Case Study


Abdominal Hernia

An abdominal hernia is an abnormal protrusion of the intestine or other abdominal contents or organ through a defect or weakness in the abdominal wall. A normal or intact abdominal wall prevents any such protrusion. It is also sometimes called a rupture. Examples of abdominal hernias are: Inguinal hernia, ventral hernia and umbilical hernia.

This is a picture of a big inguinal hernia on the left side.

Our fellow citizens who suffer from these terrible conditions are mostly farmers who live in rural areas or communities; cocoa farmers, yam, maize and other food crop producers. The cocoa farmers produce the cocoa for export to bring in the Dollars, Pounds and Euros.

The food crop farmers produce the yam, maize for kenkey and banku and the plantain and cassava for fufu. Let us not forget the fishermen who bring the fish we eat every day. Other people who are not farmers like drivers, mechanics, masons, carpenters, the boys who push trucks also suffer from hernia.

The man in this picture below cannot go to the farm or do any work. He cannot take part in any social activities.

Procedures


Introduction of Self / Dress Code.

Requesting permisison to examine.

Expose from waist down and ask patient to stand up.

Note groin lump: site, size, shape,scrotal extension; both sides.

Ask patient to cough and observe visible cough impulse.

Touch and feel for the spermatic cord and scrotal contents/mass.
If scrotal mass is present, palpate spermatic cord to get above the scrotal mass.

Touch and feel the groin area or lump. Describe groin lump: size, shape, edge and consistency.

Feel Cough Impulse.Touch and compress firmly the inguinal lump or area, patient turns head to opposite side and coughs. If lump or area becomes tense and expands,there is a palpable cough impulse.

Reducibility.Ask patient if hernia goes back inside. If yes, ask patient to push it back. If not, press firmly on the hernia mass to reduce it.

Look for the umbilicus. Run down to the bone in the midline to feel the Pubic Symphysis

Feel from the Pubic Symphysis along the upper edge of the bone i.e. the pubic crest and feel lateral towards the hernia site till the end of the bone, the pubic tubercle (PT).

Keep right index finger firmly on the PS and ask patient to cough. If hernia re-appears above the PT it is an inguinal hernia.

Release hernia off the internal ring and watch hernia reappear.

Auscultation.Listen with the bell/diaphragm of sthetoscope.

Locate the ASIS by feeling down on the mid-axillary line to the bone, the illiac crest, then feel forwards till the end of the bone, the ASIS.

Locate and feel the mid-point between the pubic symphsis and the ASIS, the internal inguinal ring.

Keep right index finger firmly on the internal inguinal ring and ask patient to cough. If hernia re-appears it is a direct inguinal hernia and if not, it is an indirect hernia.