Inguinal hernia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Directed inguinal hernia is caused by Protrusion through Hesselbach triangle, passes medial to inferior epigastric vessels.
Pathophysiology
Pathogenesis
- It is understood that indirected inguinal hernia is caused by:[1][2]
- Passes through internal inguinal ring, traverses inguinal canal to external ring
- May extend into scrotum in males and labia major in females
- Passes lateral to inferior epigastric vessels and has an oblique inferior course
- Considered a congenital defect and associated with a patent processus vaginalis
- It is understood that directed inguinal hernia is caused by:
- Protrusion through Hesselbach triangle
- Generally does not extend into scrotum
- Passes medial to inferior epigastric vessels
- Considered an acquired defect
| Predisposing factors •Being male •Having muscle weakness from birth along with a hernia sac •Having muscle weakness from aging •Having one or more inguinal hernia | Precipitating factors •Being overweight or having a recent,large weight loss •Having weak abdominal muscles from poor diet, lack of exercise or both •Straining during urination or bowel movements •Chronic cough,such as from smoking | ||||||||||||||||||||||||||||||
| Incresed pressure in the compartment of the abdomen in develops | |||||||||||||||||||||||||||||||
| Intra-abdominal wall of inguinal canal into the scrotum becomes weakend | |||||||||||||||||||||||||||||||
| Causing the inguinal ring not to close | |||||||||||||||||||||||||||||||
| Evolves into a hole or defect | |||||||||||||||||||||||||||||||
| Fat or part of the small intestine slides through the inguinal canal | |||||||||||||||||||||||||||||||
| Swollen or enlarged scrotum | Feeling of weakness or pressure in the groin | Pain or discomfort | |||||||||||||||||||||||||||||
Genetics
- Genes involved in the pathogenesis of inguinal hernia include microdeletion disorders such as 22q11.2 microdeletion.[3]
Microscopic Pathology
- On microscopic histopathological analysis, inflammatory infiltration, vascular damage and regressive nerve lesions, fibrohyaline degeneration and fatty dystrophy of the muscle fibers are characteristic findings of inguinal hernia. [4]
References
- ↑ Berliner SD (1983). "Adult inguinal hernia: pathophysiology and repair". Surg Annu. 15: 307–29. PMID 6353636.
- ↑ Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
- ↑ Barnett C, Langer JC, Hinek A, Bradley TJ, Chitayat D (2009). "Looking past the lump: genetic aspects of inguinal hernia in children". J. Pediatr. Surg. 44 (7): 1423–31. doi:10.1016/j.jpedsurg.2008.12.022. PMID 19573673.
- ↑ Amato G, Agrusa A, Romano G, Salamone G, Cocorullo G, Mularo SA, Marasa S, Gulotta G (2013). "Histological findings in direct inguinal hernia : investigating the histological changes of the herniated groin looking forward to ascertain the pathogenesis of hernia disease". Hernia. 17 (6): 757–63. doi:10.1007/s10029-012-1032-0. PMID 23288217.