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Herniae

Overview

  • Herniae represent portions of bowel or ommentum that have passed outside of the abdominal cavity. Herniae may be reducible but may become trapped (encarcerated) or vascularly compromised (strangulated).
  • Examine for herniae while sitting on a stool with the patient standing.
    • Inspection

    • Look for the presence of a bulge, above or below the inguinal crease 
    • Examine with a light source shone at an oblique angle
    • Ask the patient to cough
    • Palpation

    • Palpate for a mass over the femoral region, external & internal inguinal rings
    • Ask the patient to cough
  • In the male, invert the scrotum on each side and palpate along the course of the spermatic cord to the inguinal canal. Ask the patient to cough. Feel if it is possible to get above the hernia
  • If any hernia is palpated, gently attempt to reduce it with the patient supine. Do not attempt to reduce a tender hernia or a hernia associated with nausea or vomiting (as it may be strangulated).
    • Interpretation

    • A mass above the inguinal crease - suggestive of a femoral hernia
    • A mass below the inguinal crease - suggestive of a direct or indirect inguinal hernia
    • Able to palpate above the mass - likely related to lesion within the scrotum such as a hydrocoele or varicocoele
    • Mechanisms of Herniae

    • Femoral herniae - pass through a defect within the femoral canal medial to the femoral vein.
    • Indirect inguinal herniae - pass through the deep inguinal ring and through the inguinal canal into the scrotum.
    • Direct inguinal herniae - pass through a weakness in the transversalis fascia, rarely into the scrotum.
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