Flashcards in Hernias Deck (13):
28-year-old man presents with pain in groin. Likely cause if physical exam reveals:
1. Firm, tender mass in medial portion of groin
2. Tender area in the lateral portion of the groin and impulse the travels down inguinal canal when coughing
3. Firm, tender mass below inguinal ligament
4. Firm, tender mass with nausea, vomiting, and abdominal distention
5. Large, soft mass in scrotum, separate from the testicle, with fullness in inguinal canal
6. Large, soft mass and scrotum, separate from the testicle, with the fullness in the inguinal canal that can be pushed back into abdomen
7. Firm, tender mass with fever, leukocytosis, and acidosis
1. Direct inguinal hernia
2. Indirect hernia
3. Femoral hernia
4. Incarcerated or strangled intestine and hernia
5. Bowel in scrotum
6. Reducible Indirect hernia that has extended into scrotum
7. Strangulated segment of bowel
28-year-old presents with pain in groin. Interpretation if:
1. Several 1 cm tender lymph nodes
2. Acutely tender testicle that began suddenly
3. Acutely tender testicle that began insidiously
4. Acutely tender epididymis
1. Lymphadenitis likely from malignancy in groin/leg/foot
2. Torsion of testes.
3. Viral orchitis or epididymitis
Types of hernias that are most likely to be strangulated?
Characteristic of a hernia that increases risk of strangulation?
Femoral hernias >indirect hernias >direct hernias
Direct versus indirect hernia?
Weakness in floor of the canal, originates medially to inferior epigastric vessels
Intact posterior surface, originates at the internal ring and traverses down inguinal canal
INdirect hernia into INguinal canal
Conditions that can lead to a hernia?
Anything that increases intra-abdominal pressure – COPD, ascites, obesity, BPH/bowel obstruction (increased straining)
Types of open repairs for hernia?
1. Bassini repair – reconstruction of posterior inguinal canal and suturing of superior abdominal wall to inguinal ligament
2. McVay (Cooper's ligament) repair – suture transversalis fascia to Cooper's ligament (periosteum of the pubic ramus)
3. Shouldice Repair - attach reinforced transversalis fascia to inguinal ligament in two layers
4. Liechtenstein repair – uses prosthetic mesh to approximate superior abdominal wall structures to inguinal ligament
Cooper's ligament repair – most useful for?
Major weakness of the Bassini repair?
Femoral hernias and attenuated inguinal ligaments
Increased Tension – likely to fail with poor tissue
Principal complication of hernia repair? Likelihood?(What specifically affected ?)
Nerves or nearby structures
Genitofemoral, ilioinguinal, iliohypogastric, and lateral femoral cutaneous nerves
During hernia surgery – most important structures to identify and preserve?
Ilioinguinal nerve and spermatic cord
Pediatric versus adult inguinal hernia?
1. Usually due to Persistent patent processes vaginalis
2. High incidence of bilaterality
3. Involve no defect in the floor of the inguinal canal
Femoral hernia Borders?
Anterior – iliopubic tract (reflection of inguinal ligament)
Posterior – Cooper's ligaments
Medial – pubic tubercle
Lateral – femoral vein
Sliding hernia? Most commonly seen with what type of hernia? Common organs involved?
Hernias involving other structures
Bladder, cecum, sigmoid colon