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HERNIA Part 02

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Clinical presentation

  1. contributing factors
    • obesity, chronic cough, pregnancy, constipation,straining on urination, ascites, activities which increase intra-abdominal pressure
    • previous hernia repair
  2. groin mass of variable size
  3. develops insidiously in most cases
    • occasionally precipitated by single forceful muscular event
  4. associated discomfort
    • worse at end of day
    • relieved at night when patient reclines and hernia reduces
    • relieved with manual reduction
  5. +/- obstruction
  6. +/- local tenderness
  7. must examine patient in both supine and standing positions
  8. hernial sac and contents enlarge and transmit palpable impulse when patient coughs or strains
  9. may auscultate bowel sounds
  10. unable to “get above” groin mass with palpation
  11. mass does not transilluminate
  12. strangulation results in
    • intense pain followed by tenderness
    • intestinal obstruction
    • gangrenous bowelsepsis
    • a surgical emergency
    • small, new hernias more likely to strangulate
  13. do not attempt to manually reduce hernia if sepsis present  or contents of hernial sac thought to be gangrenous

 

Treatment

  1. surgical: goals are to prevent strangulation, eviscerations
    and for cosmetics
  2. indirect hernias - principle of repair is high ligation of sac and tightening of the internal ring
  3. direct hernias - principle of repair is to rebuild Hesselbach's triangle: need good fascia or a prosthesis
  4. femoral hernias - principle of repair is to remove sac of fat and close the femoral canal with sutures

 

Postoperative complications

  1. scrotal hematoma
  2. deep bleeding - may enter retroperitoneal space and not be initially apparent
  3. difficulty voiding
  4. painful scrotal swelling from compromised venous return of testes
  5. neuroma/neuritis
  6. stenosis/occlusion of femoral vein when treating femoral hernias causing acute leg swelling

 

Prognosis (inguinal hernia repair)

  1. indirect: < 1% risk of recurrence
  2. direct: 3-4% risk of recurrence
HERNIA Part 02 HERNIA Part 02 Reviewed by Radiology Madeeasy on August 29, 2010 Rating: 5
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