Signs and Symptoms
Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. The inability to "reduce", or place the bulge back into the abdomen usually means the hernia is 'incarcerated' which requires emergency surgery.
Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).
As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed "strangulated" and gut ischemia and gangrene can result, with potentially fatal consequences. The timing of complications is not predictable. Emergency surgery for incarceration and strangulation carry much higher risk than planned, "elective" procedures. However, the risk of incarceration is low, evaluated at 0.2% per year. On the other hand, surgical intervention has a significant risk of causing inguinodynia, and this is why minimally symptomatic patients are advised to watchful waiting.
Differential diagnosis of the symptoms of inguinal hernia mainly includes the following potential conditions:
- Femoral hernia
- Epididymitis
- Testicular torsion
- Lipomas
- Inguinal adenopathy (Lymph node Swelling)
- Groin abscess
- Saphenous vein dilation, called Saphena varix
- Vascular aneurysm or pseudoaneurysm
- Hydrocele
- Varicocele
- Cryptorchidism (Undescended testes)
Read more about this topic: Inguinal Hernia
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