INGUINAL HERNIA

• An inguinal hernia is an abnormal protrusion of intra abdominal contents through the inguinal canal
• This inguinal region is a weak part of the abdominal wall by the presence of the inguinal wall, the deep inguinal ring and the superficial inguinal ring
• Patients complain of a swelling in the groin which becomes more obvious on coughing or straining associated with dragging pain

Classification:

Indirect hernia– Contents of the abdomen enter the deep inguinal ring and transverse the whole length of the inguinal canal to come out through the superficial inguinal ring. This is more common than direct hernia

According to the extent of the hernia, it is divided into

• Bubonocele – hernia is limited in the inguinal canal and the processus vaginalis is closed at the superficial inguinal ring. This presents as inguinal swelling. Usually seen in young adults
• Funicular hernia –The processus vaginalis is closed at its lower end just above the epididymis. So the contents of the hernia can be felt separately from the testis and the testis lies below the hernia. occurs in adults
• Complete or vaginal or scrotal hernia - Processus vaginalis is patent throughout. Hernia descends down to the bottom of the scrotum lying in front and at the sides of the testis. It is congenital and common in children yet may not appear until adolescent or adult life

Direct hernia– a direct inguinal hernia protrudes through the posterior wall of the inguinal canal medial to the inferior epigastric vessels

According to the contents of the sac, hernia can be classified into:

• Enterocele - sac contains intestine
• Omentocele – sac contains omentum
• Entero-omentocele – sac contains both intestine and omentum
• Cystocele – sac contains a part of urinary bladder

• Powerful muscular effort or strain e.g. Lifting a heavy weight
• Any condition which raises intraabdominal pressure like whooping cough in children, chronic cough in adults, straining on micturition and defaecation in adults
• Intraabdominal malignancy
• Stretching of the abdominal musculature as in obesity and in pregnancy
• Weakness of aponeurosis

Uncomplicated inguinal hernia

Typically manifests as an ill-defined mass in the inguinal region with the following features:

• Increases in size on coughing or straining
• Decreases in size on lying supine
• Inguinal pain (inguinodynia) or vague inguinal discomfort that increases with physical activity; can also be painless
• Inguinodynia with no palpable groin mass is typically the only manifestation of an occult inguinal hernia

Physical examination

• Perform a Valsalva maneuver and observe for an expansile cough impulse in the inguinal region
• Palpate the inguinal canal : Invaginate the scrotal skin toward the superficial inguinal ring with the index or little finger. Ask the patient to perform a Valsalva maneuver. A bulge palpable on the fingertip confirms the diagnosis of an inguinal hernia
• Hernia is completely reducible

Complicated inguinal hernia

Incarcerated hernia

• The hernia is irreducible.
• If associated with mechanical bowel obstruction - sudden onset of pain, nausea, vomiting, abdominal distension, constipation

Strangulated hernia

• Sudden, severe groin pain caused by constriction and ischemia (or necrosis) of hernial contents
• Features of bowel obstruction if the hernia contains intestinal loops

• General examination – pallor, clubbing, distension of the abdomen
• Local examination – site, size, shape, skin on standing position, visible expansile impulses on coughing, malgaigne’s bulgings – weakness of oblique muscle
• Palpation – local warmth, tenderness, palpable impulse on coughing, top of swelling, palpate cord structure, consistency, extent of hernial sac, reducibility
• Specific tests – invagination test, ring occlusion test, getting above the swelling test, leg raising test
• Ultrasound of the Groin

Conservative:

• No treatment – indicated in patient with severe general ill-health, with a short life expectancy, in those who refuse operation

Operative:

• Herniotomy
• Herniorrhaphy
• Hernioplasty
• Transabdominal preperitoneal repair

Ayurvedic Treatment

Internal medicines

• Gandharvahasthadi Kashaya
• Ullivettudakaadi Kashaya
• Sukumara erandam

Procedure

• Dhanawantara Taila Pichu
• Matra vasthi -Dhanwantara Taila