EpistemisReducible inguinal mass
Specialty: Gastrointestinal.
Why it occurs
- Indirect inguinal hernia due to persistence of the peritoneovaginal duct with passage of intestinal loops or omentum
- Direct inguinal hernia due to weakness of the transversalis fascia in the Hesselbach triangle
- Crural or femoral hernia due to weakness of the femoral ring (more common in women).
Initial workup
Dynamic bilateral inguinal physical examination (valsalva maneuvers while standing and recumbent) | Inguinal and inguinopelvic ultrasound (to confirm the hernia defect, measure the annulus and assess the content) | CT of the abdomen and pelvis if associated with symptoms of acute intestinal obstruction.
red flags
Sudden severe pain in the inguinal region associated with nausea and vomiting, a mass that becomes hard, painful, erythematous and impossible to reduce by manual maneuvers (incarcerated or strangulated hernia with risk of intestinal necrosis).
Standard management
- Transient symptomatic analgesic support — paracetamol 1 g IV or orally every 8 hours, avoiding pushing efforts
- Osmotic laxatives — polyethylene glycol 17 g per day to avoid constipation and the subsequent increase in intra-abdominal pressure that exacerbates the hernia
- Scheduled elective surgical treatment (hernioplasty with placement of polypropylene mesh).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gastrointestinal
- Listed causes
- 3
- Treatment options
- 3