List clinical features of uncomplicated inguinal hernia.
Typically manifests as an ill-defined mass in the inguinal region with the following features:
Increases in size when coughing or straining
Decreases in size on lying supine
Inguinal pain (inguinodynia) or vague inguinal discomfort that increases with physical activity; can also be painless
Inguinodynia with no palpable groin mass is typically the only manifestation of an occult inguinal hernia.
Ask the patient to perform the Valsalva maneuver and observe for an expansile cough impulse in the inguinal region.
Palpate the inguinal canal.
Male patients: Invaginate the scrotal skin toward the superficial inguinal ring with the index or little finger.
Female patients: Palpate the area over the inguinal ligament.
Ask the patient to perform the Valsalva maneuver.
A palpable bulge confirms the diagnosis of an inguinal hernia.
The hernia is completely reducible and soft.
Female patients rarely present with visible bulges but often report a sensation of heaviness or dull discomfort in the groin or pelvis that is worsened by lifting, straining, or prolonged standing.
List clinical features of complicated inguinal hernia.
The hernia is irreducible.
Skin overlying the hernia: normal
Obstructed hernia: symptoms of mechanical bowel obstruction (sudden onset of pain, nausea, vomiting, abdominal distention, constipation or obstipation)
Sudden, severe groin pain caused by constriction and ischemia (or necrosis) of hernial contents
Signs of sepsis or signs of shock
Features of bowel obstruction if the hernia contains intestinal loops
Skin overlying the hernia: warm, erythematous, tender, and may appear exfoliated or blistered
Manual reduction of an inguinal hernia should not be attempted if there are any signs of strangulation!