Inguinal Hernia

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[edit] Inguinal hernia

Introduction:

This condition is associated with a defect in the lower abdominal wall just below the inguinal ligament. In the indirect hernia there is a congenital defect of the tube ( in doctor lingo: "processus vaginalis") through which in late embryonic life of the male the testicle migrated into the scrotum. Not infrequently this tube stays open, although in normal development this should have disappeared on its own.

As the person grows older, depending on the size of the persistent processus vaginalis, there comes a point in life where a bowel loop or a piece of intraabdominal fatty tissue gets pushed through this opening and ends up in the scrotum (see this image). With a direct hernia the defect is directly in the abdominal wall and it is not congenital, but is acquired. Often it is associated with the quality of connective tissue and with how overweight the person is( pressure dependent from inside). Here is an image that explains the difference between direct and indirect hernia. About 25% of inguinal hernias are direct, 75% of inguinal hernias are indirect.

Inguinal hernia symptoms:

There is a local piercing pain when a hernia suddenly enlarges. As the ileoinguinal nerve, which is located near the hernia, gets irritated, there can be considerable pain in the right or left lower abdominal wall and pain felt in the lower abdomen on the side where the hernia has developed. At the same time there is a bulging mass locally and if it is a big hernia, some of the mass might reach into the scrotum on the right or left side. Some of these hernias are the ones where a bowel loop might be caught in the abdominal wall opening and there is a danger of strangulation of the bowel.

Treatment:

The surgeon will carefully examine and see whether or not the hernia can be pushed back. If it is, then there is time to fix the hernia on an elective basis and the patient can wear a hernia truss prior to the surgery to prevent deterioration of the condition.

However, if the hernia can not be reduced, then the condition is an emergency and needs to be taken to the operating room right away. There are only 4 to 6 hours before the danger of irreversible gangrene of the bowel would set in. Surgery might be done by the laparoscopic method through three stab wounds. A plastic mesh, which is rolled up, is brought in and is stapled in place over the hernia defect of the abdominal wall from inside under television camera supervision. Following this the instruments are withdrawn and the patient can go home either on the same day or the following day. In the past with conventional incision the recovery took 7 to 10 days!

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Abdominal pain

References:

1. DM Thompson: The 46^th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems".

6. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:"Abdominal pain".

7. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".

8. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.