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INQUINAL HERNIA PRESENTATION Name: Esther OPoku Age:58yrs Sex: female Occupation: Hair dresser arrital status: married

!ith " children #eligion: $hristian%Protestine& #esidence:South Suntreso PC: ass in a'domen()months

HPC:Patient !ho has had an a'dominal operation done 5 months prior to a'domenal mass to deli*er a 'a'e 'ecos she could not push !as !ell until 5 months ago !hen he noticed a small s!elling in a'domen+ ,he s!elling 'ecomes more prominent !hen she strains or coughs and has 'een increasing in si-e till date 'ut !ith no associated pain or fe*er+ She reported to ,ech hospital !here she ad*iced to report to .A,H for expert management+She remem'ers that post op she de*elop an infection o*er the surgical !ound that !as oo-ing a yello!ish fluid !ith associated fe*er+ She also de*eloped a cough / days post op+ ODQ chronic cough(*e $hronic constipation(*e Straining 0 urination(*e Hea*y manual !ork(*e She has " chilren 1ysuria (*e 2e*er(*e 3imiting(*e A'domenal pain(*e P 4SH $hronic medical illnesses %1 5 H,N5 Asthma5 ,65 Epilepsy5S$1& Pre*ious admissions(*e Surgical operation7 a c8s a 9:months ago+Haemotransfussion(*e Birth&Reproductive Hx !P! all ali*e5 ,he 9st 5 pregnancies !ere *ia *aginal deli*ary+,he last one !as *ia c8s cos she could not push+ Dru" Hx: Not on any long term medications No kno!n drug allergies Her'al preparation use(*e #$%i&' Hx: No kno!n family hx of chronic medical illnesses+ Social Hx She is a hair dresser li*ing at South Suntreso !ith family+She is married !ith " children5she neither smokes cigarette nor drink alcohol+ S; A#< = present a 58yr old !oman !ho presented !ith a 5 month hx of a'domenal mass !hich 'ecomes more prominent !hen she strains+She had a c8s 9:months ago !hich the !ound got infected post op !ith oo-ing of a yello!ish fluid !ith associated post op coughing+ = P#ESS=ON =ncisional Hernia

11 ;m'ilical hernia Paraum'ilical hernia 1irect inguinal hernia O(E iddle age !oman !ho is o'ese not ill looking5 not pale5 anicteric5 afe'rile5 !ell hydrated+ C)S Pulse )8'pm regular5 good *olume and non collapsing+ 6P 9/>88> mm of mm S97S?7> RS ## 9"cpm Air entry ade@uate 'ilaterally5 'reath sounds *ersicular !ith no added 'reath sounds+ A61O EN Presence of a su'um'ilical incisional scar !hich is thin+ ,here is an o'*ious 'ulge in the lo!er a'domen in*ol*ing the !hole lenghth of the scar5S!elling has 'oth a *isi'le and expansile cough impulse+S!elling 'ecame more prominent !hen she tried lifting 'oth legs+ S!elling is reduci'le5tympanitic and 'o!el sounds could 'e heard on ascultation+ A'd is soft5 non tender5 no guarding+ No organs palpa'le5 shifting dullness negati*e+ 6o!el sounds present and normal+ 1#E Perianal area is healthy5 no anal tags5no fissure in ano+ Sphincter tone normal+No masses palpa'le in the pouch of 1ouglas+ ,he rectum !as empty+Examining finger stained !ith faeces+ CNS Patient is concious and alert and !ell oriented in person place and time+ ,one5 po!er and reflexes appear intact+ 1++ REDUCIBLE INCISIONAL HERNIA Co%p&ic$tio*+ o, her*i$ =rreduci'ility Strangulation O'struction #upture of hernia sac 2istula formation IN)ESTI ATIONS 26$ Sickling 6lood grouping and ABmatching ;rinalysis A'o*e :5yrs(E$C ($hest x(ray TREAT-ENT %,reat underlying cause 4o.e+e p$tie*t+ $re $&&o/ed to reduce /ei"ht ,ir+t& Surgical repairD( herniotomy especially for ones likely to strangulate+=f the defect is too 'ig5a tension free mesh is used eg polypropylene $O PE=$A,=ONS O2 S;#CE#< I*tr$ op

haemorrhage damage to 'o!el

E$r&' co%p&ic$tio* Haematoma Surgical site infection Post operati*e malaria5 pneumonia LATE CO-PLICATIONS #ecurrence Hypertrophic scars .eloid formation