About hernia

HERNIA,WHAT IS IT?

A hernia is an abnormal protrusion of an organ or tissue through a body wall, usually the abdominal wall. The most common type of abdominal hernia occurs in the groin (inguinal hernia). An inguinal hernia occurs when part of the abdominal contents, usually a loop of intestine, bulges through a weakness or abnormal opening in the abdominal wall. The abdominal wall is relatively weak at the groin (where the lower abdomen meets the thigh). Three distinct locations in the groin are associated with three different types of hernia: indirect inguinal, direct inguinal, and femoral. Indirect inguinal hernias are the most common, a result of normal fetal development. In males, the testes, initially located in the abdomen, descend into the scrotum through the inguinal canal. This canal then normally closes off, with only the spermatic cord remaining. In females, only a small fibrous ligament passes through the canal. In some people, the canal does not close off tightly. By early adulthood, increased pressure inside the abdomen, as during strenuous activity, may force it open, forming a hernial sac that protrudes into the canal alongside the spermatic cord. As the hernia enlarges, it may extend into the scrotum, or for women, into the groin.A direct inguinal hernia, in contrast, is acquired later in life. The hernia bulges directly through a weakened abdominal wall adjacent to the canal. The weakening usually results from a combination of aging and increased abdominal pressure, as from chronic coughing or straining. This type of hernia is seen most commonly after age 40. Both direct and indirect inguinal hernias occur more often in men.Femoral hernias are much more likely to affect women. In a femoral hernia, the hernial protrudes downward through the opening where large blood vessels (the femoral artery and vein) pass into the thigh. Besides the different anatomical types, hernias also are described as reducible or incarcerated. A reducible hernia is one in which the protruding loop of intestine can be pushed back into the abdomen by a finger. In an incarcerated hernia, the loop of intestine has become trapped so it cannot be put back without surgery.Any condition that increases pressure in the abdomen (such as obesity, chronic cough, or chronic straining) may encourage the development of a hernia. Hernias often occur as a complication of an enlarged prostate gland (prostatic hypertrophy) as a result of straining at urination. Hernias are also seen in individuals with colon cancer or any other cause of chronic constipation. Pregnancy may be a contributing factor

HOW IS IT DIAGNOSED?

History is of a swelling in the groin. It may be painless, or discomfort may be reported with straining or coughing. It may or may not be associated with an episode of heavy lifting.Physical exam: A bulge or swelling appears in the groin or scrotum (or upper thigh, in a femoral hernia), particularly with straining or coughing. The type of hernia can often, but not always, be determined by examining with a finger; the exact diagnosis is confirmed at the time of surgery. Tests are not needed in this diagnosis, but laparoscopy may be useful in rare cases.

HOW IS IT TREATED?

Surgical repair is the only definitive treatment. In uncomplicated cases, an indirect or femoral hernia can be repaired under local anesthesia in an outpatient setting.

WHAT MIGHT COMPLICATE IT?

Indirect and femoral hernias can become trapped (incarcerated) and lead to intestinal obstruction and/or become strangulated (which may lead to gangrene) because the hernial sac passes through a narrow opening. A strangulated hernia is a surgical emergency. Immediate surgery is required to prevent death of the trapped loop of intestine because its blood supply is severely compressed. Recurrence of the hernia is another possible complication.
WHAT IS THE PREDICTED OUTCOME?

In most cases, complete recovery is expected after hernia repair. A percentage of hernias recur, sometimes after many years. The likelihood of recurrence depends on the size and severity of the hernia, history of any previous recurrence, presence of predisposing factors, and the surgical technique. If during surgery the risk of recurrence is felt to be high, it may be lessened by using a synthetic patch to repair the abdominal wall.
WHAT ELSE MIGHT IT BE?

Hernias must be distinguished from other conditions like hydrocele, spermatocele, varicocele, enlarged inguinal lymph nodes, epididymitis, orchitis, testicular tumors, that cause pain or swelling of the groin or scrotum
user posted image