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Inguinal hernia (RIsk factors (Male, Chronic cough, Constipation, Ascites,…
Inguinal hernia
RIsk factors
Male
Chronic cough
Constipation
Ascites
Prev abdo surgery
Heavy lifting
Diagnosis
Examination
Genital exam
Unilateral lump, unable to get above,
may be tender, often soft, separate to testis,
check if retractile or not (ask patient to retract)
cough reflex +ve, distinguish indirect vs direct by retraction and exclusion of deep inguinal ring (if reappears, it is direct)
Investigations
Bedside
Obs (nil)
Imaging
USS testes: r/o torsion
Surgical exploration: official diagnosis
History
DH
Meds, allergies
FH
Hernias, cancers
PMH
Known medical/surgical conditions
SH
Living arrangements, occupation/school,
smoking, alcohol
PC/HPC
Testicular lump
Complications
Strangulation
Irreducible
Incarceration
Pathophysiology
Inguinal contents
Fascia: external spermatic, cremasteric, internal spermatic fascia
Cord: vas deferens, PV, lymphatics, arteries (vas, cremasteric, testes), veins (pampiform plexus), nerves (genital branch of genitofemoral, sympathetic)
Inguinal canal
Floor: inguinal ligment
Roof: transversalis and int oblique muscle
Anterior: ext oblique aponeurosis, int oblique muscle
Posterior: transversalis fascia
Deep ring: midpoint of ligament (1.5cm above fem pulse)
Superficial ring superior and medial to pubic tubercle, where there is a split in the ext oblique aponeurosis
Types
Indirect
Passes via patent PV through internal and external rings
Direct
Passes via defect in abdo wall (Hesselbach's triangle)
through posterior wall of inguinal canal
Rarely strangulate
Management
Conservative
Information, advice, support
Lifestyle (weight loss, smoking)
Surgical
Mesh repair (hemiorrhapy)
Indication: direct hernia in adults
MOA: mesh reinforces abdo wall
CI: strangulated, infection
Laparoscopic repair
MOA: transabdominal or extraperiotoneal
PV ligation (hemiotomy)
Indication: children with indirect
MOA: ligation of PV, removal of herniation sac
Epidemiology
Common in boys
Indirect>direct
Clinical
presentation
Scrotal swelling
Definition
Hernia along the
inguinal canal
