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Christian de Virgilio , Areg Grigorian. Sliding inguinal hernias have a much higher risk of colonic injury during repair than other hernias. This is because the posterior wall of the hernia sac is formed by a retroperitoneal organ colon or bladder. A clue to the presence of a sliding hernia is the finding of a thickened posterior wall of the hernia sac at surgery, in association with a large indirect hernia D that has descended into the scrotum direct hernias rarely descend into the scrotum.
Attempting to completely excise the hernia sac A which is otherwise normally done , or to divide the sac completely at the internal ring E which is again normally recommended , would result in dividing the bowel or bladder. Sliding hernias are more common on the left side C the sigmoid colon is less fixed and more likely to slide down than the right colon. A sliding hernia is an indirect inguinal hernia D. Multigravida causes stretching of the abdominal musculature and increases the risk of femoral hernia.
The most common type of hernia in women, and in men, is an indirect inguinal hernia A. Because of the high risk of strangulation, surgical repair of a femoral hernia is indicated D once diagnosed, regardless of whether the patient is having symptoms. Always consider a nonmechanical postoperative ileus in patients that have had a recent surgery. Although the exact cause has not been elucidated, it most likely involves impaired peristalsis of intestinal contents.
Inflammatory mediators e. Initial management should begin with changing pain medication to a non-opiate analgesic. Encouraging ambulation A should also be done for all postoperative patients, but is not as imperative as discontinuing opiates. Returning to the OR for exploration E is inappropriate for postoperative ileus.
