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Inguinal Hernia

Contents of the abdominal cavity protrude through the inguinal canal with a bulge in the groin area showing prominence when coughing or straining. Usually not appearing when lying down, it does not cause any pain. Progressively, the intestines and the liver slowly start descending into the hernia causing intestinal obstruction due to pinching. Inguinal hernias are considered as groin hernias. They are at a high risk of incarceration and irreducibility.

Causes

  • Increased intra-abdominal pressure

  • Weakened spot in the abdomen

  • Straining

  • Lifting heavy weights and objects

  • Ascites

  • Obesity

  • Pregnancy

  • COPD

Types of inguinal hernias

Inguinal hernias are of three types:

  • Direct inguinal hernia: Direct inguinal hernias can affect both males and females with higher incidences found in males. There is a protrusion through a weak area in the transversalis fascia bounded by the inguinal triangle or Hesselbach’s triangle. It has the ability to exit through the superficial inguinal ring. Direct hernias generally occur in the aged and elderly due to weakening of the abdominal walls with age.

  • Indirect inguinal hernia: Evident embryonic closure of the deep inguinal ring is not present though the testicle has passed through the ring. The deep inguinal canal opening is large enough for the spermatic cord to pass through it due to incomplete obliteration of the proccessus vaginalis. The most common cause of groin hernias is protrusion of contents through the superficial inguinal ring. There are three types of indirect inguinal hernia:

    • Complete or vaginal hernia: presence of a patent processus vaginalis with the hernia descending right down to the scrotum with no differentiation between the hernia and the testes.

    • Bubonocele: presence of the hernia is restricted to the inguinal canal

    • Funicular hernia: the lower end of the processus vaginalis is closed above the epididymis and hernial sac contents can be felt from the testes

  • Pantaloon hernia: An individual experiences both direct and indirect hernia on the same side

Diagnosis

  • Physical examination: Physical exam will include collecting the medical history along with the family history of the patient. The patient is examined standing upright or in supine position. Patient may also be asked to cough or strain for better examination of the area.

  • Imaging: Imaging tests allow the diagnosis of a hernia for strangulation or incarceration; in patients who are obese where the hernia is not palpable or if another condition is the cause of the swelling in the area. The following imaging tests may be conducted:

    • Abdominal x-rays

    • Abdominal ultrasound

    • CT or Computerized Tomography

Treatment and medication

Enlarged and painful inguinal hernias usually require surgical repair. Ibuprofen or acetaminophen medications are usually prescribed to decrease pain in small hernias.

Surgical intervention is imperative for all hernias due to the risk of incarceration and strangulation. Consult Dr.Deepak for surgical treatment of hernias.

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