INGUINAL HERNIA


Consists of abdominal contents in the scrotum

"Incarceration" = inability to reduce hernia into the abdominal cavity; a strong indication for surgical repair

"Strangulation" = bowel ischemia due to mechanical interruption of blood supply from an incarerated inguinal hernia; a surgical emergency (may perforate in as little as 2h)

Male:Female 6:1, though incarceration is more common in females

Distinguishing characteristics from a hydrocele: Don't move with application of traction to the testicle; may have audible bowel sounds; shouldn't be able to feel superior margin

In a study in 160 men with asymptomatic inguinal herniae randomized to surgery (mesh repair) vs. observation; at 1-year, intent-to-treat analysis showed no sig. diff. in pain level though general health status (on SF-36) was sig. better in the surgery group (Ann. Surg. 244:167, 2006--JW)

In a study in 724 men with minimally symptomatic inguinal hernia randomized to watchful waiting or open hernia repair; over 2y f/u, there were no sig. diffs between the groups in pain. The incidence of hernia incarceration was 1.8 per 1000 patient-years (JAMA 295:285, 2006--JW)

(Sources include Core Content Review of Family Medicine, 2012)