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INGUINAL HERNIA

Inguinal Hernias are very common and according to Gardner and Boyd (2008), “Groin
hernias are the most common clinical problem addressed by surgeons, with more than
700,000 repairs performed annually in the United States alone” (p. 35). We not only need
to recognize the different types of hernias, but also to be more knowledgeable of the
condition in order to determine the surgical cases, consulting to General surgery and the
education of our patients. Defined by Gardner and Boyd (2008), “The word hernia
comes from the Latin for rupture and the Greek for bud” (p. 35).

Hernias present themselves in a variety of ways and are defined by their anatomical
locations. Types of hernias include: Indirect, direct and femoral.
Gardner and Boyd (2008) report that:
Indirect hernias that occur in men are the result of a congenital defect called a
patent processus vaginalis. The processus vaginalis is an outpouching of the
peritoneum, which may be viewed much like the finger of a glove, that allows for
descent of the testicle into the scrotum, as directed by the gubernaculums, during
fetal development. The processus vaginalis typically closes by age 2 years in male
children, but retained patency is found in 20% of adult males, providing potential
for communication with the abdominal cavity. (35-36)

Direct hernias basically find a weakened area and protrude or bulge directly through
the abdominal wall-hence the type of hernia. Last but not least, the femoral hernia.
Femoral hernias are more common in females and almost 50 times more likely to
strangulate than any other type due to the location where the hernia presents itself. To
examine the anatomy and pathophysiology in more detail, click the following link:
http://jaapa.com/issues/j20080601/articles/hernia0608.htm.

Hernias can be asymptomatic and reducible which requires no surgery. However, they
can become incarcerated or strangulated which requires a different approach for
treatment. An incarcerated hernia is when the abdominal contents are slightly pinched,
held in place and non reducible. These patients are surgical and should be considered for
consult. According to Gardner and Boyd (2008), “In patients who present acutely with a
hernia, the greatest risk of strangulation is in the first 3 months” (p. 35). Strangulation is
exactly what it sounds like. The abdominal contents are no longer just pinched, but now
they are completely cut off from all blood supply.

Hernias are quite simple to diagnose. The patient’s history and a bulge found on
physical examination are the cornerstones for diagnosis. On rare occasion, an ultrasound
and/or CT scan could be ordered for those tough cases to diagnose. If strangulation is
suspected, a WBC should be ordered and a positive test will show an elevated count.
On physical exam, the patient might have a slight fever and erythema at the location of
concern. When in doubt, consult to a specialist!

Gardner, R., & Boyd, C. (2008). Examining modern approaches to inguinal and femoral
herniorrhaphy. Journal Of The American Academy of Physician Assistants. 21(6), 35-
41.

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