Groin swellingg

Groin swelling History : when the lump 1st notice ? what are the symptom related to lump? Has lump change ? in size ,shape ,color since it was appear ? Dose the lump ever disappear ?what makes the lump disappear ? Has the patient had any ather lump ? What dose the patient think cause the lump ? Is there any discharge ? What ttt has been suggested or administered ?

Also we have to ask potential complication of hernia : Irreducibility Obstruction :abdo pain , distension , constipation ,vomiting Strangulation :tender, painfull   Also we ask about risk factor for hernia : Chronic cough B.A Chronic constipation Straining with urination Occupation  Social hx : smoking ,occupation , heavy lifting

Examination:  •Inspection , palpation , auscultation •Asymmetry ( swelling ): site , size , tenderness , mobility •Neck……..defect Sac…………content Overlying skin Reducibility Expansilecough

Differential diagnosis of groin swelling : Inguinal hernia Femoral hernia Femoral aneurysm Lymphadenopathy Ectopic testis undescending testis Lipoma of spermatic cord Hydrocele of cord  abcess

For dx of swelling we have to do : Ultra sound CT abdomine AXR erect + supine

Hernia : is protrusion of viscus into an area in which it is not normally contained . Male>femal = 9:1 Most common surgical disease of males .

Type of common hernia : Inguinal :80% Umbilical : 15 % Femoral : 5 %

Inguinal hernia Direct vs indirect direct indirect Directly through the abdominal wall muscle (hesselbach’s triangle ) Originate at deep inguinal ring pass to ext.inguinal ring Medial to I.EpiGAstric vessel Lateral to inferior epigastric vessel Less likely to be in carcerated than indirect More likely to be incarcerated Usually not pass to scrotal Etiology : aquired weakness in transversalis fascia or increase intra-abdominal pressure Pass to scrotal sac Etiology : congenital persistence of processus vaginalis in 20% of adults Direct vs indirect All inguinal hernia reduced to point above and medial to pubic tubercle

Complication of hernia Incarceration Strangulation Ischemia Necrosis Intestinal obstruction This complication need ergent surgery and laproscopic exploration

Sign and symptom of peritonitis are absolut indication for abdominal exploration

Treatment 1- observation for asymptomatic small inginal hernia and reducible and repaired electively 2- can be reduced manually if no strangulation .how? 3- don’t attepmt to reduce hernial sac if sepsis or gangernous occure it is surgical emergency 4- surgical repaire for indirect : tension free mesh repaire

Treatment Surgical repaire for direct : bassini ,Mcvay ,lichtenstienrepaire Can be done open or laproscopic Laproscopic usefull for patient has recurrent or bilateral hernia .

Post -operative complication Recurrence Scrotal hematoma Nerve entrepment Ischemia and occlusion of femoral vein Wound infection Temperary urinary retintion Injury to spermatic cord structure

Femoral hernia Origin from femoral ring and pass to saphenous hiatus through femoral canal . Pass medially to femoral vein artery nerve . Occure mush more in women but still the inguinal is most common . Prone to incarceration and strangulation Point of reduction ( below and lateral to pubic tubercle )

Treatment Femoral hernia are generally repaired because it is high risk for strangulation . Reduction is often difficult Is nessery to assure adequate closure of femoral canal

Hematoma Blood collection within muscles layer of ant abdominal wall Due to mild truma or blood disease Present with abdominal pain and painfull abdominal mass and may be ecchymosis over abdomine fothergill’s Dx by CT + u/s Usually resolve without surgery and evacuation done if clot with adequate hemostasis with sever pain and persistent

Tumar of abdominal wall Mostly benign ( lipoma , hemangioma , fibroma ) Rarly malignant and often from mets from intra-abdominal sourse