Inguinal hernia
A hernia occurs when all or part of a viscus protrudes from a normal location in the body. Most hernias are protrusions of part of the abdominal viscus through the abdominal wall. Although many kinds of abdominal hernias are possible, inguinal hernias are most common.
With an inguinal hernia, the large or small intestine, omentum, or bladder protrudes into the inguinal canal. Hernias can be reducible, incarcerated, or strangulated.
Causes
In males, during the 7th month of gestation, the testes normally descend into the scrotum, preceded by the peritoneal sac. If the sac closes improperly, it leaves an opening through which the intestine can slip. In either sex, a hernia can result from weak abdominal muscles or increased intra-abdominal pressure. An inguinal hernia may be indirect or direct.
Indirect inguinal hernia
An indirect inguinal hernia, the more common hernia, results from weakness in the fascial margin of the internal inguinal ring. This type of hernia enters the inguinal canal through the internal inguinal ring and emerges through the external inguinal ring. The hernia extends down the inguinal canal into the scrotum or labia.
An indirect inguinal hernia may develop at any age, is three times more common in males, and is especially prevalent in infants younger than age 1.
Direct inguinal hernia
A direct inguinal hernia results from a weakness in the fascial floor of the inguinal canal. Portions of the bowel or omentum protrude through the floor of the inguinal canal to emerge through the external ring extending above the inguinal ligament. Instead of entering the canal through the internal ring, the hernia passes through the posterior inguinal wall, protrudes directly through the fascia transversalis of the canal (in an area known as Hesselbach’s triangle), and comes out at the external ring.
Signs and symptoms
Inguinal hernia usually causes a lump over the herniated area when the patient stands or strains. The lump disappears when the patient is in a supine position. Tension on the herniated contents may cause a sharp, steady pain in the groin, which fades when the hernia is reduced.
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