INGUINAL HERNIA (ADULT)

This is usually an acquired condition and is often linked with activity associated with increase of abdominal pressure.

Complications

  • Obstruction (when a hollow viscus goes through a ring of variable size and cannot be reduced)
  • Incarceration (when non-hollow organ for example omentum, goes through a ring of variable size and
    cannot be reduced).
  • Strangulation is a process in which blood flow into the obstructed viscus is compromised, and if not corrected culminates in ischaemia of the viscus supplied by the involved blood vessels. Pain and tenderness over the hernial area are ominous signs. Sudden change from reducible to irreducible status especially if discolouration of tissues over the area is present is an ominous sign.

Clinical Features

  • Protrusion in the groin region, initially on straining and later may be spontaneous.
  • There may also be a nagging or painful sensation in the groin or a strangulated
  • Painful groin mass.

Examination

  • Observation of the bulge with the patient coughing while standing and when lying down, and with a finger invaginated into the external ring, repeating the same examinations.
  • This examination is able to differentiate femoral from inguinal hernia.
  • There is no great advantage of differentiating indirect from direct inguinal hernia, pre-operatively.

Management

Admit for

  • Emergency surgery if obstructed or incarcerated.
    • Urgent surgery for children under 1 year.
    • Elective admission for others.
  • Emergency surgery after resuscitation (if emergency surgery is not possible at the hospital refer).
  • Preoperative preparation as for the preoperative section.
  • In strangulation, with obstruction of viscus, especially bowel the usual resuscitative measures are carried out/continued before and after surgery.
  • Elective surgery for non complicated cases.
  • Surgical repair is necessary for all inguinal hernias.
  • Umbilical, incisional, and lumbar hernias require similar treatment as above