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| {{CMG}}
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| {{Editor Help}}
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| ==Overview==
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| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Inguinal hernia | | | Name = Inguinal hernia | |
| ICD10 = {{ICD10|K|40||k|40}} |
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| ICD9 = {{ICD9|550}} |
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| Image = Inguinalhernia.gif | | | Image = Inguinalhernia.gif | |
| Caption = Diagram of an [[indirect inguinal hernia|indirect]], [[scrotum|scrotal]] [[inguinal hernia]] ( [[Anatomical position|median]] view from the left).| | | Caption = Diagram of an [[indirect inguinal hernia|indirect]], [[scrotum|scrotal]] [[inguinal hernia]] ( [[Anatomical position|median]] view from the left).| |
| ICDO = |
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| OMIM = |
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| DiseasesDB = 6806 |
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| MedlinePlus = 000960 |
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| eMedicineSubj = med |
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| eMedicineTopic = 2703 |
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| eMedicine_mult = {{eMedicine2|emerg|251}} {{eMedicine2|ped|2559}} |
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| MeshName = Hernia,+Inguinal |
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| MeshNumber = C06.405.293.249.437 |
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| }} | | }} |
| {{SI}} | | {{Inguinal hernia}} |
| '''Inguinal hernias''' ({{IPAEng|ɪnˈgwinəl ˈhɝniəz}}) are protrusions of [[abdominal cavity]] contents through the [[inguinal canal]]. They are very common and their repair is one of the most frequently performed [[surgery|surgical]] operations.
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| There are two types of inguinal [[hernia]], ''direct'' and ''indirect''. Direct inguinal hernias occur when abdominal contents herniate through a weak point in the fascia of the abdominal wall and into the inguinal canal. Indirect inguinal hernias occur when abdominal contents protrude through the [[deep inguinal ring]]; this is ultimately caused by failure of embryonic closure of the internal inguinal ring.
| | ==[[Inguinal hernia overview|Overview]]== |
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| ==Origin== | | ==[[Inguinal hernia historical perspective|Historical Perspective]]== |
| In men, inguinal hernias usually arise as a consequence of the descent of the [[testes]] from the [[abdomen]] into the scrotum during the [[development of the urinary and reproductive organs]]. They are more commonly seen in men due to larger size of their [[inguinal canal]], which transmitted the testicle and accommodates the structures of the [[spermatic cord]]. Men are 25 times more likely to have an inguinal hernia than women, but since this is such a common problem in the general population (it is estimated that 5% of the population will develop an abdominal wall hernia), inguinal hernia does occur in women to some extent.
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| ==Clinical presentation== | | ==[[Inguinal hernia classification|Classification]]== |
| Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are often painful, and the bulge commonly disappears on lying down. The inability to "reduce" the bulge back into the abdomen usually means the hernia is "incarcerated," often necessitating emergency surgery.
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| As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed "strangulated," and gut ischemia and [[gangrene]] can result, with potentially fatal consequences. The timing of complications is not predictable; some hernias remain static for years, others progress rapidly from the time of onset. Recent data questions the routine elective repair of all inguinal hernias. Some studies indicate that inguinal hernias can be left alone with no greater risk than prompt elective treatment. Nevertheless, the bias remains toward surgical repair. Provided there are no serious co-existing medical problems, patients are advised to get the hernia repaired surgically at the earliest convenience after a diagnosis is made. Emergency surgery for complications such as incarceration and strangulation carry much higher risk than planned, "elective" procedures.
| | ==[[Inguinal hernia pathophysiology|Pathophysiology]]== |
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| ==Diagnosis== | | ==[[Inguinal hernia causes|Causes]]== |
| The diagnosis of inguinal hernia rests on the history given by the patient and the physician's examination of the groin. Further tests are rarely needed to confirm the diagnosis. However, in unclear cases an [[Medical ultrasonography|ultrasound]] scan or a [[CT scan]] might be of help, especially to rule out a [[hydrocele]].
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| '''CT images demonstrates a large right inguinal hernia'''
| | ==[[Inguinal hernia differential diagnosis|Differentiating Inguinal hernia from other Diseases]]== |
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| <gallery>
| | ==[[Inguinal hernia epidemiology and demographics|Epidemiology and Demographics]]== |
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| Inguingal-hernia-001.jpg
| | ==[[Inguinal hernia risk factors|Risk Factors]]== |
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| | ==[[Inguinal hernia screening|Screening]]== |
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| Inguingal-hernia-002.jpg
| | ==[[Inguinal hernia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| | ==Diagnosis== |
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| Inguingal-hernia-003.jpg
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| Inguingal-hernia-004.jpg
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| Inguingal-hernia-005.jpg
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| Inguingal-hernia-006.jpg
| | [[Inguinal hernia history and symptoms|History and Symptoms]] | [[Inguinal hernia physical examination|Physical Examination]] | [[Inguinal hernia laboratory findings|Laboratory Findings]] | [[Inguinal hernia x ray|X Ray]] | [[Inguinal hernia CT|CT]] | [[Inguinal hernia ultrasound|Ultrasound]] | [[Inguinal hernia other imaging findings|Other Imaging Findings]] | [[Inguinal hernia other diagnostic studies|Other Diagnostic Studies]] |
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| </gallery>
| | ==Treatment== |
| | [[Inguinal hernia medical therapy|Medical Therapy]] | [[Inguinal hernia surgery|Surgery]] | [[Inguinal hernia primary prevention|Primary Prevention]] | [[Inguinal hernia secondary prevention|Secondary Prevention]] | [[Inguinal hernia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Inguinal hernia future or investigational therapies|Future or Investigational Therapies]] |
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| ==Surgical treatment== | | ==Case Studies== |
| :''See main article at [[herniorrhaphy]].''
| | [[Inguinal hernia case study one|Case #1]] |
| Surgical correction of inguinal hernias, called a herniorrhaphy or hernioplasty, is now often performed as an ambulatory, or "day surgery," procedure. There are various surgical strategies which may be considered in the planning of inguinal hernia repair. These include the consideration of mesh use, type of open repair, use of laparoscopy, type of anesthesia, appropriateness of bilateral repair, etc. During surgery conducted under local anaesthesia, the patient will be asked to cough and strain during the procedure to help in demonstrating that the repair is "tension free" and sound.
| | {{WH}} |
| <ref>http://www.paralumun.com/inguinal.htm</ref>
| | {{WS}} |
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| ==Subtypes of inguinal hernias==
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| {| class="wikitable"
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| | '''Type''' || '''Description''' || '''Relationship to [[inferior epigastric vessels]]''' || '''Covered by [[internal spermatic fascia]]?''' || '''Usual onset'''
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| | [[indirect inguinal hernia]] || protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the internal inguinal ring after the [[testicle]] passes through it || Lateral || Yes || Congenital
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| | [[direct inguinal hernia]] || enters through a weak point in the fascia of the abdominal wall || Medial|| No || Adult
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| |}
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| Inguinal hernias, in turn, belongs to [[groin]] hernias, which also includes [[femoral hernia]]s. A femoral hernia is not via the inguinal canal, but via the [[femoral canal]], which normally allows passage of the common [[femoral artery]] and vein from the pelvis to the leg. | |
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| ==Additional images==
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| <gallery>
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| Image:Gray1084.png|Different types of inguinal hernias.
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| Image:Inguinal fossae.png|Inguinal fossae
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| </gallery>
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| ==References==
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| <References/>
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| ==External links==
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| *[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-adult-Operationscript Hernia inguinal adult: Operation Script on Wikisurgery].
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| *[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-adult-daycase-Patientinformation Hernia inguinal adult day case: Information for patients on Wikisurgery].
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| *[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-TAPP-Operationscript Hernia inguinal TAPP: Operation Script on Wikisurgery].
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| *[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-child-herniotomy-Operationscript Hernia inguinal child: Operation Script on Wikisurgery].
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| *[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-child-herniotomy-Patientinformation Hernia inguinal child: Information for patients on Wikisurgery].
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| ===External images===
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| * [http://www.geocities.com/desarda/canal1 Posterior wall of the inguinal canal at rest]
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| * [http://www.geocities.com/desarda/canal2 Posterior wall of the inguinal canal during raised intra-abdominal pressure]
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| {{SIB}} | |
| {{Gastroenterology}} | |
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| [[Category:Injuries]]
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| [[Category:Surgery]]
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| [[Category:Hernias]]
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| [[Category:Gastroenterology]]
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