1.INDIRECT INGUINAL HERNIA CASE PRESENTATION.pptx

Indirect inguinal hernia

1. A CASE OF INDIRECT INGUINAL HERNIA MITHRAAZ 2013 BATCH, KILPAUK MEDICAL COLLEGE, CHENNAI.

2. HISTORY OF PRESENTING COMPLAINTS Swelling in the right groin-2 years, insidious in onset, initially small in size and gradually progresses to attain current size, extending into scrotum, aggravated on coughing,standing and straining,fully reducible by patient manually,not associated with pain

3. No h/o abdominal distension/abdominal pain/vomiting/constipation No h/o chronic cough/difficulty in micturition /difficulty in defaecation H/o weight lifting present No h/o trauma, no h/o loss of appetite/weight No h/o sudden increase in size of swelling No h/o discolouration of skin over the swelling No h/o irreducibility No h/o swelling elsewhere in the body

4. PAST HISTORY No h/o similar complaints in the past No h/o previous hospitalisation /surgeries No h/o Diabetes Mellitus,Hypertension,Tuberculosis Bronchial Asthma,Epilepsy,Jaundice,Ischemic Heart Disease No h/o drug allergy

5. PERSONAL HISTORY Consumes mixed diet Normal bowel and bladder habits Smoker for the past 10 years: consumes 1 pack per day Not an alcoholic FAMILY HISTORY: Not relevant

6. GENERAL EXAMINATION Conscious,oriented,moderately built and moderately nourished No pallor/ icterus /cyanosis/clubbing/pedal edema/ generalised lymphadenopathy

7. VITAL SIGNS Pulse Rate- 68/ min,regular in rhythm,no specific character,felt equally in all peripheral palpable vessels,no radioradial delay and radiofemoral delay Blood Pressure: 120/80 mm Hg measured in right upper limb in sitting posture Respiratory Rate: 16/ min,regular in rhythm,abdominothoracic Afebrile

8. LOCAL EXAMINATION EXAMINATION OF RIGHT INGUINOSCROTAL REGION: INSPECTION: - 15 x 8 cm swelling in right inguinoscrotal region which is pyriform in shape, extending 9 cm from ASIS to bottom of scrotum - surface smooth, margins well defined

9. - Skin over the swelling appears normal - No redness/dilated veins/scars/sinuses - No visible pulsations and peristalsis - Visible cough impulse is seen - Urethral meatus normal External Genitalia: -Scrotum appears normal,rugosities present -Penis appears to be pushed to left side Inspection in supine position: - Swelling does not disappear

10. PALPATION: -Not warm, not tender - Inspectory findings of site,size,shape and extent of the swelling are confirmed: Extent-9cm from ASIS and 1 cm from pubic tubercle - Expansile cough impulse felt - Cannot get above the swelling - Consistency: soft - Swelling is reducible manually, with initial difficulty and reduces with gurgling

11. RING OCCLUSION TEST: After reducing the swelling in standing position,deep ring was occluded with left thumb:- swelling does not appear on coughing

12. RING INVAGINATION TEST : After reducing the content, in recumbent position, fold of scrotum invaginated into right external ring using right little finger:- Impulse is felt on tip of finger Direction of finger is upwards, backwards and outwards

13. ZIEMAN’S TECHNIQUE: - After reducing the swelling, in standing position, right index finger is placed over the right deep ring, middle finger over the superficial ring and ring finger over the saphenous opening: Impulse is felt on index finger on coughing

14. PERCUSSION: -Resonant note heard on percussion over the swelling AUSCULTATION: -Normal bowel sounds heard - Bowel sounds heard over the swelling

15. EXAMINATION OF LEFT INGUINOSCROTAL REGION: Normal EXAMINATION OF REGIONAL LYMPH NODES: Not enlarged EXAMINATION OF TESTIS,SCROTUM,PENIS: Normal

16. EXAMINATION OF ABDOMEN: Abdomen is normal in shape, not distended,umbilicus in midline No dilated veins/scars/sinuses No palpable mass On head raising test,no Malgaigne’s bulge No divarication of recti Abdominal muscle tone is normal Other hernial orifices free Per-rectal examination- to be done

17. SYSTEMIC EXAMINATION: EXAMINATION OF RESPIRATORY SYSTEM: - Normal vesicular breath sounds heard, no added sounds EXAMINATION OF CARDIOVASCULAR SYSTEM: -S1,S2 heard, no murmurs EXAMINATION OF CENTRAL SYSTEM: - No focal neurological deficit EXAMINATION OF SPINE AND CRANIUM: -Normal

18. DIAGNOSIS: Right sided reducible, indirect complete inguinal hernia with bowel as content without any complications European Hernia Society Classification : PL2

19. INVESTIGATIONS BASELINE: -Complete haemogram , BT, CT -Urine routine - Chest X ray - ECG,ECHO - Renal Function test - Liver Function test SPECIFIC: - USG –Abdomen and Pelvis

20. TREATMENT Lichtenstein’s tension free open hernioplasty on right inguinal region

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