A 67-year-old man presents to the emergency department complaining of excruciating right groin pain. On examination he found to have an incarcerate inguinal hernia. He undergoes an open hernia repair. This incision is taken down through the skin, Camper and fascia. What is the next layer?
External oblique aponeuroses
A 40-year-old man is undergoing an open inguinal hernia repair. After incising the skin and the external layer of subcutaneous fat, you see Scarpa’s fascia. If you were to follow Scarpa’s fascia medially to the scrotum, it would turn into which structure?
A 64-year-old woman is in the emergency room with signs and symptoms of a bowel obstruction. She has no history of prior abdominal operations. The symptoms/signs most consistent with the diagnosis of an obturator hernia would be:
Symptoms of intermittent bowel obstruction
A 25-year-old man comes to the office because of a bulge in his groin. He is otherwise healthy. On physical examination there is a reducible bulge, inferior to the inguinal ligament, medially at the top of the thigh. No bulge can be palpated at the external ring. Which of the following is the most likely diagnosis:
An 80 year-old man has a recurrent inguinal hernia. He has an incision close to his groin that he states was from a hernia that was fixed as a young adult. He bring you a copy of the operative report and it is unreadable except for the diagnosis of a Ricter’s hernia. What was most likely finding at a time of the first hernia repair?
A non-circumferential incarceration of bowel wall
A thin 18-year-old man is undergoing an appendectomy. An incision made 2-4 cm above the anterior superior iliac spine and runs parallel to the external oblique of the abdomen. The senior resident asks you to name the incision.
You are evaluating a 75-year-old man in your office with a moderate left-sided inguinal hernia. His past medical history is significant for laprascopic cholecystectomy, open radical prostratectomy, and thyroidectomy. Which of the following repairs is relative contraindication?
Total extraperitoneal laprascopic repair
A 54-year-old man comes to your office because of abdominal pain and distention. He has a long history of excessive alcohol consumption. On physical examination, he has severe scleral icterus. His abdomen is quite protuberant and mildly tender. He has a large umbilical hernia surrounded by engorged veins. How do you best explain these large abdominal wall veins?
High Blood pressure; portal vein blood is diverted to the lower pressure veins of the abdominal wall via the paraumbilical veins.
A 52 year old man is referred to you by his primary care physician for a possible hernia. The patient states that when he strains while doing sit ups on the floor he notices a bulge in the epigastric area. A CT scan ordered by family physician shows the entire transversalis fascia has thinned out but is intact. On examination he does sit up and indeed has a bulge in the epigastrium from the xiphoid to just below the umbilicus between the rectus muscles. Based on your exam and CT scan findings, what is the most likely diagnosis?
Diastasis Recti (large abdominal muscles separate)
A 76 year old woman is in the hospital recovering ten days following an emergency lapratomy for a perforated diverticulum. She has a history of pernicious anemia and cirrhosis secondary to chronic hepatitis C. On the fifth postoperative day she developed a wound infection and the skin staples were removed and the wound was packed open. The fascia was intact. She is now afebrile with normal vital signs and tolerating a soft diet. Her abdomen is non-tender and the wound is clean with some granulation tissue. Which of the following places her at greatest risk for incisional hernia formation?