Overview Snapshot A 54-year-old male comes to the emergency room with right-sided groin pain, swelling, colicky abdominal pain and abdominal distension, nausea and 2 episodes of vomiting. He had been having intermittent pain and swelling in the right groin for 2 years always triggered by straining during defecation. He recalls that on all previous occasions, the swelling was reduced with gentle finger massage. However, finger massage was ineffective this time. He has a 20 pack-year smoking history. Examination reveals an overweight male with abdominal distension. There is a red, tender swelling in his right groin, descending into his right scrotum. Radiographs reveal dilated small bowel loops. He was diagnosed with an incarcerated, obstructed,indirect right inguinal hernia. Introduction Clinical definition a hernia is a protrusion of an organ (or a portion of the organ) through a body wall can be congenital or acquired login to view 2 more bullets Epidemiology Inguinal hernia incidence of all hernias, approximately 75% are inguinal with login to view 2 more bullets demographics more common in men risk factors aging male sex increased intra-abdominal pressure secondary to login to view 3 more bullets family history smoking prior history of hernia prior history of hernia repair Femoral hernia incidence 3-5% of all hernias are femoral hernias demographics more common in women risk factors look at risk factors for inguinal hernias above Umbilical hernia incidence approximately 14% of all hernias are umbilical hernias demographics premature children in adults, it is more common in women risk factors prematurity African American race low birth weight congenital syndromes such as login to view 2 more bullets Inguinal and Femoral Hernia Pathophysiology pathoanatomy indirect inguinal hernia login to view 1 more bullet direct inguinal hernia login to view 5 more bullets femoral hernia login to view 2 more bullets Presentation symptoms asymptomatic localized pain heavy sensation in the groin hernia may worsen with activities that increase intra-abdominal pressure physical exam groin fullness/swelling in cases of strangulated hernia the patient may present with login to view 1 more bullet provocative tests login to view 1 more bullet Imaging ultrasonography indication login to view 1 more bullet Studies diagnostic criteria in the majority of cases, inguinal hernias can be diagnosed clincially Treatment conservative watchful waiting login to view 2 more bullets operative surgical repair login to view 4 more bullets Umbilical Hernia Pathophysiology pathoanatomy failure to spontaneous close the umbilical ring Presentation symptoms painless protrusion of the umbilicus in the infant or child strangulation login to view 1 more bullet physical exam a reducible mass of the umbilicus Studies diagnostic criteria a clinical diagnosis Treatment conservative watchful waiting login to view 2 more bullets operative surgical repair login to view 3 more bullets Differential Diagnoses Hydrocele Varicocele Lipoma Testicular torsion Epididymitis Inguinal adenopathy Groin abscess Complications Complications include incarcerated or obstructed bowel strangulated bowel (vascular compromise) reduction of strangulated bowel may lead to reduction of ischemic bowel into peritoneal cavity, resulting in perforation