DIRECT INGUINAL HERNIA
BY : DONY FERNANDO
DEFINITION
A hernia is the abnormal exit of tissue or an organ, such as the bowel,
through the wall of the cavity in which it normally resides.[1]Hernias come
in a number of different types.
A direct inguinal hernia arises from protrusion of abdominal viscera
through a weakness of the posterior wall of the inguinal canal medial to
the inferior epigastric vessels, specifically through the Hesselbach's triangle.
TYPE OF HERNIA
CAUSES
Causes of hiatus hernia vary depending on each individual.
Examples include :
- obesity
- heavy lifting
- coughing
- straining during a bowel movement or urination,
- chronic lung disease, and
- fluid in the abdominal cavity
SIGN AND SYMPTOMPS
Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or
standing up. They are rarely painful, and the bulge commonly disappears on lying down. The inability to "reduce",
or place the bulge back into the abdomen usually means the hernia is 'incarcerated' which is a surgical
emergency.
Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).
As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend into the hernia
and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the
portion of the intestine caught in the hernia is compromised, the hernia is deemed "strangulated," and gut
ischemia and gangrene can result, with potentially fatal consequences
CLASSIFICATION
There are two types of inguinal hernia direct and indirect :
indirect inguinal hernia
herniates lateral and superior to the inferior epigastric vessels
do not displace the canal, instead seems to get into it
femoral hernia
exit bellow the inguinal ligament and caudal to the emergence of the inferior epigastric vessels
PREVENTION OF HERNIAS
Maintain a healthy weight.
Eat a healthy diet and exercise routinely to minimize the risk of constipation and straining to have a bowel
movement.
Use proper lifting techniques especially when trying to lift heavy objects. This is important to remember at work,
home, and in sports.
Stop smoking to decrease recurrent coughing.
If a hernia develops, seek medical care to have it evaluated and potentially treated before it gets too large or
becomes incarcerated.
TREATMENT AND PROGNOSIS
Treatment is surgical repair which consists of reduction of the sac
and reinforcement of the posterior wall of the inguinal canal
usually with a synthetic mesh.
COMPLICATIONS
A surgically treated hernia can lead to complications such as inguinodynia, while an untreated hernia may be
complicated by:
Inflammation
Obstruction of any lumen, such as bowel obstruction in intestinal hernias
Strangulation
Hydrocele of the hernial sac
Hemorrhage
Autoimmune problems
Irreducibility or Incarceration, in which it cannot be reduced, or pushed back into place,[18] at least not without
very much external effort.[19] In intestinal hernias, this also substantially increases the risk of bowel obstruction
and strangulation.
TERIMA KASIH
