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06-08-2008, 08:25 AM
1- Irreducibility:
ÄAetiology Due to adhesions between the sac and its content.
ÄComplications Irreducible hernia is more liable to strangulation so surgery should be hurried.
ÄDiagnosis The hernial sac canít be reduced but not tense.The expansile impulse on cough is maintained.
ÄTreatment Early surgery is recommended before strangulation occurs.
2- Inflammation:
ÄAetiology. due to frequent trauma or true bacterial infection e.g. appendix, ovary, tubes.
ÄDiagnosis. Reducible or irreducible hernia with tender content. The clinical picture of the inflamed organ can be detected.
ÄTreatment. The inflamed organ is dealt with during hernia operation .

3- Obstruction:
ÄAetiology. Usually due to faecal impaction or adhesions.
ÄDiagnosis. The hernia is neither tense, nor tender but irreducible. General manifestation of simple intestinal obstruction is present. (see before)
ÄTreatment. Frequent enema can resolve the impaction so, surgery is not needed urgently in most cases.
4- Hydrocele of the Hernial sac:
ÄAetiology. Adhesions close part of the sac over peritoneal fluid content.
ÄDiagnosis. Translucency can differentiate between it and irreducible hernia.
ÄTreatment. Excision of the sac and repair of the defect.
5- Strangulation:
ÄAetiology:
1- Narrowing of the neck by fibrosis " Common ".
2- Sudden descent of big amount of content " rare ".
ÄPathology. Proximal, distal, at the site (see intestinal obstruction).
ÄDiagnosis. General features of intestinal obstruction: See before.
ÄLocal features: the Hernia becomes:
1- Very tender due to inflammation of peritoneal sac.
2- Very tense due to distention with fluid & exudate.
3- Irreducible with no impulse on cough.
* Because of the fact that not all strangulated hernia are obstructed so, the local features of strangulation is more import than general.

Differential Diagnosis of Strangulated Inguinal hernia of strangulated. ing. hernia:
a- Obstructed hernia. b- Acute funiculitis.
c- Torsion of testis. d- Other causes of int. obst.

Treatment:
[I] Taxis: "External reduction by force". Within 6 hours. from the onset of strangulation.
Better avoided as it may lead to:
a- Rupture of strangulated loop. b- Reduction of gangrenous loop.
c- En-block reduction i.e. reduction of the sac with the content.
[II] Urgent operation for strangulated inguinal hernia:
1- Incision should be extended to the scrotum.
2- The sac is opened at the fundus. ģ evacuation of toxic fluid.
3- Division of the neck.
4- Extraction of the content & dealing with. Viable, gangrenous, suspecious. (see before).
5- As the tissues are inflammed and oedematous no repair is done & close the wound with drain.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
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