 Blog updatesSite updatesContent provided by Jon Lund Clinical Associate Professor, School of Graduate Entry Medicine & Health, University of Nottingham |
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DefinitionA hernia is a protrusion of part or all of a viscus beyond its normal confines.When talking about hernias many immediately think of inguinal hernias. The inguinal region is only one part of the body where hernias may occur. For example: the stomach protruding through the hole for the oesophagus in the diaphragm is a hiatus hernia; the protrusion of abdominal contents through a congenital hole in the diaphragm is a congenital diaphragmatic hernia; the protrusion of the brain through the tentorium cerebelli is a tentorial hernia. Inguinal hernias are therefore hernias which occur in the inguinal canal. Inguinal hernias are the most common kind of hernia. There are 2 types of inguinal hernia: Direct inguinal hernia. The abdominal contents bulge forward directly through the back wall of the inguinal canal. The hernia does not pass through the superficial inguinal ring and does not pass into the scrotum. Indirect inguinal hernia. The abdominal contents pass indirectly through the inguinal canal inside the spermatic cord. The hernia begins at the deep inguinal ring and may pass as it enlarges along the inguinal canal, through the superficial inguinal ring (above and medial to the pubic tubercle) and into the scrotum.
Context Inguinal hernia is a common. By the age of 65, 30% of men have had hernia surgery. Seventy thousand hernia repairs were performed in England in 2001/2 (5,000 of these for recurrent hernia). The histogram below shows peak incidence in the infant and the elderly. Indirect inguinal hernias are slightly commoner than direct, and right-sided hernias are commoner than left-sided, perhaps because the testicle descends later on the right-hand side and there is a slightly higher rate of failure of closure of the processus vaginalis. A congenital sac and an additional weakness of the posterior inguinal wall with age contribute to the pathogenesis of indirect hernias. Degenerative factors which can be compounded by smoking, straining to empty the bladder and pass stool , heavy lifting and a chronic cough, account for direct inguinal hernias.
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