Overview
Definition
A protrusion of abdominal cavity contents (usually bowel or omentum) through the inguinal canal.
Epidemiology
Very common, affecting up to 25% of men in their lifetime. Indirect hernias are the most common type in both sexes.
Etiology & Risk Factors
- Indirect: Protrudes through the deep inguinal ring (lateral to the inferior epigastric vessels) due to a patent processus vaginalis (congenital).
- Direct: Protrudes directly through the posterior wall of the inguinal canal (Hesselbach's triangle, medial to the inferior epigastric vessels) due to acquired weakness in the transversalis fascia.
Clinical Symptoms
- A bulge in the groin or scrotum that may become more prominent with coughing or straining (Valsalva)
- Aching pain or heaviness in the groin
- If Incarcerated: Painful, irreducible bulge, nausea/vomiting
- If Strangulated: Severe pain, erythema overlying the skin, systemic toxicity (ischemia)
Clinical Approach
Diagnosis
- Clinical diagnosis: Physical exam showing a palpable bulge in the groin that increases with Valsalva
- Ultrasound or CT can be used if the diagnosis is unclear or to evaluate for complications
Management
- Watchful waiting: For asymptomatic, reducible hernias
- Elective Herniorrhaphy (Surgical repair): Usually with mesh, for symptomatic hernias
- EMERGENT Surgery: Required for incarcerated or strangulated hernias
Complications
- Incarceration (inability to reduce the hernia)
- Strangulation (compromised blood supply leading to bowel necrosis)