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Hernia


Symptoms of a Hernia

A hernia may first be noticed as a small bulge or protrusion. Most often, it does not cause pain, but may cause a little discomfort. A hernia can get larger with exercise or coughing. At this early stage, the hernia is often known as reducible because its contents (typically bowel) can be pushed back into the abdomen. However, in some cases, the hernia could progress to the point of what is known as being incarcerated, meaning that pushing the hernia contents back through the abdominal wall is no longer possible.
 
A more serious complication occurs If blood stops flowing through an incarcerated bowel, resulting in a strangulated hernia, which can be quite painful, can cause nausea, vomiting, and obstruction.  In severe situations, a strangulated hernia may cause necrosis of bowel segments and subsequently bowel perforation, sepsis and possibly death.9, 11

How is a Hernia Diagnosed?

A healthcare provider typically bases the diagnosis of a hernia on a physical examination. While standing, a patient may be asked to cough, which increases pressure inside the abdominal cavity.  A hernia will bulge outward, making it easier for the doctor to detect. The doctor may place a finger into a fold on the upper part of the groin to feel the sac and the opening where the hernia descends. Sometimes ultrasonography or computed tomography (CT) are used to assist in making the diagnosis.3


References

  1. Beadles CA, Meagher AD, Charles AG. Trends in Emergent Hernia Repair in the United States. JAMA Surg.2015;150(3):194-200.
  2. Chan Y, Durbin-Johnson B, Kurzrock EA. Pediatric inguinal and scrotal surgery – Practice patterns in in U.S. academic centers.J Pediatr Surg. 2016 Nov;51(11):1786-1790.
  3. Kahrilas PJ, Kim HC, Pandolfino JC. Approaches to the diagnosis and grading of hiatal hernia.Best Practice & Research Clinical Gastroenterology. Volume 22, Issue 4, August 2008, pp 601–616.
  4. Lomanto D,  Shabbir IA, Cheah WK. Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surgical Endoscopy and Other Interventional Techniques. July 2006, Volume 20, Issue 7, pp 1030–1035.
  5. Pediatric Umbilical Hernia Repair.  American College of Surgeons Division of Education. Reviewed April 2013.
  6. Mudge M, Hughes LE. Incisional hernia: A 10 year prospective study of incidence and attitudes. British Journal of Surgery.  January 1985, Volume 72, Issue 1.
  7. Inguinal hernia repair: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved November 09, 2016, from https://medlineplus.gov/ency/article/007406.htm
  8. Kovachev, L.S. (2014) The Femoral Hernia: Some Necessary Additions. International Journal of Clinical Medicine, 5, 752-765.
  9. Pluta RM, Burke AE, Golub RM. Abdominal Hernia. JAMA. 2011;305(20):2130.
  10. Jones D. Anatomy and pathophysiology of hernias. In: Fischer J, ed. Hernia: Master of techniques in surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:1-6.
  11. Incarcerated and Strangulated Hernias in Children. A Statistical Study of High-Risk Factors Arch Surg. 1970;101(2):136-139.
  12. Fitzgibbons Jr RB, Ramanan B, Arya S. Long-term results of a randomized controlled trial of a non-operative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Annals of Surgery. Volume 258(3), September 2013, pp 508–515.
  13. de Sá Ribeiro, F.A., de Araujo Fernandes, B. and de Araujo Simões Corrêa, J.P. (2014) Inguinal Hernia Repair with Local Anesthesia in the Outpatient—10 Year Experience. International Journal of Clinical Medicine, 5, 644-649.
  14. Nawaz T, Ayub MW, Murad F, Ali Q, Khan A, Anwar I. Comparison of laparoscopic total extra peritoneal (TEP) techniques versus transabdominal preperitoneal (TAPP) technique for inguinal hernia repair 2005, Issue 1. Journal of Rawalpindi Medical College (JRMC); 2015;19(3):220-222.
  15. Tran H. Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair.  Journal of the Society of Laparoendoscopic Surgeons. 2011;15(1), pp 47-52.
  16. Arcerito M, Changchien E, Bernal O,Konkoly-Thege A, Moon J. Robotic inguinal hernia repair: technique and early experience. Am Surg. 2016 Oct;82(10), pp 1014-1017.