A hernia occurs when part of an internal organ protrudes through an abnormal opening in the wall of the cavity that

surrounds it.
In an inguinal hernia, the most common form of hernia, the bowel or fatty tissue protrudes into the groin. This type of hernia mainly
occurs in men. A painful dragging sensation may be felt, as well as pain and swelling in the scrotum and testicles.

Based on the given scenario, we have identified the modifiable and non-modifiable risk factors that could trigger and prohibit the
disease. Under the modifiable risk factors are chronic coughing due to smoking, straining during bowel movement, strenuous activity,
history of abdominal trauma and previous surgical procedure. On the other hand, the non-modifiable risk factors are age, gender and
congenital malformation.

In inguinal hernias, a loop of the intestine protrudes through a hole in the abdominal wall into the inguinal canal, which contains
the spermatic cord. While a male fetus is in the womb, the testes are formed in the abdomen and before birth, they descend into the
scrotum via the inguinal canal. The weakness that occurs in the abdominal wall may be present at birth or may develop later on in life.
An indirect inguinal hernia is one that occurs as a congenital lesion. It occurs as a result of the deep inguinal ring failing to close during
embryogenesis after a testicle has moved through it.

In cases of indirect inguinal hernia, an increased pressure in the abdominal compartment caused by chronic coughing, straining
and strenuous activities stretches the musculoaponeurotic structures. These structures are tissues rich in collagen and are the main
constituents of abdominal muscle providing support and protection. The inguinal ring is also made up of these structures. Smoking can
cause collagen degeneration and this in turn weaken the abdominal fibromascular tissue, causing the malfunction of the inguinal ring.
This malfunction causes the failure of the inguinal ring to close, as evidenced by low creatinine levels, which is an indicator of muscle
damage/injury. The open inguinal ring will eventually evolve into a hole or a defect and the abdominal viscera follows the spermatic
cord. Then, they emerge at the external ring and extend down into the inguinal canal, often into the scrotum. Once bowel or other
abdominal tissue moves into and enlarges the empty space, a visible bulge forms and the hernia becomes clinically evident which
caused pain or discomfort in the groin and induced pain during heavy lifting for the patient. The pain experienced by the patient was
treated by administering Ketorolac through IV. Heavy or dragging sensation, constipation and the sense of feeling full may also be
experienced but these symptoms were not manifested by our patient.
 If the contents of the hernia become trapped in the weak point in the abdominal wall, the contents can obstruct the bowel. This is
now what we call our incarcerated inguinal hernia which led to severe pain, nausea, vomiting, abdominal distention, abdominal pain and
swelling, and bowel obstruction, that was manifested by the patient. Due to the swelling of the groin, there is an increased levels of
white blood cells. Neutrophils react within an hour of tissue injury and are the hallmark of acute inflammation. Lack of appetite, and
irritability can also occur but these were not manifested by our patient. The patient was prescribed to take the following medications:
Hyoscine butylbromide which is an antispasmodic drug, Metroclopromide to relieve nausea and vomiting and Omeprazole to prevent
stomach acid reflux. The doctor ordered for the patient to undergo an emergency mesh hernioplasty, as this was the only way to
manage the incarceration.