HERNIA INGUINALIS

LATERALIS INKARSERATA

MUHAMMAD IQBAL CAHYANA EKA PUTRA

19710104
 CHAPTER I
CASE REPORT
 PATIENT IDENTITY
Name : Mr. S
Age : 73 Years Old
Place & Date of Birth : Mojokerto, September 27th 1946

Address: Sambirejo, Randugenengan, Dlanggu, Mojokerto

Job : Self Employed

Marriage Status : Married
Religion : Moslem
Ethnic : Javanese
Date of MRS: 10 February 2020

Date of KRS : 13 February 2020

No. RM: W1908304462

 HISTORY
Main Complain : Pain in a lump in the lower right abdomen
Current Medical History :
The patient came to Wahidin Sudiro Husodo Mojokerto Hospital with
complaints of pain in the lump in the lower right abdomen. Lumps existed since ±
7 years ago, but never painful. Fever (-), nausea / vomiting (-). The lump cannot
enter alone. Flatus (+). History of BPH surgery 2 weeks ago. After surgery,
urinate often straining. Normal bowel movements. Good appetite / drinking.
Past Medical History : BPH(+), DM(-), HT(-)

Family History : denied

Treatment History: denied

General
  circumstances : enough
Awareness : Compos Mentis
GCS :456
Vital Sign

BP : 110/70 mmHg

Pulse : 84 x/min

RR : 20 x/min

Temperature : 36
SpO2 : 96 %
 GENERAL STATUS

HEAD & NECK :

A/ I/ C/ D : -/-/-/-
Eyes : Round Pupil (+), isochorous
Nose : Stuffy (-), nosebleed (-)
Ear : No fluid or blood comes out of the ear hole
Mouth : Sprue (-), dry mouth (-)
Throat : Hoarseness (-), painful swallowing (-)
Lymph nodes : There is no lymph nodes enlargement
THORAX :
PULMO

Inspection : Symmetrical left/right; retraction (-)

Palpation : Symmetrical fremitus touch left/right
Percussion : Sonor on the right and left
Auscultation : Ves +/+ Rh -/- wh -/-
COR

Inspection : Ictus cordis is not visible

Auscultation : Vesicular, S1 S2 single regular, murmur (-), gallop (-)
ABDOMEN

Inspection : No distension

Auscultation : Bowel sound (+) are normal

Palpation : Palpable lump in right inguinal dextra

Percussion : Timpani
EXTREMITIES :

CRT < 2 second

Warm acral + +

+ +

Edema - -

- -
LOCALIST STATUS :
INSPECTION

There are lumps in the inguinal region (D), erythema (-), the same
color as the surrounding tissue.
PALPATION

Palpable lumps, chewy solid consistency, firm boundaries,

tenderness (+), unable to reenter the abdominal cavity.
CLINICAL PHOTO
EXAMINATION REPORT
PHOTO OF THORAX
ECG
 DIAGNOSIS

Hernia Inguinalis Lateralis

Inkarserata Dextra
 PLANNING
Planning Diagnose : Planning Action :
Complete Blood Install NGT
Thorax Photo Install catheter
ECG Trendelenburg Position
Planning Therapeutic : Total Fasting
Inf. RL 21 tpm Planning Monitoring :
Cefuroxim 2 prophylaxis vial Vital sign
drip Clinical
PZ 100 cc
Inj. Ketorolac 3x30 mg
PICTURE OF DURANTE OP.
(HERNIORAPHY)
 CHAPTER II
LITERATURE REVIEW
 DEFINITION

A hernia is an abnormal protrusion of part or all of the intra-

abdominal organs through a hole or defect in the abdominal wall
that is coated by the peritoneum.
 ETIOLOGY

The existence of an open vaginal processus

Chronic increased intra-abdominal pressure such as chronic

cough, prostatic hypertrophy, constipation, ascites, multiparous
pregnancy and obesity
Abdominal wall muscle weakness and connective tissue
degeneration due to old age
 CLASSIFICATION

Based on occurrance

1.Hernia congenital

2.Hernia akuisita
Based on location

1. Hernia inguinalis lateralis (indirect)

2. Hernia inguinalis medialis (direct)

3. Hernia femoralis
 CLINICAL MANIFESTATION

In general, complaints from adults in the form of a bump in the

inguinal arises when straining, coughing or lifting heavy loads and
disappearing at recess, it is called an reponible hernia. If the
contents of hernia cannot be re-entered, it is called an irreponible
hernia. If there is clamping contents of hernia by the annulus and a
passage of intestinal content occurs and/or a vascular disorder, it is
called an incarcerated hernia.
PHYSICAL EXAMINATION

Inspection

Palpation

Special palpation :
 Ziemann test

 Finger test

 Thumb test
SUPPORTING EXAMINATION

Complete blood count and serum electrolytes

USG abdomen and/or scrotum

X-Ray abdomen
 DIFFERENTIAL DIAGNOSIS

Medial or femoral inguinal hernia

lymphadenitis
Varicocele, hydrocele
Testicular tumor
Orchitis
Cryptokismus
Lipoma
 MANAGEMENT

Conservative : Reposition and position of trendelenburg

Definitive : Performed surgery.

 PROGNOSIS

Prognosis depends on the general condition of the patient and the

accuracy of treatment. But it is generally 'good' because recurrence
after surgery is rare. Except in recurrent hernias or large hernias
that require the use of prosthetic material. In hernias this is
important to prevent predisposing factors.
CHAPTER III
CONCLUSION
In history taking, the patient complains of pain in a lump in the lower right
abdomen. Lumps existed since ± 7 years ago, but never painful. Fever (-), nausea /
vomiting (-). The lump cannot enter alone. Flatus (+). History of BPH surgery 2
weeks ago. After surgery, urinate often straining. Normal bowel movements. Good
appetite / drinking.
On physical inspection, it was found that there were lumps in the right inguinal
region, erythema (-), the same color as the surrounding tissue. While on palpation
there are lumps, springy consistency, firm boundaries, tenderness (+), unable to re-
enter the abdominal cavity.
On Supporting examination, complete blood obtained increased leukocytes
(leukocytosis).
From the results of history, physical examination, and supporting examination the
diagnosis patient has a Hernia Inguinalis Lateralis Inkarserata Dextra.