Inguinal Swellings 07

INGUINAL SWELLINGS BY DR ABDEL RAHMAN EL TAYEB MBBS, FRCS Eng, FRCS Edin

INGUINAL HERNIAS DEFINITION Protrusion of part of the

abdominal contents through the inguinal region of the abdominal wall

INGUINAL HERNIAS INCIDENCE Common throughout the world Accounts for approximately 75% of all

forms of hernias More common in males than females Slightly more on the right than the left side

INGUINAL HERNIAS CLASSIFICATION Indirect Direct Recurrent

INGUINAL HERNIALS DESCRIPTIVE DEFINITIONS REDUCIBLE: IRREDCIBLE:  Incarcerated: viable contents  strangulated: ischemic or necrotic

contents SLIDING (HERNIA-EN-GLISSADE): part of the wall of the sac may be colon on the left, caecum on the right, or bladder on either side

INGUINAL HERNIAS DESCRIPTIVE DEFINITIONS (cont.) Richter`s hernia: a hernia that has

strangulated part of the intestinal wall, without compromising the lumen Maydl`s hernia: a hernia containing two adjacent loops of small intestine with strangulation of the segment between the loops Littre`s hernia: a hernia containing a Meckel`s diverticulum 

INGUINAL HERNIA ANATOMY:

 

INGUINAL CANAL:  Direction Posterior wall Upper end Lower border Lower end Upper border Anterior



wall

INGUINAL HERNIA ANATOMY (Cont.) INGUINAL CANAL Length:

3-4 cm in adults

Contents: Males:

spermatic cord and ilioinguinal nerve Females: round ligament and ilioinguinal nerve 

INGUINAL HERNIA ANATOMY (Cont) INTERNAL INGUINAL RING Point at which the spermatic cord or

round ligament passes through the transversalis fascia to enter the inguinal canal U shaped sling Acts as a shutter Inferior epigastric vessels make its medial border 1.25 cm above the mid inguinal point

INGUINAL HERNIA ANATOMY (Cont.) EXTERNAL INGUINAL RING V shaped defect Apex of the V is super lateral Immediately above the pubic

tubercle

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INGUINAL HERNIA CLINICAL FEATURES SYMPTOMS Local symptoms Many hernias are painless, patient

present with a lump Pain or discomfort may be present before a lump is noticed Pain associated with irreducibility of a previously reducible hernia indicates strangulation 

INGUINAL HERNIA CLINICAL FEATURES (Cont.) SYSTEMIC SYMPTOMS Colicky abdominal pain, vomiting,

abdominal distention, and absolute constipation if the hernia causes intestinal obstruction

INGUINAL HERNIA FUNCTIONAL ENQUIRY Indications of abdominal

straining or raised intraabdominal pressure: persistent cough, difficulty with micturition and constipation

INGUINAL HERNIA SIGNS Reducible lump with Expansile cough impulse Above and medial to the

pubic tubercle  

INGUINAL HERNIA DIFFERENTIAL DIAGNOSIS Femoral hernia: below and lateral to

pubic tubercle Lymph node: no cough impulse Varicocele: Dilated veins in spermatic cord, visible with patient standing Cyst of canal of Nuck (females only): able to get above the lump Hydrocele of the cord(males only): not reducible Undescended testis: absent from scrotum

INGUINAL HERNIA TREATMENT ALL INGUINAL HERNIAS

SHOULD BE REPAIRED UNLESS THERE IS AN ABSOLUTE PERMANENT CONTRAINDICATION FOR SURGERY

INGUINAL HERNIA PRINCIPALS OF THE

OPERATION excision or reduction of the sac Repair of the posterior wall of the inguinal canal 