Hernia, inguinal

Hernia of the abdominal membrane (possibly containing an intestinal loop) through the muscle and tendon wall of the lower abdomen (inguinal canal), the point at which in the man the vas deferens descends from the abdomen into the testis. The abdominal membrane is forced through this passage by high pressure in the abdomen caused by straining or coughing, for example. This is a continuing process; when abdominal pressure is lowered again, the herniated sac, the protruding section of the abdominal membrane, slips back into the abdominal cavity. There are two kinds of inguinal hernia. In an indirect inguinal hernia the herniated sac follows the path of the vas deferens and can finally reach the scrotum. In women, where the vas deferens is replaced by a connective strand, the herniated sac can descend to the labia majora. In a direct inguinal hernia the herniated sac does not follow the vas deferens, but protrudes directly through the slack tendons and muscles of the lower abdomen. Indirect inguinal hernia is the more common form. The condition can occur on one or both sides, and be congenital or caused by weakening of the tissue. In its early stages inguinal hernia can cause pain in the groin, but this usually decreases in the course of time. Sometimes the herniated sac can return into the abdomen, sometimes not. If severe pain results from a herniated sac which cannot be drawn back into the abdomen it is known as a strangulated hernia. The trapping also restricts the flow of blood to the herniated sac, with the result that the strangulated tissue could die. A dead intestinal loop can burst and cause peritonitis; thus a strangulated hernia should be operated upon as soon as possible. A hernia which is not strangulated is also best treated by surgery, because there is always a risk of later strangulation.

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