Abnormal protrusion of intra-abdominal contents

Reducible (uncomplicated)

  • ASX, vague abd/inguinal discomfort

  • Cough impulse (expands with cough)

Irreducible (complicated)

  • Incarcerated hernia

    • ± Bowel obstruction

    • Cough impulse

  • Strangulated (emergency)

    • Bowel obstruction

    • No cough impulse

    • Overlying skin tender, erythematous

  • DX: Clinical, US, CT

  • TX: Surgical repair

    • Complicated: open > laparoscopic

      • Hernioplasty (mesh)

      • Herniorrhaphy (autologous tissue)

Inguinal Hernia

Direct inguinal hernia

  • Directly though weak spot in Hesselbach's triangle

    • Inferior epigastric vessels, rectus abdominis, inguinal ligament

Indirect inguinal hernia

  • Incomplete obliteration (patent) of processus vaginalis

    • Through the internal (deep inguinal ring), "in" the spermatic cord

Invaginate scrotal skin and palpate external inguinal ring

Valsalva maneuver or cough ➔ expansion

Palpable bulge (felt laterally is indirect)