clinical features of inguinal hernia

signs and symptoms of an inguinal hernia

1. SIGNS AND SYMPTOMS OF PATHOLOGY IN INGUINAL CANAL TEJAS D ROLL NO 122

2. Hernia is defined as an abnormal proteusion of a viscous or a part of a viscous through an opening,artificial or natural with a sac covering it. Hernia is most common pathology in the inguinal canal (73%) Two types –direct and indirect hernia Indirect hernia is more common than direct hernia.

3. Aetiology Straining Lifting of heavy weightt Chronic cough( tuberculosis,chronic bronchitis , asthma,emphysema ) Chronic constipation(rectal stricture) Urinary causes like Old age- BPH,carcinoma of prostate Young age-stricture urethra Very young age- phimosis,meatal stenosis

4. Obesity Smoking Ascitis Appendicectomy through Mcburney’s incision may injure the ilioinguinal nerve causing right sided direct inguinal hernia. An indirect inguinal hernia occurs in a congenital,preformed sac i.e remains of processus vaginalis

5. Indirect inguinal hernia Indirect inguinal hernia comes out of the abdominal cavity through the deep inguinal ring traverses all along the inguinal canal and becomes superficial through the superficial inguinal ring Coverings (from inside out) Extraperitoneal tissue Internal spermatic fascia Cremastric fascia External spermatic fascia skin

6. Types include Bubonocele -hernia limited to inguinal canal Funicular- processus vaginalis is closed just above the epididymis Complete-testis appears to lie within the lower part of hernia and occurs in congenital preformed sac

7. Clinical features Dragging type of pain Swelling in the groin better seen while coughing and standing;felt together with an expansile impulse In complete type contents descends down to the scrotum completely . On palpation ,one cannot get the above swelling.

8. Contents are either small or large bowel,omentum,or combination. In females sometimes ovary and tubes may be the content.

9. Direct inguinal hernia It enters the inguinal canal through hesselbach’s triangle and becomes superficial through the superficial inguinal ring. It is always acquired due to the weakening of the posterior wall of inguinal canal Direct hernia is classified into medial or lateral depending on which part of hesselbach’s triangle it is arising from.

10. Clinical features Malgaigne bulgings are more often seen direct inguinal hernia than indirect type. They are protrusion of the abdominal wall muscle during leg raising test as weak, soft, supple swellings signifying poor muscle tone. It is seen in old age and indicates that hernia requires mesh repair.

11. Direct hernia rarely descends into the scrotum and strangulation is not common Prevesical hernia is a direct type which is prone for strangulation. However in long standing cases contents may descend down to the scrotum and strangulation can occur.

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