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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 disappear 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 intra abdominal fatty tissue gets pushed through this opening and ends up in the scrotum. 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 a link showing the different hernias in the inguinal area.

Inguinal hernia symptoms

There is a local piercing pain when a hernia suddenly enlarges. As the ilioinguinal nerve, which is located near the hernia, gets irritated, there can be severe abdominal 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.

 Inguinal Hernia

Inguinal Hernia

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 Following this the instruments are withdrawn and the patient can go home either on the same day or the following day.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!

 

References

1. DM Thompson: The 46th 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.

9. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

Last modified: September 9, 2015

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.