The inguinal canal is a short passage that is about four to six centimeters in length located just above the inguinal ligament and extends medially and inferiorly through the inferior part of the abdominal wall. Structures pass from the abdominal wall to the external genitalia through this canal. In men, the spermatic cord passes to the testis through the inguinal canal. In women, the ligament that supports the uterus is present in the inguinal canal.

Inguinal hernia is a condition that occurs when abdominal tissues, such as part of the intestine, protrudes through a weak spot of the inguinal canal. Inguinal hernia can occur in both men and women. The resultant bulge caused by the inguinal hernia can lead to pain and discomfort during movement especially when you cough, bend, or lift a heavy object.

Picture showing intestine protruding into the inguinal canal

The inguinal hernia can be classified into following:\

• Indirect inguinal hernia: commonly found hernia in new born babies. The hernia will be formed lateral to the blood vessels when the inguinal canal is not fully developed.
• Direct inguinal hernia: Direct inguinal hernia is found in adults in the middle from the blood vessels.
• Incarcenated hernia: When the abdominal get stuck in the groin, then the hernia is known as incarcerated hernia.
• Strangulated hernia: Strangulated hernia is more severe and stops the blood flow to the small intestine and has to be treated immediately.

Symptoms of inguinal hernia

Inguinal hernia symptoms include:

• Bulge : A bulge in the groin area on either side of the pubic bone. This can be more obvious couging or straining.
• Burning Sensation : Burning or aching sensation at the bulge
• Groin Pain and Discomfort : Pain or discomfort in the groin especially when bending over, straining, coughing or lifting
• Dragging Sensation : Heavy, dragging sensation at the groin
• Groin Weakness : Groin weakness or pressure
• Pain and swelling : Protruding intestine that descends into the scrotum causes occasional pain and swelling around the testicles.

Incarcerated Hernia

A hernia can become incarcerated. This happens if the hernia becomes trapped in the abdominal wall. This can lead to bowel obstruction that leads to severe pain, inability to have bowel movement, nausea, vomiting.

Strangulated Hernia

Strangulated hernia occurs when the incarcerated hernia becomes strangulated and blood flow to the tissue that is trapped is cut. Unless treated, a strangulated hernia can be life threatening and is a surgical emergency.

Symptoms of an incarcerated or strangulated hernia include:

• Nausea and vomiting.
• Fever
• Sudden Pain and tenderness that quickly intensifies
• Bulge that turns red, purple or dark
• Inability to move the bowels or pass gas

Causes of inguinal hernia

Some of the factors that lead to inguinal hernia are discussed below:

• Increased pressure within the abdomen
• Weak tissues and muscles in the abdominal wall
• Straining during bowel movements
• Strenuous activity
• Pregnancy
• Chronic coughing or sneezing

Treatment for inguinal hernia

Laparoscopic hernia surgery can be performed that is minimally invasive with less pain and discomfort. The surgeon initiates the surgery by administering a dose of general anesthetic to relax the muscles and to put the patient in sleep like state. The surgeon makes a small incision in the abdomen and is inflated with air to get a clear view of the internal abdominal cavity. A laparoscope (a thin long tube with a camera attached to its end) is inserted through the incision that allows the surgeon to view enlarged images of the organs and abdominal cavity that is connected through the monitor. After inspection, more incisions are made and other surgical repairing tools are inserted through the incisions into the abdominal cavity. A mesh is positioned in the weak spot of the inguinal canal to reinforce the abdominal wall. Later the incision are stitched and closed.

Laparoscopic hernia surgery can be categorized into two techniques:

• Transabdominal preperitoneal (TAPP) – In TAPP hernia surgery, a small flap of the lining is peeled back from the hernia and a mesh is placed that acts as a support to the abdominal wall. This mesh acts as a barrier and prevents further thrusting of the abdominal tissues into the inguinal canal.
• Totally extraperitoneal (TEP) – TEP technique involves refurbishing the hernia without inward bounding of the peritoneal cavity.

Other Types of Hernias

Other types of Hernias include:

• Hiatal hernia
• Ventral Hernia
• Obturator Hernia
• Femoral Hernia
• Umbilical hernia
• Incisional hernia

Video Talk in Malayalam

View animation – Inguinal Hernia meaning in Malayalam

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Symptoms of Liposarcoma

You may notice a lump that can be usually painless, but growing slowly. Unfortunately, abdominal tumors can grow to be quite large before they are found. Liposarcoma forming in the abdomen can cause abdominal pain, swelling of the abdomen, blood in the stool, constipation, feeling of fullness sooner when eating.

Types of Liposarcoma

There are four types of liposarcoma

• Well-differentiated liposarcoma
• Myxoid liposarcoma
• Pleomorphic liposarcoma
• Dedifferentiated liposarcoma

A Case Study

82-year-old man came in with onset of pain in the abdomen since one week, inability to have food since few days, and gradually increasing abdominal distension for past six months.

On physical examination, his general condition okay, abdomen grossly distended with huge mass.

CECT (High-dose Contrast-Enhanced Computed Tomography) revealed mass extending from diaphragm to pelvis: ? Liposarcoma.

Midline laparotomy was performed, there was a huge mass in the mesentery of the large bowel. The mass was carefully separated and resected weighing 4.2 kg. There was another mass attached to the small bowel by single vessel causing torsion and obstruction of bowel. Derotation of the bowel was carried out, division of the feeding vessel was done and the mass was resected weiging 1.2 kg.

Liver nodule was taken for biopsy and biopsy report confirmed Liposarcoma

Post-op recovery was good and the patient was taking normal diet.

Dr. Padmakumar and Team performs various cancer surgeries in Kochi.

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