A case of inguinal hernia

Yogapriya.M
Kapvgmc,Trichy.
Patient details

Name : Mr. Ramu

Age : 50
Sex : male
Occupation : manual labourer
Address : 7th cross,thillai nagar,Trichy.
Chief complaints

Mr. Ramu presented with the chief

complaints of swelling in the right
groin for past 1 year.
History of presenting illness

Patient was apparently normal before

1 year,then he noticed a swelling in his
right groin region which was initially
smaller in size (2 inches) and gradually
progressed to the current size reaching
upto scrotum.
 Swelling increases in size on standing, and on coughing.
 Swelling decreases in size on lying down and disappears
on manipulation (reducing himself by pushing it with his
fingers)
 No h/o vomitting, abdominal distension, bloating,
constipation, mass per abdomen .
 No h/o acute onset of severe pain,recent increase in the
size of the swelling.
 H/o chronic cough with sputum ×20 yrs
 No h/o straining on defecation
 No h/o increased weight lifting or heavy manual work
 No h/o lower urinary tract symptoms like increase in
frequency,Urgency ,dysuria or straining to void.
Past history

No h/o similar complaints in the past.

Patient is a known case of chronic obstructive
pulmonary disease (copd) ×15 yrs and he is on
bronchodialators.
Not a known case of DM,hypertension, TB and
asthma
No previous abdominal /groin surgery.
Treatment history

Patient is On bronchodialators(levosalbutamol)
for past 15 years for COPD.
No h/o allergy to any medications.

FAMILY HISTORY :
 No h/o any connective tissue disorders in the
family.
Personal history

Normal bowel and bladder habbits

Normal appetite
Both vegetarian and non vegetarian diet .
History of smoking for past 30 years
 2 packs /day
History of alcohol consumption for past 30 years
 General examination

AfTer taking consent from the patient,the

patient was examined in a well lighted room.
Patient is conscious, well oriented to time ,place
and person and comfortable at rest.
Patient is moderately built and moderately
nourished and afebrile.
Wt = 65 kg; ht : 160 cm BMI 24.8 kg /m².
Vitals ::
Pulse : 82 beats per min normal in
volume and rhythm
Bp : 126 /80 mm of hg measured
in right upper arm in supine
position.
Respiratory rate : 18 cycles per
minute.
No pallor
No icterus
No cyanosis
No clubbing
No generealised lympahdenopathy
No edema.
 Local examination of inguinal region
 After getting consent from the Patient and
ensuring his privacy examination was done in a
well lighted room.
 Examination was done on both standing and
supine position and exposed from nipple to mid
thigh.
 Inspection ::
 A pyriform shaped swelling is present
in the right inguinal region extending from
Medial side of midinguinal point upto
scrotum Of size 8*4*3 cm.
 Skin over the swelling is normal.
 Surface : smooth
Margins : well defined
Expansile cough impulse is present and the
swelling is reduced on lying down.
Visible persistalsis couldnot be appreciated.
No visible pulsations
No engorgement of viens
Penis is slighyly pushed to the left side.
The opposite side inguinal region appears to be
normal.
External genitalia appears to be normal.
 Palpation
Inspectory findings are conformed by palpation.
Skin isNontender,not warmth.
 A pyriform shaped swelling of size (8*3*3
cm)Extending from medial to the mid inguinal
point to upper pole of right testis.
 surface of the swelling is smooth and the
margins are well defined.
Consistency is soft and elastic
Surrounding skin is normal
Swelling is reducible,difficulty in reducing the first
part and reduces with gurgling sound.
Expansile cough impulse is present.
Peristalsis can be felt.
No visible pulsations
Cannot get above the swelling
Testis is palpated separately.
Deep ring occlusion test –swelling doesnt
appear on occluding the deep ring and on
removing the thumb,swelling appears .
Zeimans test : swelling is felt over the index ring
over deep inguinal ring.
Finger invagination test : swelling is felt over the
tip of the little finger.
 Percussion : resonant
 Auscultation : Couldnt appreciate the peristaltic bowel
sound well .
 Examination of inguinal lymph nodes : Normal
 Examination of opposite inguinoscrotal region : normal
and no swelling present
 Examination of external genitalia :
 Scrotum : skin normal
 Testis : both testis is normal and palapable
 Spermatic cord : normal and palpable.
 Penis : no phimosis
 Normal urethral meatus
 No dicharge.
 Urethra : no stricture.
Examination of abdominal muscle tone :
No undue protrusion of abdominal muscles on standing.
no malgaigne’s buldging are seen.
Tone of abdominal muscle is normal.
Per rectal examination : not done.
Other system examination :
 Respiratory system :barrel shaped chest,decreased
breath sounds,prolonged expiration and coarse
crackles at the beginning of inspiration.
 Cardiovascular system : S1 S2 hear.No murmur heard.
 Cns : no focal neurological deficit
Summary

 A 50 yr old male Mr .Ramu who is Manual labourer by occupatiom with a

history of smoking for 30 years and COPD for 15 years
 Presented with reducible inguinal swelling for past 1 year and positive for
expansile cough impulse and no history suggestive of obstruction or
strangulation.
 On examination,swelling didn’t appear on occluding deep ring and it was
felt over index finger in the zeimans test.
Diagonosis

It is a Case of right sided indirect incomplete

inguinal hernia,which is uncomplicated and
contains enterocele

Thank you.