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An
abdominal wall hernia is a protrusion of a viscus or part of
a viscus through an abnormal opening in the wall of the abdominal
cavity. Inguinal hernia is by far the most common type of hernia
in males, accounting for about 70% of all hernias. It is followed
in frequency by femoral, umbilical and incisional hernia.
Groin hernias include:
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Indirect
inguinal hernia: a persistence of a congenital peritoneal
tract that follows the indirect path of the spermatic
cord |
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Direct
inguinal hernia: a defect in the floor of the inguinal
canal |
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Femoral
hernia: not an inguinal hernia, but a defect medial to
the femoral sheath. |
The
neck of an inguinal hernia will be above and medial to the
pubic tubercle whereas the neck of a femoral hernia will
be below and lateral to the pubic tubercle. Surgery is the
only definitive treatment for an inguinal or femoral hernia.
Predisposing factors include:
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Congenital
failure of obliteration of the processus vaginalis in
infants (inguinal hernia) |
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Increased
intra-abdominal pressure, for example, as a result of
chronic cough or straining at micturition |
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Previous
surgery for ventral hernia. |
A hernia is either:
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Reducible:
the contents of the sac can be completely pushed back
into the abdominal cavity |
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Incarcerated:
the hernia cannot be completely returned into the abdominal
cavity |
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Strangulated:
the content of the sac has a compromised blood supply
with a consequent risk of gangrene. |
Assessment
Examine the standing patient. The hernia appears as a visible
or palpable mass when the patient stands up or coughs.
A hernia is non-tender and is painless unless it is strangulated.
Patients with strangulated hernia require emergency surgery.
They will complain of pain in the abdomen and the groin where
the hernia is located. Many vomit. The hernia is very tender,
tense and incarcerated. Make the diagnosis by physical examination.
Preparation for surgery
A possible complication of hernia repair is recurrence caused
by wound infection, haematoma or poor technique.
Strangulation is the most dangerous complication of a hernia.
Recurrence is the commonest complication of hernia operation.
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Inguinal hernia bulges above the
inguinal ligament, with the hernia neck above and medial
to the pubic tubercle
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Femoral hernia bulges below the inguinal ligament in
the upper thigh, with the hernia neck below and lateral
to the pubic tubercle
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Inguinal hernia is most common in males
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Femoral hernia, which occurs less frequently than inguinal
hernia, is more common in women.
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