Inguinal hernia
Updates to Article Attributes
Inguinal hernia is a type of abdominal wall hernia 1.
Epidemiology
They are the commonest type of abdominal wall herniation (up to 80% 3) and are most often acquired. There is a recognised male predilection with an M:F ratio of up to 7:1 3.
Clinical presentation
Patients most commonly present with a swelling and/or pain in the relevant groin, iliac fossa, loin. Men may also have testicular pain.
Pathology
Classification
It is broadly divided into two types:
-
indirect inguinal hernia
- more common
- herniates lateral to the inferior epigastric artery 2
Passingpasses throughthedeep inguinal ring- anterior to the spermatic cord in males 8
- follows the round ligament in females 8
-
direct inguinal hernia
- less common
- a weakness in the fascial floor of the inguinal canal 10
- herniates medial to the inferior epigastric artery 2
- often through a defect in the Hesselbach triangle
EtiologyAetiology
All of the following confer an increased risk for indirect inguinal hernia:
- prematurity and low birth weight 9
- patent processus vaginalis
- urologic conditions (e.g. cryptorchidism, hypospadias or epispadias, bladder exstrophy, ambiguous genitalia)
- abdominal wall defects (omphalocele, gastroschisis, cloacal exstrophy, bladder exstrophy)
- family history
Direct inguinal hernia is a consequence of weakened abdominal musculature, often brought on by
- advanced age
- strain
- previous abdominal surgery
While inguinal hernias in general are much more common in males than in females, direct hernias in particular are rare in women since the broad ligament acts as an additional barrier.
Treatment and prognosis
Surgical treatment options include
Complications
Complications, as in any other abdominal wall herniation, include:
Compared with other types of abdominal wall hernias, the incidence of complications is considered lower 3.
Differential diagnosis
Possible imaging differential considerations include
- femoral hernia: often remain lateral to the pubic tubercle and compress the femoral vein
- hydrocele (may coexist)
- varicocele
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