(Surgery)

Overview

• Hernia → condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it
• Inguinal Hernia → abdominal or pelvic contents protrudes thorugh the inguinal canal (also have femoral hernia but less common). Most common type of hernia (75%). Further divides into direct and indirect (indirect more common).
  • Direct Inguinal → protrusion directly through the posterior wall of the inguinal canal. Develop over time due to straining and is caused by weakness in the abdominal muscles. Usually occurs in older men, rare in children. Medial to inferior epigastric vessels.
  • Indirect Inguinal → protrusion into the inguinal canal through the deep inguinal ring. Caused by defect in abdominal wall that will have typically been present since birth. May occur in infants. Lateral to inferior epigastric vessels.
    • When reduced and pressure is applied to the deep inguinal ring, indirect hernia will remain reduced (direct hernia reappears).
  • Hesselbach’s Triangle = inferior epigastric artery, rectus border, inguinal ligament
  • Risk Factors → Male, prematurity, age, obesity, raised intra-abdominal pressure (Chronic cough), constipation, family history, AAA, Marfan syndrome, Ehlers-Danlos syndrome
• Femoral Hernia → only 5% of hernias. More common in women.
• Inguinal = supermedial to the pubic tubercle. Femoral = inferolateral to the pubic tubercle.

Making Diagnosis

Clinical Features:

• Inguinal Hernias
  • Experience pain (dull, heaviness, dragging) in association with a bulging hernia
  • Visible + Palpable groin mass (may also enlarge with standing or coughing) → inguinal hernias are superior and medial to the pubic tubercle
  • N&V, Constipation
• Femoral Hernia
  • Typically non-reducible
  • Cough impulse often absent

<aside> 💡 INGUINAL ⇒ supermedial to pubic tubercle, reducible, cough impulse present. FEMORAL ⇒ inferolateral to pubic tubercle, non-reducible, cough impulse absent.

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Investigations:

Clinical Diagnosis → via observation and palpation

• Ultrasound scan of groin → useful when there is diagnostic uncertainty
• CT Scan → useful in very obese patients