Inguinal hernia

Inguinal hernia

Done by:

Dr. Kawther A Alsadady.

Supervised by :

Prof. Ahmad K. Elbana.

Faculty of Medicine

Dar Al Uloom University

What Is hernia ?

When part of an organ protrudes through an abnormal

opening or in an abnormal way, this is called a hernia.

A groin (inguinal) hernia occurs when part of the

intestine bulges through a weak spot in the abdominal

wall at the inguinal canal.

Inguinal hernias are up to 10 times more common in

men than in women.

Sites of Hernia

Inguinal canal :

The inguinal canal is a passageway

through the abdominal wall from

superficial to deep inguinal ring.

1- Superficial Inguinal Ring:

- It is triangular aperture in the

aponeurosis of the external

oblique muscle

- lie 1.25 cm above the pubic

tubercle.

2- Deep Inguinal Ring:

- It is U shape

condensation of

transversalis fascia

- it lies 1.25 cm above

inguinal ligament.

Types of inguinal hernia ?

1- direct Inguinal hernia :

Who ?

Direct inguinal hernia become more common in

the elderly.

Where ?

A direct inguinal hernia comes out directly

forward through posterior wall of inguinal

canal.

When ?

This occurs when a portion of the intestine

protrudes through a weakness in the abdominal

muscles along the wall of the inguinal canal.

2- Indirect Inguinal hernia :

who ?

Is most common hernia of all especially in young

children.

where ?

An indirect hernia travels down the canal on the outer (Lateral & anterior) side of spermatic cord.

When ?

This occurs when the internal opening of the inguinal canal, which usually closes around the time of birth, remains open. This allows a portion of the intestine to slip through the inguinal canal.

Inguinal hernia signs and symptoms in Adult

include: 1. A bulge in the area on either side of your

pubic bone

2. A burning, gurgling or aching sensation at the

bulge

3. Pain or discomfort in your groin, especially

when bending over, coughing or lifting

4. A heavy or dragging sensation in your groin

5. Weakness or pressure in your groin

6. Occasionally, pain and swelling around the

testicles when the protruding intestine

descends into the scrotum

Signs and symptoms in children :

Inguinal hernias in newborns and children result from a

weakness in the abdominal wall that's present at birth.

Sometimes the hernia may be visible only when an

infant is crying, coughing or straining during a bowel

movement. In an older child, a hernia is likely to be

more apparent when the child coughs, strains during a

bowel movement or stands for a long period of time

1. Increased pressure within the abdomen .

2. A pre-existing weak spot in the abdominal wall .

3. A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall .

4. Straining during bowel movements or urination .

5. Heavy lifting .

6. Fluid in the abdomen (ascites) .

7. Pregnancy .

8. Excess weight .

9. Chronic coughing or sneezing .

Treatment :1- Herniorrhaphy

In this procedure, also called an open hernia repair, the surgeon

makes an incision in your groin and pushes the protruding

omentum or intestine back into your abdomen. The surgeon then

sews together the weakened or torn muscle. The weak area

often is reinforced and supported with a synthetic mesh

(hernioplasty).

After the surgery, four to six weeks before you're fully able to resume your normal activities

Herniorrhaphy

2- Laparoscopy

In this minimally invasive procedure, the surgeon

operates through several small incisions in your

abdomen. A small tube equipped with a tiny camera

(laparoscope) is inserted into one incision. Guided by

the camera, the surgeon inserts tiny instruments

through another incision to repair the hernia using

synthetic mesh.

Laproscope

References :

• Clinical anatomy by region for Snell

• Mayo clinic.org

• inguinalherniatreatment.co.uk

• Webmd.com