When part of an internal organ protrudes through an abnormal opening in the containing wall of its cavity, a hernia results. In an inguinal hernia - the most common type - the large or small intestine, omentum, or bladder protrudes into the inguinal canal.
Hernias can be reducible (if the hernia can be manipulated back into place with relative ease); incarcerated (if the hernia can't be reduced because adhesions have formed in the hernial sac); or strangulated (if part of the herniated intestine becomes twisted or edematous, causing serious complications).
Inguinal hernias can be direct (herniation through an area of muscle weakness in the inguinal canal) or indirect (herniation through the inguinal ring). Indirect hernias, the more common form, can develop at any age but are especially prevalent in infants under age 1. This form is three times more common in males.
A hernia occurs when there's a weakness in the muscles or tissues, which allows the internal organs to push through.
An inguinal hernia results when a structure called the inguinal canal doesn't close properly after birth. This is the tube through which the testes descend from inside the abdomen into the groin during development in the womb. If the inguinal canal remains open, other abdominal contents can also pass down it.
Inherited factors may be important, especially in umbilical hernias, and other family members are often affected.
Signs and Symptoms
The patient history may reveal precipitating factors, such as weight lifting, recent pregnancy, and excessive coughing. Usually, the patient reports the appearance of a lump in the inguinal area when he stand or strains. He may also complain of sharp, steady groin pain, which tends to worsen when tension is placed on the hernia and improve when the hernia is reduced.
If the patient has a large hernia, inspection may reveal an obvious swelling in the inguinal area. If he has a small hernia, the affected area may simply appear full. As part of your inspection, have the patient lie down. If the hernia disappears, it's reducible. Also ask him to perform Valsalva's maneuver; while he does so, inspect the inguinal area for characteristic, bulging.
Auscultation should reveal bowel sounds. The absence of bowel sounds may indicate incarceration or strangulation. Palpation helps to determine the size of an obvious hernia. It also can disclose the presence of a hernia in a male patient.
Although assessment findings are the cornerstone of diagnosis, suspected bowel obstruction requires X-raysand a white blood cell count, which may be elevated.
The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result, from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. (A truss is a firm pad with a belt attached that is placed over the hernia to keep it reduced.) Although a truss doesn't cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous.
Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which inwives reinforcing the weakened area with steel mesh, fascia, or wire.
A strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require, a temporary colostomy.
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