S09C87 - hernias

Question 1

strangulated hernia

Answer 1

= impaired blood flow (arterial, venous, both)

• severe pain
• surgical emergency

Question 2

Hernias - types

Answer 2

• 75% inguinal (2/3 indirect-passes through internal inguinal ring)
• ventral (epigastric, umbilical, incisional, hypogastric)
• femoral (10:1 female to male), prone to incarceration and strangulation
• spigelian hernia (lateral ventral hernia), should be surgically corrected b/c high rate of incarceration
• obturator - through obturator canal, presents as partial/complete bowel obstruction (howship-romberg sign- pain in medial portion of thigh), high perforation and mortality rate (20%)
• richter hernia - antimesenteric border of the intestine, usually no vomiting or intestinal obstruction b/c incomplete involvement of circumference of intestine, often leads to strangulation and gangrene

Question 3

DDx groin mass

Answer 3

• hernia
• hydradenitis
• abscess
• sebaceous cyst
• lymphoma
• hydrocele
• femoral hernia
• femoral aneurysm