[SUMAN-SAJAN]

SOME MORE FACTS ON HERNIA

Femoral hernia is more common in females as compared to males but again the commonest hernia in females is inguinal hernia.

Femoral hernia is below and lateral to the pubic tubercle where as inguinal hernia is medial and above the pubical tubercle.
It refers not to the position of the hernia but to the point at which the hernia reduces into the abdominal wall.

Difference between hernia and hydrocele.
Hernia differs from hydrocele in that :
-in hernia we can't get above the swelling but in hydrocele we can
-cough impulse is positive in hernia not hydrocele
-testis is palpable in hernia not hydrocele
-translumination test is positive in hydrocele and negative in hernia


Classification of hernia
According to site
umbilical
epigastric
spigelian
inguinal
femoral
gluteal

According to presentation
Irreducible
Reducible
obstructed
strangualted
inflammed

According to content
enterocele
omentocele
reichter's hernia
littre's hernia

congenital or acquired .



Why is femoral hernia more likely to strangulate ?
Because of narrowness of the neck (femoral ring) and its rigid surround:
Anteriorly: inguinal ligament
Posteriorly :Pectineus muscle and pubic ramus
Medially : lacunar ligament and pubic bone
Laterally : femoral vein


What is usual site of strangulation of the inguinal hernia ?
Superficial or external inguinal ring


Direct inguinal hernia lies outside the spermatic cord while indirect lies within it .


Why is indirect inguinal hernia common in right ?
Right processus vaginalis become oblitered later than the left and right testis descend later than the left.

Indirect inguinal hernia is more common in young and the direct in the elderly.

Types of indirect inguinal hernia
Bubonocele - lies within the inguinal canal
Funicular - there is small funis (stalk) between the testis and processus vaginalis ie. lies few centimetres above the testis
Complete (scrotal)- where processus vaginalis is intact, hernia reaches scrotum


Differential diagnosis of inguinal hernia
In male :
vaginal hydrocele
encysted hydrocele of cord
spermatocele
femoral hernia
incompletely descended testis
lipoma of cord

in female :
hydrocele of canal of Nuck
femoral hernia


Differential diagnosis of femoral hernia
inguinal hernia
saphenous varix
enlarged femoral lymph node
lipoma
femoral aneurysm
psoas abscess
distended psoas bursa