An inguinal hernia occurs when abdominal contents protrude through a weakness in the abdominal wall, usually via the inguinal canal.
Contents may include peritoneum, fat, or small bowel.

🔬Anatomy

Types of Inguinal Hernias

Reducible: Contents can be pushed back into abdomen.
Irreducible: Contents cannot be pushed back → risk of incarceration.
Incarcerated: Trapped bowel, may obstruct.
Strangulated: Blood supply compromised → ischaemia, necrosis.

Indirect vs Direct

Indirect: Passes through deep inguinal ring, lateral to inferior epigastric vessels. Often congenital, may track into scrotum.
Direct: Bulges through posterior wall of canal (Hesselbach’s triangle), medial to epigastric vessels. Usually acquired in older men.

Risk Factors

Male sex (8× higher risk).
Ageing, family history, previous pelvic surgery.
Chronic raised intra-abdominal pressure (obesity, coughing, straining, heavy lifting).
Connective tissue disorders.

🩺 Clinical Features

Groin swelling above and medial to pubic tubercle, may extend to scrotum.
Positive cough impulse.
Pain/discomfort; tenderness or sudden severe pain suggests strangulation.

🔎 Investigations

Bloods: FBC, U&E, CRP, group & save.
Imaging: USS (useful in women/children), CT/MRI for diagnostic uncertainty, AXR if obstruction suspected.

💊 Management

Emergency: ABCs, IV fluids, NBM, analgesia, antibiotics if strangulated → urgent surgical repair ± bowel resection.
Elective: Most hernias benefit from repair (open or laparoscopic, mesh-based).

Surgical Approaches

Open (Lichtenstein): Local or general anaesthetic; incision and mesh repair.
Laparoscopic (TAPP/TEP): General anaesthetic, smaller scars, faster recovery.

⚠️ Complications

Recurrence, wound infection, bleeding, chronic groin pain.
General anaesthetic risks, DVT/PE.
Rare: injury to cord structures, bladder, or bowel.

References

Kenhub – Inguinal Hernia Anatomy
NICE Guidance: Hernia – Surgical Management

📊 Comparison: Femoral vs Inguinal Hernias

Feature	Femoral Hernia	Inguinal Hernia
👥 Typical Patient	Older women (wider pelvis)	Young to middle-aged men
📍 Location	Below inguinal ligament, lateral to pubic tubercle	Above inguinal ligament, medial or lateral to inferior epigastric vessels
🧵 Neck of Hernia	Narrow → high risk of strangulation 🚨	Wider → lower risk of strangulation
🩺 Clinical Features	Small lump in groin, tender if incarcerated, often difficult to reduce	Groin lump enlarges on coughing/straining, often reducible
🔎 Examination Clues	Swelling below & lateral to pubic tubercle	Swelling above & medial/lateral to pubic tubercle
⚕️ Management	Urgent surgery due to strangulation risk	Elective repair unless obstructed/strangulated
📉 Complications	Obstruction, strangulation, bowel necrosis	Less likely strangulation, but recurrence possible

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Inguinal Hernia

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