Inguinal Hernia

The posterior wall of the inguinal canal situated in the groin region is sometimes weak and there is a natural weakness in the abdominal wall at that site which predisposes to the formation of an inguinal hernia.

An inguinal hernia presents itself as a bulge in the groin region, which initially is small and later on, it increases in size. It is reducible at first and it presents itself on coughing or straining. Later on, the patient may develop pain and the patient may slowly have an irreducible hernia.

It may present in infants due to an anatomical developmental anomaly. In such a case, it is known as a congenital hydrocele. There is a swelling in the scrotum which is apparent when the child is running about but it settles when the child is lying down. This is because the hernia is due to a patent communicating path from the abdominal cavity to the scrotum and fluid from the abdomen settles into the scrotum when the child is in the upright position. When the child is lying down, the fluid returns to the abdominal cavity and the swelling disappears.The treatment is surgery. The procedure is called herniotomy.

In adults, the treatment for all herniae is surgery. The choice of procedure performed depends on the age of the patient, job profile and the findings in the hernia itself. The hernia can be treated with or without an artificial net called a mesh which is used to strengthen the weakened abdominal musculature. This procedure is known as herniorrhaphy when it is done without a mesh and a hernioplasty when it is done with a mesh inserted.

Initially, a hernia is uncomplicated, when its contents freely move from the abdominal cavity to the hernia sac. Slowly it starts getting irreducible when the contents of the hernia sac cannot find their way back into the abdominal cavity. At this stage, the reducible bulge becomes irreducible and the patient now starts getting pain in the hernia. If neglected further, the blood supply of the contents of the hernia sac become compromised and there is now severe pain, strangulation of the contents and severe tenderness locally with skin changes of inflammation. The patient may also have signs and symptoms of intestinal obstruction with vomiting, constipation abdominal distension with severe abdominal pain. This is a state of emergency and the patient requires surgery to relieve the obstructed hernia as soon as possible.