A hernia is a protrusion of abdominal organs outside of its cavity. Unless described in any other way, "hernia" refers to an inguinal hernia. These hernias occur in the inguinal canal, a small opening in the muscles of the abdomen on either side of the groin. In males, this canal serves to allow the passage of the spermatic cord, containing the vas deferens, to the testes. Hernias are often asymptomatic or produce a small bulge in the groin. Vomiting, however, may occur in the event of complicated hernias, such as obstruction or strangulation. These complications indicate serious disease and the need for immediate surgery.
Symptoms of Hernia
Most inguinal hernias are asymptomatic; they often cause a bulge in the groin. The bulge may appear more during straining, such as during constipation, coughing or weightlifting. It gradually increases in size and can eventually spread downward into the scrotum. In uncomplicated cases of hernia, it can be returned back inside the abdomen without difficulty. Vomiting does not occur in these cases, but some patients may complain of a dull aching pain in the event of longstanding hernias.
Obstruction
When a loop of bowel enters into the hernial sac, it can become kinked and prevent food from passing through it. This condition is known as obstruction, or alternatively, as incarceration. Obstructed inguinal hernias cause pain as the intestine contracts against the obstruction. In addition, they prevent the passage of food, leading to vomiting and constipation. An obstructed hernia is an emergency and can progress to strangulation.
Strangulation
Like all organs, the intestine is supplied by arteries, which give it oxygen and nutrients. When a hernia contains intestinal contents, there is a risk of occluding the veins which drain blood away from the site. As the veins get more backed up, the arteries reach a point where they can no longer deliver blood. This leads to a severe complication, known as strangulation. The herniated intestine starts to die over several hours and the condition may quickly become life threatening as infection starts to set in. Like obstruction, a strangulated hernia can lead to vomiting, pain in the abdomen and constipation. In addition, it can cause fever, worsening pain all over the abdomen, low blood pressure and a thready pulse.
Treatment of Hernias
Because the risk of complications is so serious, hernias should be treated when they are diagnosed. The treatment of choice for hernias is laparoscopic hernioplasty. In this, the contents of the hernia are returned to the abdomen, and the inguinal canal is narrowed to prevent a recurrence. The use of laparoscopic technique decreases the size of the scar and the time needed to recover. In addition, a polypropylene mesh is placed over the canal. In complicated hernias, however, an open hernioplasty is done, where the surgeon makes an incision over the abdomen. A mesh is not used in these cases as it can increase the risk of infection.
