Hernia (abdominal wall and groin)

Rationale

A hernia is an abnormal protrusion of part of a viscus through its containing wall. Hernias, in particular inguinal hernias, are very common, and thus, herniorrhaphy is a common surgical intervention.

Causal Conditions

(list not exhaustive)

1. Congenital hernia
   1. Infantile inguinal hernia
   2. Umbilical
2. Acquired hernia
   1. Inguinal hernia
      1. Indirect
      2. Direct
   2. Femoral hernia
   3. Umbilical hernia
   4. Ventral (incisional) hernia

Key Objectives

Particular attention should be paid to the physical examination and identification of the type of hernia. Non-reducible (incarcerated) hernias are at increased risk for strangulation and require emergent, rather than elective, repair.

Enabling Objectives

Given a patient with a hernia, the candidate will

1. list and interpret critical clinical findings, including
   1. differentiate the various types of hernias on the basis of physical exam;
   2. differentiate hernias from other causes of a groin masses;
   3. identify hernias needing emergent surgical repair;
2. list and interpret critical investigations of a patient who may have strangulation, ischemia, or bowel obstruction;
3. construct an effective management plan, including
   1. select patients in need of surgical consultation;
   2. counsel and educate patients on the risks associated with uncorrected hernias as well as strategies to reduce post-operative recurrence (especially with ventral hernias).