Inguinal Hernia

Presented by: Miguel D. Bolivar

 Case Introduction

An inguinal hernia is a protrusion of abdominal or

pelvic contents through a dilated internal inguinal
ring or attenuated inguinal floor into the inguinal
canal and out of the external inguinal ring, causing
a visible or easily palpable bulge.
 Demographic & Chief Complain

This is a case of patient R.B. 65 y/o male, married,

Roman Catholic living in Las Pinas. He is a retired
officer in the Philippine Navy. Patient came to the
hospital with a complain of pain in his groin when
he bends over to pick up something.
History of Present Illness

During his younger years in the service, R.B. used to

lift heavy equipments. He’s also an occasional drinker.

During his senior years in the service, patient R.B.

is engaged in supervising practices for occasions,
standing for longer periods of time, and is often busy
in his office.
History of Present Illness

After he retired, patient R.B. stayed in their home.

He sometimes feel pain on his groin whenever he
carries heavy objects and whenever he bends
over to pick up something on the floor but didn’t
mind to have a check up.
History of Present Illness

An hour prior to consultation, patient R.B. felt

pain on his groin when he carried a sack of rice.
He noticed a bulge in the painful area and decided
to go to the nearby hospital to have a check up.
Past Medical History

Patient was diagnosed with chronic bronchitis

during his younger years in the service. He has
no surgical history and has no known allergies to
food or medicines.
 Family Medical History

There are no significant family history. Patient is

married with 3 kids.
 Personal and Social History

Patient R.B. is an alcoholic. He consumes 6 bottles

per week. He is a non smoker. He has minimal to
no exercise ever since his senior years in the
service.
 Physical Examination

• General: patient is awake, coherent, and conscious

• Vital Signs: BP=135/100mmhg;CR=100 bpm RR;= 18 cpm
T;= 38˚C, SaO2= 97%
• HEENT: Head is normocephalic
• Lungs: Normal Breath Sounds
• Abdomen: Presence of bulge in the right lower quadrant of the
abdomen,
tender to palpation
• Extremities: No significant findings.
 Detailed Physical Examination

• Cough and Drop Test

- the doctor will ask you to cough while cupping your
testicles. By coughing, the bulge will be felt by the doctor.

• While patient R.B. is coughing, the doctor felt a lump on

his right area of his scrotum.
Diagnostic Exam
Magnetic Resonance Imaging

-The MRI revealed a bulge on the patient’s

abdomen
Diagnostic Exam
Herniography
-The Herniography shows a bulge on the
patient’s right lower quadrant of the abdomen
 Salient Features
• A burning or aching sensation at the bulge
• Bulge in the right lower quadrant of the abdomen is
painful when coughing
Differential Diagnosis
Disease/Condition Rule In Rule Out

Femoral Hernia - Lump in the groin - Herniography shows

- Pain in groin area that the bulge is near
the pubis

Psoas Abscess - Lump in the groin -MRI did not show an

- Pain in groin area inflammatory mass

Undescended Testis - Pain in groin area - Both testicles are in the

scrotum
Inguinal Hernia -Pain in the groin area
- Lump in the groin
 Final Diagnosis
Based on the findings of the MRI and Herniography, the
patient has an inguinal hernia on the right lower abdominal
area.
 Treatment and Management
Open Inguinal Hernia Repair
- is an open surgery requires one larger incision instead
of several small incisions. Open hernia repair can be done
under general, spinal, or local anesthesia. A single long
incision is made in the groin. If the hernia is bulging out of
the abdominal wall, the bulge is pushed back into place.
 Treatment and Management
Procedure
- Patient R.B. is given local anesthesia in the abdomen or
spine to numb the area, general anesthesia to sedate or
help the person sleep. Then the surgeon makes an incision
in the groin, moves the hernia back into the abdomen, and
a piece of mesh is also sewn into place. Then, reinforces
the muscle wall with stitches.
 Results
After a month and a half, patient R.B. has recovered from
the surgery and does house chores for his daily exercises
to strengthen his body.
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