Introduction

Definition
Inguinal hernias occur when soft tissue — usually part of the intestine — protrudes
through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful
— especially when you cough, bend over or lift a heavy object. An inguinal hernia occurs when
tissue pushes through a weak spot in your groin muscle. This causes a bulge in the groin or
scrotum. The bulge may hurt or burn.

Cause
Most inguinal hernias happen because an opening in the muscle wall does not close as it
should before birth. That leaves a weak area in the belly muscle. Pressure on that area can
cause tissue to push through and bulge out. A hernia can occur soon after birth or much later in
life.

You are more likely to get a hernia if you are overweight or you do a lot of lifting,
coughing, or straining. Hernias are more common in men. A woman may get a hernia while she
is pregnant because of the pressure on her belly wall.

Sign and Symptom

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels
like a round lump. The bulge may form over a period of weeks or months. Or it may appear all
of a sudden after you have been lifting heavy weights, coughing, bending, straining, or laughing.
The hernia may be painful, but some hernias cause a bulge without pain.

A hernia also may cause swelling and a feeling of heaviness, tugging, or burning in the
area of the hernia. These symptoms may get better when you lie down.

Sudden pain, nausea, and vomiting are signs that a part of your intestine may have
become trapped in the hernia. Call your doctor if you have a hernia and have these symptoms.

Risk Factors
You're far more likely to develop an inguinal hernia if you're male. Nearly 10 times more
men than women have inguinal hernias, and the vast majority of newborns and children with
inguinal hernias are boys.

Other risk factors include:

 Family history. Your risk of inguinal hernia increases if you have a close relative, such as
a parent or sibling, with the condition.
  Certain medical conditions. Having cystic fibrosis, a life-threatening disorder that causes
severe lung damage and often a chronic cough, makes it more likely you'll develop an
inguinal hernia.
 Chronic cough. A chronic cough, such as occurs from smoking, increases your risk of
inguinal hernia.
 Chronic constipation. This leads to straining during bowel movements — a common
cause of inguinal hernias.
 Excess weight. Being moderately to severely overweight can put extra pressure on your
abdomen.
 Pregnancy. This can both weaken the abdominal muscles and cause increased pressure
inside your abdomen.
 Certain occupations. Having a job that requires standing for long periods or doing heavy
physical labor increases your risk of developing an inguinal hernia.
 Premature birth. Infants who are born sooner than normal are more likely to have
inguinal hernias.
 History of hernias. If you've had one inguinal hernia, it's much more likely that you'll
eventually develop another — usually on the opposite side.

Complication
Most inguinal hernias enlarge over time if they're not repaired surgically. Large hernias can
put pressure on surrounding tissues — in men they may extend into the scrotum, causing pain
and swelling.

But the most serious complication of an inguinal hernia occurs when a loop of intestine
becomes trapped in the weak point in the abdominal wall (incarcerated hernia). This may
obstruct the bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel
movement or pass gas.

It can also diminish blood flow to the trapped portion of the intestine — a condition called
strangulation — that may lead to the death of the affected bowel tissues. A strangulated hernia
is life-threatening and requires immediate surgery.

Treatment
A doctor can usually know if you have a hernia based on your symptoms and a physical
exam. The bulge is usually easy to feel.

If you have a hernia, it will not heal on its own. Surgery is the only way to treat a hernia.

If your hernia does not bother you, you most likely can wait to have surgery. Your hernia
may get worse, but it may not. In some cases, hernias that are small and painless may never
need to be repaired.
 Most people with hernias have surgery to repair them, even if they do not have
symptoms. This is because many doctors believe surgery is less dangerous than strangulation, a
serious problem that occurs when part of your intestine gets trapped inside the hernia.

But you may not need surgery right away. If the hernia is small and painless and you can
push it back into your belly, you may be able to wait.

Babies and young children are more likely to have tissue get trapped in a hernia. If your
child has a hernia, he or she will need surgery to repair it.
Exam: Whole Abdomen 08/20/09
Clinical Data
Reports:

Result Normal Significance

GB intraluminal 2.3cm 4.0cm
diameter
GB wall thickness 0.3cm 0.4cm
Common duct 0.2cm 0.6cm
Liver span 16.5
Spleen 10.6X5.5cm
Pancreas 2.1X1.4X2.6cm
Pancreatic duct 0.2cm
Right Kidney 10.9X5.5X4.3cm LWH
Cortical thickness 1.9cm
Left Kidney 11.5X5.8X5.8cm LWH
Cortical thickness 1.7cm
Uterus __cm
Right Ovary 2.5X2.7cm
Left Ovary __cm

Elaborations: (Abnormal findings/Areas of concern)

The liver is mildly enlarged. Configuration & lobar proportion are within physiologic range.
Parenchymal echogenicity is mild to moderately increased. Parenchymal ecotexture is
homogenous with no solid masses or cystic lesions. The hepatic are of normal course and
caliber.

The structure and left ovary are surgically absent. The right ovary is physiologic in appearance.
No definite abnormal solid masses or cystic lesions are noted in the pelvic cavity.

The bulging in the right anterior perineal region labeal level is d/t a blind ending saccular
structure with mildly echogenic, approximately the appearance of fatty tissue. This finding is
also seen in the left, but it is less pronounced. Compression study shows reduction of the
herniated fatty lesions possibly emental fat.

Conclusion:
>Consider bilateral anterior perineal hernia, labial level, more pronounced in the right
composed of non-specific fatty tissue.
>Unremarkable GB, CBD & biliary radicles.
> Mild to moderate degree of fatty changewith resultant mild increase in liver dimensions
Essentially normal kidneys, spleen & pancreas
S/P TAHLSO; physiologic appearance of the right ovary
>structurally unremarkable urinary bladder
>structurally unremarkable aorta with no evidence of aneurismal dilatation of significant
atheroslerostic plaque formation

Exam: Whole Abdomen 01/08/08

Clinical Data
Reports:
Result Normal Value
GB intraluminal diameter 2..24cm 4.0cm
GB wall thickness 0.10cm 0.4cm
Common duct 0.29cm 0.6cm
Pancreas 2.01X0.81X1.30
Pancreatic duct 0.2cm
Liver Span 13.04cm
Spleen 8.06X7.97cm
Right Kidney 9.98X3.89X6.47
Left Kidney 9.85X4.13X5.14cm LWH
Cortical thickness RR:1.06cm
LR:1.30cm
Right Ovary Observed by
overloading bowel gas
Left Ovary Observed by
overloading bowel gas
Abdominal Aorta 148cm

System/Organ ______

GB, biliary is normal

Liver – The liver is normal in size. Configuration and lobar proportion are ____ physiologic
range. Parenchymal echogenicity is mildy and diffusely increased with resultant increase
alternation. Echotexture in fairly homogenous. No definite abnormal _______ ____ or cystic
lesions are seen which the ____ parenchymal. Hepatic veins are non elastic.

Pancreas Normal
Spleen Normal
Kidney Normal
Urinary Bladder Normal
Uterus The uterus is surgically
Ovaries The uterus is surgically

-observed by ____ bowel

-no gross pelvic masses seen
Chemical Chemistry Test 05/27/09 9:59am

Result Normal Value Significance

Glucose 89 60-110 Within normal
limits
Creatinine 0.6 0.6-1.5 Within normal
limits
Cholesterol 219 150-240 Within normal
limits
Triglycerides 143 45-150 Within normal
limits
VLDL 28.6 0-40 Within normal
limits
LDL 139.3 0-150 Within normal
limits
HDL 51.1 30-90 Within normal
limits

CBC 01/08/08 3:18pm

TEST Result Normal Value Significance

WBC 10.70 4.8-10.8 Within
normal
findings
RBC 3.98 4.2-5.4 anemia
Hemoglobin 11.9 12-16 Polycythemia
dehydration
Hematocrit 36.5 37-47 Polycythemia
dehydration
MCV 92 81-99 Within
normal
findings
MCH 29.9 27-31 Within
normal
findings
MCHC 32.6 33-37 Intravascular
hemolysis
Platelet 360 130-400 Within
normal
 findings
RDW 13.1 11-16 Within
normal
findings
PDW 12.5 9-14 Within
normal
findings
MPV 7.8 7.2-11.1 Within
normal
findings

Date:October 27, 2004

Operation: Total Abdominal Hysterectomy Left Salphingo – Oophorectomy

Postop - Total Abdominal Hysterectomy Left Salphingo – Oophorectomy
Time: 11:55 Ended:1:45
Technique of Operation:
Epidural Spinal Anesthesia inducted and maintained. Patient was then placed on dorsal spine
position operative field aseptically prepared & draped. An intraumbilical midline incision was
done on the skin using a knife. This was deepened down to the subcutaneous fat & fascia.
Peritoneum was tented & entered. Pathology indentified.

Intra-op Findings:
Uterus: Regularly enlarged to 16 weeks. Size A 10X10cm intramural myomatous mass was
noted deviating the uterus towards the left. On section, the endometrium is thin and smooth.
Cervix: grossly normal
Left Ovary: grossly normal; adherent to the fundus
Right Ovary: grossly normal
Right and Left: grossly normal
Appendix: Grossly normal

Urinary Analysis 01/08/2008

Macroscopic
Result Normal Values Significance
Color light yellow Straw/amber Within normal
findings
Character clear clear Within normal
findings
pH 6.4 4.6-8.0 Within normal
findings
 Specific Gravity 1.014 1.005-1.030 Within normal
findings
Albumin Negative negative Within normal
findings

Macroscopic (per hpf)

WBC: 0-1 0-5 Within normal
findings
RBC: 0-1 0-5 Within normal
findings
Epithelial Cells: 0-2 rare
Bacteria: none rare

Urinary Analysis
05/27/2008

Physical Characteristics
Result Normal Values Significance
Color yellow Straw/amber Within normal
findings
Transparency: blazy clear Within normal
findings
pH 5.0 4.6-8.0 Within normal
findings
Specific Gravity 1.025 1.005-1.030 Within normal
findings

01-28-09
Reports:
The bulging in the right perineal region/labial level echoes within which approximates
the appearance of fatty tissues. This findings is also see in the left, but to a lesser degree.
Compression study shows reduction of the herniated fatty tissue/mental fat.

Conclusion:
Consider bilateral anterior perineal hernia, labia level, more pronounced in the right
size, composed of non specific fatty tissue.

Ultrasound Report 01/08/08

Conclusion:
 Normal sized of liver with mild degree of diffuse fatty change.
Unremarkable GB, CBO and biliary radicles.
Essentially normal kidneys, pancreas and spleen.
S/P TAH
Unremarkable
Structurally unremarkable urinary bladder.
Normal abdominal aorta

The Anatomy of HERNIA

  
The most common location for hernia is the abdomen. The abdominal wall -
a sheet of tough muscle and tendon that runs
down from the ribs to the legs at the groins -
acts as 'nature's corset'. Its function, amongst
other things, is to hold in the abdominal
contents, principally the intestines.

If a weakness should open up in that wall, and

it does not really matter how or why it
happened (more on this later), then the
'CORSET EFFECT' is lost and what pushes
against it from the inside (the intestines)
simply pushes through the 'window'. The
ensuing bulge, which is often quite visible
against the skin, is the hernia.

These 'windows of weakness' commonly

occur where there are natural weaknesses in our abdominal wall - such as
where the 'plumbing' goes through it. Examples of these are the canals
(inguinal and femoral) which allow passage of vessels down to the scrotum
and the legs, respectively. The umbilical area (navel) is another area of
natural weakness frequently prone to hernia. Another area of potential
weakness can be the site(s) of any previous abdominal surgery.

How do Hernias happen?

The wall of the abdomen, comprising muscle and tendon, performs several functions, one of
which is to provide strong support to the internal organs which are exerting significant outward
pressure. The opening of a gap in the tissue can occur of its own accord at a point of natural
weakness, or by over-stretching a part of the tissue. Overexertion can cause it, but so could a
simple cough or sneeze.
The occurrence of the gap in the abdominal wall is not normally, of itself, a problem. The
problems result from the ensuing bulge of intestine through the gap. The effects felt by the
patient can range from being perfectly painless, through discomfort, to being very painful
indeed.

Almost every movement we make puts additional pressure on the internal tissues which, in
turn, push out through the opening a little more each time. This also enlarges the opening itself.
If unchecked, this process can continue even to the extent of allowing much of the intestine to
hang down through the hernia.