Inguinal
Hernia
Demographic
details
• Name: Mr. Vengat Narayanan
• Age: 48
• Sex: Male
• Occupation: welding
• Address: Sriperumbudur
Chief complaints
• C/o swelling in the left groin for 4 months
History of presenting
illness
• The Patient was apparently normal 4 months ago after which he noticed a
swelling in the left inguinal region, which was insidious in onset and gradually
progressive in size.
• The swelling increases in size on standing, coughing and straining and reduces
on lying down.
• It is reducible by the patient.
• Associated with mild pain, which was dull-aching, non radiating, non progressive
in nature, aggravated by straining and relieved by rest x 4 months
• Pt also c/o Burning micturition x 4 months
• H/o lifting heavy weights
• No h/o chronic cough
• No h/o chronic constipation
• No h/o urinary urgency, frequency, hesitancy
• No h/o abdominal pain or distension or vomiting
Past history
• K/c/o left inguinal hernia, for which surgery was done laparoscopically in
2010.
• He remained asymptomatic post operatively but continued lifting heavy
weights.
• Pt is not a k/c/o DM/HTN/Thyroid disorder/Asthma/TB/CAD
Family history
• No significant family history
Personal history
• Mixed diet.
• Normal sleep and appetite
• Regular bowel Habits
• C/o burning micturition for 4 months
• No h/o alcohol, smoking or substance abuse
Summary
A 48-year-old male presented with swelling in the left inguinal region for 4
months, insidious in onset, gradually increasing in size, reducible. Associated
with mild dull aching pain aggravated by straining and relieved by rest. He has
a history of laparoscopic left inguinal hernia repair in 2010 but continued lifting
heavy weights at work. No other significant family history.
General
examination
• Pt is conscious, oriented
• Examined in a well lit room
Vitals:
• Temp: Afebrile
• PR: 82bpm
• RR: 20 breaths/min
• BP: 110/70 mmHg
• Height: 164 cms
• Weight: 59kgs
• BMI: 22 kg/m²
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, or pedal edema.
Inspection
• Patient was exposed from xiphisternum to mid-thigh.
• Standing position:
• A swelling in the left inguinal region was noted.
• Size: 7 cm × 5 cm
• Site: Left inguinal region
• Shape: Ovoid
• Extent: Appears to be above the inguinal ligament and medial to pubic tubercle,
does not extend into the scrotum.
• No visible peristalsis
• Skin over the swelling: appears normal — no redness, hyperpigmentation,
ulceration or dilated veins.
• Healed surgical scars are noted infra-umbilically and in the bilateral iliac
regions.
• Impulse on coughing: Visible expansile cough impulse present.
• Scrotum and penis: Normal in position and appearance; testes visible and
normal
• Supine position : the swelling reduces spontaneously.
Palpation
• No warmth or tenderness felt.
• All inspection findings of size, site, shape, and extent were confirmed.
• Consistency: Doughy in consistency.
• Surface: smooth
• Cough impulse: felt
• Deep Ring Occlusion Test: Positive (Swelling bulges medial to the
occluding finger).
• Three Finger Test: Impulse present over the superficial ring.
• Superficial Ring Invagination Test: Impulse felt.
Systemic examination
• Abdomen: soft, non-tender, no organomegaly ; bowel sounds heard
• CVS: S1 S2 heard, no murmurs
• RS: B/L air entry present
• CNS: no focal neurological deficits
Diagnosis:
Left Recurrent Reducible Inguinal Hernia without complications with omentum as
the content.
Thank you
