answer 16

Mesh repair
hernia is surgically reduced & mesh inserted to reinforce defect in the transversalis fascia
Laprascopic mesh repair
EMERGENCY
if obstructed or strangulated
laparotomy w/ bowel resection may be indicated if bowel is gangrenous

Question 17

Complications of inguinal hernia - general

5

Answer 17

Incarceration
Strangulation
Bowel obstruction
Maydl’s hernia
Richter’s hernia

Question 18

Complications of inguinal hernia - surgical

6

Answer 18

Pain
Wound infection 
Haematoma
Penile/scrotal oedema
Mesh infection
Testicular ischaemia

Question 19

Prognosis for inguinal hernia

2

Answer 19

Slowly enlarge if left alone

Surgical mesh repair has GOOD outcome