Signs & symptoms

Complications

of
Inguinal Hernia

K.
Clinical classification of Inguinal Hernia

Reducible
Irreducible
Obstructed
Inflamed
 Anatomical classification of Inguinal Hernia
Direct
Indirect

Classification of Inguinal Hernia

(according to the extent)
Incomplete
Complete
Indirect(Oblique) inguinal hernia

This is the most common type of hernia.

This is more common in younger age group, as
compared to the direct inguinal hernia which is more
common in the older age group.
Bilateral or unilateral
Sac is thin, Neck is narrow, Hernia lies lateral to the
inferior epigastric vessels.
Coverings (from inside to out)

Extraperitoneal tissue
Internal spermatic fascia
Cremasteric fascia
External spermatic fascia
Skin
 Precipitating causes
Smoking
Obesity
Respiratory causes like bronchial asthma, tuberculosis, bronchitis.
Ascites
Appendicectomy
Chronic constipation
Urinary problems like BPH, stricture urethra
Multiple pregnancies
Types

Bubonocoele Limited to inguinal canal

Funicular Processus vaginalis is closed

just above the epididymis.

Complete Pesistent processus

vaginalis
 Direct inguinal hernia

10-15 % of the hernias are direct.

50% of the direct hernias are bilateral.
35% of the inguinal hernias are direct.
Due to the weakening of the posterior wall of the inguinal
canal.(Hesselbalchs triangle)
Sac is thick, Hernia lies medial to the inferior epigastric vessels.
Classified into medial and lateral by medial umbilical ligament.
(Obliterated umbilical artery)
Coverings (from inside to out)

Extraperitoneal tissue
Transversalis fascia
Conjoint tendon
External spermatic fascia
Skin
Predisposing factors

Chronic cough
Smoking
Constipation
Heavy work
Previous appendicectomy

Malgaigne bulges
 Clinical features Symptoms

Pain- dragging
Swelling in the groin better seen on coughing and standing
Usually reducible
Signs

Deep ring occlusion test

Ring invagination test
Ziemans test
Head or leg raising test
Per rectal examination
Complications

Incarceration
When a part of the fat or small intestion from inside the abdomen
becomes stuck in the groin or scrotum and cannot go back to the
abdomen.

Stangulation
When the incarcerated hernia is not treated, the blood supply to the
small intestine may become obstructed causing strangulation of the
small intestine.(Surgical Emergency)
Symptoms of strangulation

Extreme tenderness or painful redness in the area

of the bulge in the groin.
Sudden pain that worsens and does not go away.
Inability to have bowel movements and passing
gas.
Nausea, Vomiting, Fever.