• 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
• 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
• 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
• US, although rarely needed, can verify the presence of a hernia sac and reliably differentiate between a hernia, solid cord mass, hydrocele, or lymphadenopathy
• Physical exam usually all that is required to accurately diagnose inguinal hernia
• In equivocal cases, US may be helpful
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