Inguinal Hernia case

presentation
-Ravishankara Bhat K
4th year,MBBS
Shimoga institute of medical sciences
 Patient particulars

• Name-xxx
• Age-84years
• Sex-male
• Occupation-Cloth wender
• Address-Tippunagar, Shimoga
• Date of admission-21-2-2020 in
McGANN hospital,Shimoga.
• Date of examination -27-2-2020
 Chief complaint
• Swelling in Left groin region since
1year
History of presenting illness
• No history of pain abdomen
• No history of straining during micturition
• No history of change in size of the swelling after
micturition
• No history of chronic cough
• No history of straining during passage of stool.
• No history suggestive of raised intra abdominal
pressure like vomiting, abdominal distension etc.
• No history of similar swelling on the other side.
• Not a known case of diabetis, hypertension,
asthma
 Past history
• No history of similar complaints in the past
• Not a known case of Tuberculosis .
• No history of trauma to the abdomen
• No history previous surgery in the past.
 Treatment history
• Not taken any treatment for present
complaint
• Not taking any medication
• No history of allergy to any drug
 Family history
• No history of similar complaints in the family
• No history of inherited disorders in the family
 Personal history
• Good appetite
• Patient takes both vegetarian and non
vegetarian diet
• Undisturbed sleep
• Regular bowel and bladder habits
• No socio addictive habits
 Summary
84 year old gentle man, cloth wender by
occupation presented with reducible swelling
in left groin region since one year. Swelling
aggrevates on coughing, lifting heavy objects,
walking , reduces on lying down without any
associated symptoms.
No h/o suggestive of obstruction
&strangulation.
Probably it is an uncomplicated hernia.
 General physical examination
• Here is an elderly gentle man moderately built and
nourished, co-operative, well oriented to time place and
person.
• Consent is taken for examination.
• Vitals
• Patient is afebrile
• Pulse rate-76beats/min, normal rate, regular
rhythm,normal volume and character
• Blood pressure-120/80mmhg
• Respiratory rate -16cycles/min
•
• No pallor
• No icterus
• No cyanosis
• No clubbing
• No edema
• No geralised
lymphadenopathy
Local examination
• No skin changes over the swelling
• No visible pulsation
• No dilated veins
• Surrounding area appears to be normal.
• Right groin appears to be normal on
inspection
• Genitals appears normal on inspection
 Palpation
• All inspectory findings are confirmed by palpation
• Palpation on left inguino scrotal region.
• No local raise of temperature
• No tenderness present over the swelling
• A solitary swelling of 4*3*2cm situated in inguino
scrotal region extending from 1cm above midpoint of
inguinal ligament to pubic tubercle.
• Skin over the swelling is normal with smooth surface
and well defined margine
• The swelling is soft in consistency and reducible.
• Deep ring occlusion test
• Donevin standing position after reducing the
swelling,a bulge is seen medial to the occluded finger.
• Zeiman's test
• Done in supine position, impulse is felt on middle
finger on coughing.
• Ring invagination test ,done in supine position,
• cough impulse is felt at the pulp of the little finger.
• No abnormality found on right groin by palpation
• External genitalia is normal by palpation.
• Percussion-
• couldn't be done
• Auscultation
• Bowel sound could not be heard
• Examination of inguinal lymph nodes
• Superficial Inguinal lymph nodes are normal by
inspection and palpation.
 Systemic examination
• Per abdominal examination
• No scars are found
• Tone of abdominal muscle is normal
• Soft to palpate
• Per rectal examination is not done
• Examination of tion cardiovascular system
• S1 and S2 heard, no murmers
• Examination of respiratory system
• Normal vesicular breath sounds heared
• Examination of central nervous system
• No abnormality detected
Diagnosis
• Left sided Incomplete, uncomplicated direct
inguinal hernia
• P3M according to European hernia society
classification
Management
• Investigations
• Specific investigations
• USG abdomen
• Chest X Ray
• Investigations for screening
• Hematocrit, blood sugar, blood urea,serum creatinine,
electrolytes, blood grouping, blood gas analysis
• ECG and cardiac assessment
• Treatment
• Lichtenstein tension free hernioplasty under spinal
anaesthesia.
Thank you