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A CASE REPORT OF

HERNIA INGUINALIS
LATERALIS

PRESENTED BY
Dr. M. Ikhlas Yakin
Lasinrang Hospital, Pinrang
PATIENT IDENTITY
Mr. A

31-12-64 (52 Y.O)

MR 128***

Farmer

Examination Date ; 11
- 9 -2017
ANAMNESIS

Chief
complaint Enlarge History
lump in when pain (-) Digestive of
the left Since 3 Reponibl cough or
iliac years ago e lifting Hiperemi problem (- another
)
region heavy s (-) disease
through object (-)
the groin
PHYSICAL EXAMINATION
General Condition:
Well nourished/Compos mentis

Vital Sign
Blood Pressure : 120/80mmHg
Pulse : 88 bpm
Breathing : 20 x/min
Temp : 36,5oC
General Examination
HEAD
Conjungtiva ; anemic (-) Sclera ; icteric (-)
Nose ; Oedema of the concha (-) , Ear ; Otorrhea (-) Tophy (-) , Lips ;
Cyanotic(-)

THORAX COR
Inspection ; Symmetrical, Breathing movement (+) Inspection ; ictus cordis (-)
Palpation; Pain (-) , Mass (-), Crepitation (-) Palpation ; ictus cordis (-)
Percussion ; Sonor Percussion ; Dull
Auscultation; Vesiculer, Ronkhi(-) Wheezing (-) Auscultation ; HS1&2 reguler

ABDOMEN
Inspection : Flat
Auscultation : peristaltic (+)
Percussion : tympani
Palpation : pain (-), hepar/lien not palpable

EXTREMITY
Limb : warm, parese (-), hipestesia (-)
Oedema : (-) , pitting oedem (-)
LOCAL SIGN
REGIO INGUINALIS SINISTRA

Mass 10x4
Pain (-)
cm, mobile

Transiluminasi
Hiperemis (-)
(-)

Thumb test ;
Reponible no lump
appeared
LABORATORIUM
Type Result Normal Limit
WBC 9,6 X 103/mm3 (4,0-10,0x103/mm3)
HGB 15,0 gr/dl (13,0-17,0 gr/dL)
HCT 42,6% (40-54%)
PLT 306x103/mm3 (150-500x103/mm3)
UREUM 27,7 mg/dL (15,0-43,2 mg/dl)
CREATININ 1,02 mg/dL (0,8-1,30 mg/dl)
SGOT 25,4 u/L (0,0-37,0 u/L)
SGPT 17,6 u/L (0,0-41,0 u/L)
GDS 156 mg/dL (74-106 mg/dl)
THORAX PA
11 09 - 2017
cor: normal, aorta: dilatation
difragma normal
Intact bones
RESUME

ANAMNESIS PEMFIS LAB

DIAGNOSI
S
HERNIA INGUINALIS
LATERALIS REPONIBLE
SINISTRA

MANAGEMEN
T
HERNIORRAPHY
DISCUSSION
HERNIA ?
1. Protrution or lump of the
cavity that passed through
the defect of the organ. (1)

2. Protrution of the
abdominal cavity through
the defect of the fascia or
musculoaponeurotic of
the abdominal wall,
congenitally or as a result
of many risk factors (2)

3. Consist of Ring, Pocket


and organ(1)

1. Buku ajar bedah, sjamsuhidajat, de jong


2. Kapita selekta kedokteran FKUI. 2016
CLASSIFICATION
perfect
Congenital
WHEN Not perfect
Acquisita

Reponibilis

Irreponibilis
Hernia clinically
Strangulata

Inkaserata

Interna
Direction
eksterna
EPIDEMIOLOGI
Hernia 100% 1%
2% 16%
Inguinalis Femoralis Incisional 80%
34%
Umbilikus other 60% 97%
40%
3% 4% 50%
20%
0%
10% MALEFEMALE
8% Inguinalis Femoralis Lain-Lain

75%

1. Sjamsuhidayat. 2010
2. Rasjad C. 2010
ETIOLOGY
Opening of the processus vaginalis
Increasing of the intraabdominal pressure
Age
Diet
DIRECT VS INDIRECT
ANAMNESIS
Lump Consistency?
Retractable?
Inflammation sign?
Problem of the
passage?
Pain
PHYSICAL EXAMINATION

Thumb test
Finger test Ziemen test
Hernia exam dr. khaleed milad , www.youtube.com
INCARSERATA vs STRANGULATA
Gejala/tanda Obstruksi usus pada hernia inkarserata Nekrosis/gangren pada hernia strangulata

Nyeri Kolik Menetap

Suhu badan Normal Normal/meninggi

Denyut nadi Normal/meninggi Meninggi/tinggi sekali

Leukosit Normal Leukositosis

Rangsang peritoneum Tidak ada Jelas

Sakit Sedang/berat Berat sekali/toksik


MANAGEMENt
Reposition Belt
OPERATIF
Indikasi :
Hernia Inkaserata / Strangulasi (cito)
Hernia Irreponabilis ( urgen, 2 x 24 jam)
Hernia Reponabilis (elektif)
Hernia Reponabilis incarserasi (HIL,Femoralis)

Herniotomy : releasing of hernia pocket until the neck


Hernioplasty : reducing size of annulus inguinalis internus
& strengthen the posterior wall of canalis inguinalis
Hernioraphy : herniotomy+hernioplasty
PROGNOSIS
Bonam