A protrusion of a loop of the intestine through a weakening in the abdominal wall, located in the groin near the thigh.
Causes, incidence, and risk factors
Although hernias are commonly thought to be the result of lifting a heavy object, there is often no obvious precipitating event. A hernia occurs when abdominal contents, usually the small intestine, protrudes through a weak point or tear in the thin muscular wall of the abdomen that holds the abdominal organs in place. In the case of a femoral hernia, a bulge is usually present in the upper part of the thigh, just below the groin. Most hernias are reducible, in that the bowel protruding into the hernia can be pushed back into the abdominal cavity. A femoral hernia may become incarcerated and strangulated (the loop of bowel becomes trapped in the hernia and loses its blood supply). Nausea and vomiting and severe abdominal pain may occur with a strangulated hernia.
Signs and tests
A physical examination reveals the hernia . Tests are usually not necessary.
Treatment
Hernias generally get larger with time, and do not resolve spontaneously. Therefore, elective surgical repair is indicated in patients who are good candidates for surgery, to prevent discomfort and pain, and to prevent complications such as incarceration and strangulation. A hernia that cannot be forced back into the abdominal wall by pressure may be trapped or strangulated. Without treatment, a strangulated section of the intestine will die, because the blood supply is inadequate. Urgent operation is required for incarcerated or strangulated hernias. Surgery to reposition the loop of intestine and secure the weakened muscles in the abdomen is indicated. Often a piece of plastic mesh is used to repair the defect in the abdominal wall. A corset or a truss is not adequate treatment for a hernia, because the loop of intestine can still become strangulated.
Expectations (prognosis)
The outcome is expected to be good with proper treatment. Recurrence of hernias after surgical repair is generally less than 3%.
Complications
A strangulated intestine can result in gangrene, a life-threatening condition requiring emergency surgery.
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if a hernia cannot be reduced or pushed back into the abdomen by gentle pressure, or if nausea or vomiting develop.
Prevention
Weight loss in overweight patients may prevent formation of hernias. Chronic cough, constipation and prostatic hypertrophy that lead to straining with urination are also thought to contribute to the formation of hernias, and should be addressed prior to hernia repair.