Hernia direct or indirect

1. Inguinoscrotal swelling

2. Particulars Of Patient
• Name:Mr.XYZ
• Age:65year
• Sex:Male
• Religion:Hindu
• Occupation:Watchman
• Education:Noformaleducation.
• Address:GanjCircle,Raichur.

3. • ChiefComplaint.
BilateralGroinswellingsince4months.

4. • HISTORY OF PRESENT ILLNESS
• Patient was apparently normal 4 months back, when he noticed
swelling in both right and left groin region while taking bath. He
first noticed swelling in right side followed by left after 3 to 4 days.
Swellings is progressive, initially small and now progressed to
present size, aggravates on standing, walking, during micturition,
cough and disappears on lying down position. Swelling is associated
with pain since 4 months on both sides. Pain is of dull aching type.
It is localised to swelling site, with no radiation pain present on
exertion and relieves at rest.
• History of increased micturition 3 times at night, associated with
straining during micturition. No history of burning sensation.
• No history of nausea, vomiting, constipation, bloating sensation,
abdominal distension, mass per abdomen, cough, straining at
stools.
• No history of any other swelling in body.
• No history of prolonged heavy work, weight lifting work.

5. • Past History
• No H/o similar complaints in past.
• Not a known case of hypertension, diabetes
mellitus.
• No H/o Tuberculosis, asthma, bronchitis.
• No H/0 Trauma.
• No H/o abdominal/groin surgery.

6. • Treatment History
• Not taken any treatment for present condition.
• Not on any medication.
• No H/o allergy to food and any drug.
•
• Family History
• No history of hypertension, diabetes,
tuberculosis.
• No H/o similar complaints in family.
• No H/o any inherited disorders in family.
•

7. • Personal History
• Predominantly Vegetarian.
• Good appetite.
• Undisturbed Sleep.
• Bowel movement – regular, no strain.
• Bladder movement – 3 times at night, increased frequency
of micturition with straining to pass urine.
• H/o alcohol consumption 5 sarayi bottle/day for 30 years.
• H/o smoking beedi(sonambar) – 2 packs/day for 30 years.
• Both habits left 4 years ago.
• No H/o chewing tobacco.
• Socio Economic Status : Class 3.

8. History Summary:
• 65 year old male, watchman, presented with
bilateral reducible swelling since 4 months in
groin region. Swelling aggravates on straining
and reduces with rest, with mild dull ache
pain, straining during micturition, with normal
bowel habits. No history suggestive of
obstruction/ strangulation. Probably it is
uncomplicated hernia.

9. General Physical Examination
• Here is an elderly gentleman conscious,cooperative,moderatly built,
poorly nourished, well oriented to time,place,person,comfortable
at rest.
• Pulse Rate: 75bpm, normal rate,rhythm,volume,character, no radio
radial delay, no radio femoral delay.
• Blood Pressure: 120/80 mm Hg
• Respiratory Rate : 18 cpm.
• Temperature: 98.5 degree Fahrenheit.
•
• No Pallor, No Icterus, No Clubbing, No Cyanosis , No Edema , No
Lymphadenopathy
• Height - 155 cm
• Weight – 50 kg
• BMI – 20.81 kg/m2

10. Head to toe examination
• Head – Normal.
• Hair – Greyish, well disributed.
• Forehead – Wrinkles present.
• Eyes –Normal.
• Ears –Normal.
• Nose –Normal.
• Face – Normal.
• Oral cavity –
• Teeth –stained. Tongue – Coated, central, pinkish. Lips and gums – normal. Palate –
normal.
• Throat – normal.
• Neck – Trachea central.
• Chest – Normal.
• Upper limb – Normal.
• Abdomen - flat ,umbilicus central in position.
• Lower limb – Normal.
• External Genitalia – normal.
• Back and spine – Normal.
• No generalised Lympadenopathy.

11. • LOCAL EXAMINATION OF INGUINAL REGION.
• Examination done in standing posture.
• Exposure – Xiphoid to mid thigh.

12. RIGHT SIDE INGUINAL REGION.
• INSPECTION.
• Site: Right inguinal region.
• Extent: Extends from medial to midinguinal point upto root of scrotum.
• Size: 3*3*2 cm.
• Shape: Globular.
• Surface : Smooth.
• Margins : Well defined.
• Expansile cough impulse presnt.
• Reducibility present.
• No changes in skin over swelling.
• Surrounding area appears normal.
• No dilated vein.
• No visible peristalsis.
• No visible pulsation.

13. • PALPATION
• All the inspectory findings confirmed.
• No local rise of temperature.
• No tenderness.
• Swelling
• Site: Right inguinal region.
• Extends from medial to midinguinal point upto root of scrotum and is medial and
above to pubic tubercle.
• To get above swelling – Not possible.
• Size: 3*3*2 cm.
• Shape: Globular.
• Surface: Smooth.
• Margin: Well defined.
• Consistency – soft and elastic.
• Reducibility – Reducible, initial part difficult, last part easy.
• Impulse on coughing present.
• Skin over swelling: normal.
• Surrounding area normal.
• Visible peristalsis could not make out.
• No pulsation over swelling.

14. • Deep ring occlusion test – Swelling appears.
• Zieman’s test – Impulse at middle finger.
• Finger invagination test – one little finger
admitted, directed backwards, impulse at pulp
of finger.

15. • Examine Testes, epididymis and spermatic
cord:
• Testes can be palpable separately from
swelling.
• Penis situated in midline,no deviation to any
side.
• PERCUSSION : Resonant.
• AUSCULTATION : Peristaltic bowel sound
heard.

16. LEFT INGUINAL REGION.
INSPECTION.
• Site: Left inguinal region.
• Extent: Extends from medial to midinguinal point upto root of
scrotum.
• Size: 3*3*2 cm.
• Shape: Globular.
• Surface: Smooth.
• Margins: Well defined.
• Expansile cough impulse presnt.
• Reducibility present.
• No changes in skin over swelling.
• Surrounding area appears normal.
• No dilated vein.
• No visible peristalsis.
• No visible pulsation.

17. • PALPATION
• All the inspectory findings confirmed.
• No local rise of temperature.
• No tenderness.
• Swelling
• Site: Left inguinal region.
• Extends from medial to midinguinal point upto root of scrotum and is medial and
above to pubic tubercle.
• To get above swelling – Not possible.
• Size: 3*3*2 cm.
• Shape: Globular.
• Surface: Smooth.
• Margin: Well defined.
• Consistency – soft and elastic.
• Reducibility – Reducible, initial part difficult, last part easy.
• Impulse on coughing present.
• Skin over swelling: normal.
• Surrounding area normal.
• Visible peristalsis could not make out.
• No pulsation over swelling.

18. • Deep ring occlusion test – Swelling appears.
• Zieman’s test – Impulse at middle finger.
• Finger invagination test – one little finger
admitted, directed backwards, impulse at pulp
of finger.

19. • Examination of Testes, epididymis and
spermatic cord:
• Testes can be palpable separately from
swelling.
• Penis situated in midline, no deviation to any
side.
• PERCUSSION: Resonant.
• AUSCULTATION: Peristaltic bowel sound heard.

20. • Examination of inguinal lymph node – normal.
• Examination of abdominal muscles : Undue protrusion
of lower abdomen present.
• Per rectal examination – Not done.
• Systemic examination:
• Respiratory System : Normal vescicular Breath Sounds
Heard.
• Cardiovascular Examination : S1,S2 heard. No murmur.
• Central Nervous system: Conscious,coopertaive.

21. Provisional diagnosis:
• BILATERAL INCOMPLETE REDUCIBLE
UNCOMPLICATED DIRECT INGUINAL HERNIA
• PROBABLY CONTAINING INTESTINE.
•