abdominal hernia; femoral hernia; rupture

A hernia that may develop during intense exertion due to the production of very high abdominal
pressure. A sac of peritoneum (the connective tissue lining the abdominal cavity and its organs)
is forced through the inguinal canal. In men the hernia tends to descend along the spermatic cord
into the scrotum. Sometimes an abdominal hernia descends through the point at which the
femoral artery passes from the abdomen to protrude at the top of the thigh. This is called a
femoral hernia. Presence of an inguinal or femoral hernia in athletes is potentially dangerous
because an increase in intra-abdominal pressure accompanying physical exertion can cause
strangulation, stopping blood flow and resulting in gangrene. Therefore, surgical repair is usually
recommended. In the past, athletes with an inguinal hernia were precluded from participation in
strenuous activity, especially contact and collision sports. Although this preclusion still applies to
those with symptomatic hernias, many doctors now judge each case separately and make
recommendations dependent on the desired sport and individual circumstances.

Inguinal hernia syu

Classification and external resources

An inguinal hernia (pronounced /ˈɪŋɡwɨnəl ˈhɜrniə/) is a protrusion of abdominal-cavity

contents through the inguinal canal. They are very common (lifetime risk 27% for men, 3% for
women[1]), and their repair is one of the most frequently performed surgical operations.

There are two types of inguinal hernia, direct and indirect, which are defined by their
relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior
epigastric vessels when abdominal contents herniate through the external inguinal ring. Indirect
inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral
to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the
processus vaginalis.

Origin
In men, indirect hernias follow the same route as the descending testes, which migrate from the
abdomen into the scrotum during the development of the urinary and reproductive organs. The
larger size of their inguinal canal, which transmitted the testicle and accommodates the structures
of the spermatic cord, might be one reason why men are 25 times more likely to have an inguinal
hernia than women. Although several mechanisms such as strength of the posterior wall of the
inguinal canal and shutter mechanisms compensating for raised intra-abdominal pressure prevent
hernia formation in normal individuals, the exact importance of each factor is still under debate.
[2]
Symptoms

Frontal view of an inguinal hernia (area shaved prior to hospitalisation and surgical repair
procedure).

Hernias present as bulges in the groin area that can become more prominent when coughing,
straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying
down. The inability to "reduce", or place the bulge back into the abdomen usually means the
hernia is 'incarcerated' which is a surgical emergency.

Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).

As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend
into the hernia and run the risk of being pinched within the hernia, causing an intestinal
obstruction. If the blood supply of the portion of the intestine caught in the hernia is
compromised, the hernia is deemed "strangulated," and gut ischemia and gangrene can result,
with potentially fatal consequences. The timing of complications is not predictable. Some hernias
remain static for years, others progress rapidly from the time of onset. Provided there are no
serious co-existing medical problems, patients are advised to get the hernia repaired surgically at
the earliest convenience after a diagnosis is made. Emergency surgery for complications such as
incarceration and strangulation carry much higher risk than planned, "elective" procedures.

Surgical treatmen
Surgical correction of inguinal hernias, called a herniorrhaphy or hernioplasty, is now often
performed as outpatient surgery. There are various surgical strategies which may be considered
in the planning of inguinal hernia repair. These include the consideration of mesh use, type of
open repair, use of laparoscopy, type of anesthesia, appropriateness of bilateral repair, etc.
During surgery conducted under local anaesthesia, the patient will be asked to cough and strain
during the procedure to help in demonstrating that the repair is "tension free" and sound.[3]

Subtypes
Covered by
Relationship to
internal Usual
Type Description inferior
spermatic onset
epigastric vessels
fascia?
protrudes through the inguinal ring
indirect and is ultimately the result of the
inguinal failure of embryonic closure of the Lateral Yes Congenital
hernia internal inguinal ring after the testicle
passes through it
direct enters through a weak point in the
inguinal fascia of the abdominal wall Medial No Adult
hernia (Hesselbach triangle)

Inguinal hernias, in turn, belongs to groin hernias, which also includes femoral hernias. A
femoral hernia is not via the inguinal canal, but via the femoral canal, which normally allows
passage of the common femoral artery and vein from the pelvis to the leg.