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  • • Groin bulge elicited with the Valsalva maneuver

    • Types of inguinal hernias

    • -Indirect: Patent processus vaginalis extension lateral to the inferior epigastrics in the anterior-medial position of the spermatic cord

      -Direct: Developed weakness in the abdominal wall located at Hesselbach triangle (inguinal ligament inferiorly, lateral edge of the rectus medially, and the inferior epigastric vessels superior-laterally)

      -Pantaloon hernia is a combined direct and indirect inguinal hernia

    • Classification of hernias

    • -Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity

      -Incarcerated: Visceral contents cannot be returned to the abdominal cavity

      -Strangulated: Incarcerated inguinal hernia where the blood flow to the entrapped viscera is compromised

      -Sliding: Abdominal viscera present in hernia sac; on the left, most commonly the sigmoid colon and bladder, and on the right, most commonly the cecum and bladder

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Epidemiology

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  • • 5-10% of the world population develops an inguinal hernia in their lifetime

    • Premature infants most likely to develop inguinal hernia (> 10%)

    • Nearly all hernias in infants, children, and young adults are indirect

    • Indirect inguinal hernias develop more commonly on the right

    • Acute complications from inguinal hernias are more likely to develop in infants and children

    • Most common etiology of small bowel obstruction in children is incarcerated inguinal hernia

    • Second most common cause of small bowel obstruction in adults is incarcerated inguinal hernia

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Symptoms and Signs

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  • • Asymptomatic inguinal bulge most common symptom

    • Exam of the groin reveals a bulge adjacent to the ipsilateral pubic tubercle that may extend into the scrotum

    • The hernia bulge may or may not be reducible

    • Patients may complain of a fullness or dragging sensation

    • As a hernia enlarges, it is likely to produce a sense of discomfort that may radiate into the ipsilateral groin

    • Sharp ilio-inguinal groin pain without a detectable groin bulge is most commonly a strained groin muscle

    • Incarcerated/strangulated inguinal hernia is exquisitely painful

    • Coughing or straining will help demonstrate small hernias

    • Small bowel obstruction symptoms (nausea, vomiting, abdominal distention) may be present with incarcerated inguinal hernias

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Imaging Findings

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  • • US, although rarely needed, can verify the presence of a hernia sac and reliably differentiate between a hernia, solid cord mass, hydrocele, or lymphadenopathy

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  • • Femoral hernia

    • Hydrocele

    • Cord mass

    • Strained groin muscle

    • Epididymitis

    • Inguinal lymphadenopathy

    • Varicocele

    • Undescended testes

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Rule Out

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  • • Strained groin muscle (chronic groin pain commonly develops in these patients following operative intervention)

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  • • Physical exam usually all that is required to accurately diagnose inguinal hernia

    • In equivocal cases, US may be helpful

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When to Admit

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  • • Uncomplicated inguinal hernia management can be performed as an outpatient

    • Indications for admission include:

    • -Acute hernia incarceration

      -Clinical evidence ...

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