Case Report : - Inguinal Hernias
Inguinal Hernias
Case: Mr. Strain, a 45-year-old man, who while trying to show his wife how strong he was, strained to pick up a particularly heavy coffee table. He suddenly felt a sharp pain in his right groin. Later, he noticed that a painful bulge had developed in his groin which disappeared when he was on his back. After several months, the pain and the bulge in his groin increased and he finally agreed to see a physician. On exam, you observe a swelling which begins about midway between the anterior superior iliac spine and the midline, progresses medially for about 4 cm, and then turns toward the scrotum.
Definitions
Hernia: Protrusion of any viscus from its normal cavity through an abnormal opening.
Hernias may be described as: Reducible Contents easily put back Irreducible Contents cannot be put back Strangulated Contents are stuck, and there is constriction of the tissues at the neck of the hernia, leading to reduced venous drainage and arterial occlusion
Types of abdominal wall hernias Description Strangulation Risk
Incisional Through an area weakened by prior surgery. Low
Umbilical Congenital defect of the abdominal wall seen in infants Low as a swelling at the umbilicus.
Paraumbilical Acquired defect above or below the umbilicus. High
Femoral Herniation through the femoral canal which appears below High and lateral to the pubic tubercle. More common in women than men.
Inguinal Typically seen 'above and medial to the pubic tubercle'. Swelling is Depends caused by weakness in the abdominal wall in the area of Hasselbach's triangle.
Epidemiology
• Male > Female by 9 to 1 ratio (indirect inguinal hernia most common for both sexes)
• Lifetime incidence: 5-25% percent of males, 2% of females
• Bimodal peaks before 1 year of age and then again after 40
• Groin hernias (femoral and inguinal) = 75% of abdominal wall hernias
• Inguinal hernias account for 70-95% groin hernias; of these (2/3 of
Case: Mr. Strain, a 45-year-old man, who while trying to show his wife how strong he was, strained to pick up a particularly heavy coffee table. He suddenly felt a sharp pain in his right groin. Later, he noticed that a painful bulge had developed in his groin which disappeared when he was on his back. After several months, the pain and the bulge in his groin increased and he finally agreed to see a physician. On exam, you observe a swelling which begins about midway between the anterior superior iliac spine and the midline, progresses medially for about 4 cm, and then turns toward the scrotum.
Definitions
Hernia: Protrusion of any viscus from its normal cavity through an abnormal opening.
Hernias may be described as: Reducible Contents easily put back Irreducible Contents cannot be put back Strangulated Contents are stuck, and there is constriction of the tissues at the neck of the hernia, leading to reduced venous drainage and arterial occlusion
Types of abdominal wall hernias Description Strangulation Risk
Incisional Through an area weakened by prior surgery. Low
Umbilical Congenital defect of the abdominal wall seen in infants Low as a swelling at the umbilicus.
Paraumbilical Acquired defect above or below the umbilicus. High
Femoral Herniation through the femoral canal which appears below High and lateral to the pubic tubercle. More common in women than men.
Inguinal Typically seen 'above and medial to the pubic tubercle'. Swelling is Depends caused by weakness in the abdominal wall in the area of Hasselbach's triangle.
Epidemiology
• Male > Female by 9 to 1 ratio (indirect inguinal hernia most common for both sexes)
• Lifetime incidence: 5-25% percent of males, 2% of females
• Bimodal peaks before 1 year of age and then again after 40
• Groin hernias (femoral and inguinal) = 75% of abdominal wall hernias
• Inguinal hernias account for 70-95% groin hernias; of these (2/3 of