General Surgery

CAUSES OF AN INGUINAL HERNIA

Inguinal hernias can be apparent in infancy and result from a congenital weakness in the abdominal wall. In other cases, inguinal hernias may be caused by:

• Increased pressure within the abdomen due to accumulation of fluid
• Straining during bowel movements or urination
• Heavy lifting
• Pregnancy
• Excessive weight gain
• Chronic coughing or sneezing
• Abdominal injury or post-surgical complications

SYMPTOMS OF AN INGUINAL HERNIA

In many cases, the inguinal hernia causes no symptoms and is only found by the doctor upon physical examination. Sometimes other symptoms are present, including:

• Noticeable bulge in the upper thigh, groin, labia or scrotum
• Heaviness or aching in the groin area which is relieved when lying down
• Tugging or burning sensation in the femoral area
• Discomfort or pain in the groin, especially during sneezing, coughing or heavy lifting
• Sudden pain in the area, sometimes accompanied by nausea or vomiting

If sudden pain occurs, the hernia has become blocked or strangulated. This is an emergency situation and requires immediate care since it means blood flow is impeded and the tissue will begin to die.

TYPES OF INGUINAL HERNIAS

Reducible

Reducible inguinal hernias are minimally painful. With only moderate manipulation, they can be pushed back behind the abdominal wall.

Irreducible

An irreducible inguinal hernia occurs when intestinal tissue protrudes enough to become lodged in the opening. When this occurs, the patient usually experiences more pain and surgery may be required.

Incarcerated or Obstructed

When intestinal tissue becomes stuck, or incarcerated, the patient experiences extreme pain and and vomiting. At this point, surgery is necessary.

Strangulated

An inguinal hernia is referred to as strangulated when intestinal tissue becomes so tightly trapped that blood flow to the protrusion is cut off, causing tissue to die. If left untreated, this may result in gangrene, or tissue decay. When a hernia is strangulated, the patient experiences extreme pain, nausea and vomiting. This is a medical emergency and must be treated immediately.

TREATMENT OF AN INGUINAL HERNIA

Where there is pain or where the hernia is enlarging, surgery is usually necessary. Many doctors recommend surgery to repair a hernia as a prophylactic measure to prevent later incarceration or strangulation.

ADDITIONAL RESOURCES

• MedlinePlus
• National Institutes of Health
• Centers for Disease Control and Prevention
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• U.S. Department of Health & Human Services
• U.S. National Library of Medicine
• WebMD

An umbilical hernia occurs when abdominal tissue protrudes through the skin around the navel or belly button. A common congenital condition in newborns, it may also appear in adulthood, often precipitated or exacerbated by obesity, pregnancy, abdominal surgery or heavy lifting. Umbilical hernias, like other hernias, happen when part of an abdominal organ, usually the intestine, presses through a weak point in the abdominal wall.

Umbilical hernias are often inconsequential. In infants they are usually painless, becoming obvious only when the babies cry or strain during coughing or bowel movements. Congenital umbilical hernias usually resolve themselves by the time the infant is 2 years of age.

For adults, umbilical hernias may be painful, particularly during coughing or when straining during bowel movements or heavy lifting, and may require surgery. When the protruding tissue of a hernia becomes obstructed to the point that tissue is not nourished, serious medical problems may result and surgery becomes urgent.

RISK FACTORS FOR AN UMBILICAL HERNIA

When umbilical hernias occur in adults, they do so for a number of reasons. The causes of umbilical hernias may include:

• Being overweight
• Being pregnant
• An accumulation of fluid in the belly, known as ascites
• Chronic coughing
• Chronic constipation
• Enlarged prostate or problems urinating

If an umbilical hernia enlarges or becomes painful, it may require surgical intervention.

DIAGNOSIS OF AN UMBILICAL HERNIA

An umbilical hernia is normally easy to diagnose with physical examination since the protruding tissue can be palpated.

SYMPTOMS OF A STRANGULATED UMBILICAL HERNIA

Symptoms of a strangulated hernia may include:

• Serious pain, swelling and discoloration at the site
• Inability to move the bowels
• Inability to pass gas
• Nausea and vomiting

THE UMBILICAL HERNIA REPAIR PROCEDURE

Surgery to repair an umbilical hernia, like most general surgeries, has few risks.

The surgical repair of an umbilical hernia is normally performed outpatient under general anesthesia. The surgeon makes a small incision right above or below the navel, pushes the protruding tissue back inside the abdomen and sutures it in place. A piece of mesh is then stitched over or under the weakened area so the hernia will not return.

RISKS OF AN UMBILICAL REPAIR PROCEDURE

Hernia repairs are among the most common and safest surgical procedures performed in the United States. Complications are very rare. Nonetheless, as with any surgery, there are risks patients should be take into account. The risks of any surgical procedure may include:

• Excessive bleeding
• Blood clots
• Adverse reactions to anesthesia or medications
• Post-surgical infection
• Damage to adjacent organs
• Breathing problems
• Re-herniation at the incision site

ADDITIONAL RESOURCES

• MedlinePlus
• National Institutes of Health
• Centers for Disease Control and Prevention
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• U.S. Department of Health & Human Services
• U.S. National Library of Medicine
• WebMD

WHAT IS A COLONOSCOPY?

A colonoscopy is a diagnostic procedure performed to examine the inside of the colon and rectum.

WHY IS A COLONOSCOPY PERFORMED?

The colonoscopy procedure help determine the cause of fluctuations in bowel activity, abdominal pain, and rectal bleeding, as well as detect early signs of cancer. A colonoscopy may be recommended as an option for people who are at risk of developing cancer of the colon and rectum.

HOW CAN I PREPARE FOR THE PROCEDURE?

Patients will be given a set of written instructions to follow. Patients may need to drink a special bowel cleansing solution, the day before the procedure.

WHAT CAN I EXPECT DURING A COLONOSCOPY?

Before the colonoscopy procedure, the patient will be lightly sedated to ensure their comfort during the procedure. Vital signs will be monitored throughout the procedure. The patient will lie on their left side as the colonoscope is inserted into the anus and guided to the opening of the small intestine. The colonoscope is then slowly removed from the colon and the colon is examined carefully by the physician. The removal of polyps, or growths, for biopsy may also be conducted during the procedure. The colonoscopy procedure usually takes between 30-60 minutes to complete.

WHAT HAPPENS AFTER A COLONOSCOPY?

After the procedure, patients will be kept under observation for up to 2 hours, until the sedative used for the procedure wears off. Reflexes and judgment may be impaired and driving is not permitted for 24 hours after the procedure. Some people may experience pressure, bloating and cramping in the abdomen after the procedure, but these effects are temporary.

WHAT ARE THE RISKS OR COMPLICATIONS OF THE PROCEDURE?

Complications of a colonoscopy are rare. If they do occur, complications can include fever, abdominal pain, and dizziness, bleeding from a biopsy site, perforation of the bowel wall or a reaction to the medication used in the IV.

ADDITIONAL RESOURCES

• MedlinePlus
• National Institutes of Health
• Centers for Disease Control and Prevention
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• U.S. Department of Health & Human Services
• U.S. National Library of Medicine
• WebMD

WHAT IS THE APPENDIX?

The appendix is a small organ located at the junction of the small intestine and colon. Once thought to be only vestigial, is now known to help lubricate the colon and to assist the immune system.

WHAT IS APPENDICITIS?

Appendicitis is an inflammation of the appendix due to the buildup of bacteria. It may be caused by a blockage of mucous or fecal matter in the appendix leading to the production of pus. Pus is a combination of bacteria, white blood cells and dead tissue.

Uncontrolled inflammation can cause the appendix to rupture, spreading infection into nearby intestinal tissues; this is called peritonitis. While the body is sometimes able to contain the infection on its own or with the aid of antibiotics, untreated appendicitis can lead to intestinal blockage and sepsis, a systemic and potentially lethal condition.

WHAT ARE THE SYMPTOMS OF APPENDICITIS?

Signs that you may have appendicitis include diffuse or localized abdominal pain and tenderness, particularly in the lower right quadrant, which increases over a short period of time, elevated temperature, loss of appetite, nausea and vomiting, abdominal swelling, constipation or diarrhea with gas, back or rectal pain, or, less commonly, difficulty urinating.

WHEN IS AN APPENDECTOMY NECESSARY?

Appendicitis is the most common reason for appendectomy. Surgery is not required if the body is able to control and eradicate the infection on its own or with the help of antibiotics; this is known as confined appendicitis. For patients whose infections cannot be controlled, an appendectomy is necessary. An appendectomy is also necessary in the case of a tumor of the appendix.

HOW IS AN APPENDECTOMY PERFORMED?

Usually an appendectomy is performed laparoscopically, although open surgery may be necessary in some cases. A laparoscopic appendectomy is a minimally invasive procedure in which an endoscope and a few surgical instruments are inserted through small incisions in the abdomen so the appendix can be removed with less pain and a shorter recovery period.

WHAT ARE THE RISKS OF AN APPENDECTOMY?

An appendectomy is generally a safe procedure. As with any operation, however, particularly if it is performed as an emergency surgery, there are risks which may include the following:

• Adverse reactions to anesthesia or medication
• Excessive bleeding
• Postsurgical Infection
• Damage to adjacent organs

It is important to remember that the worst risks of appendicitis, a ruptured appendix and peritonitis, far outweigh the risk of the appendectomy itself.

WHAT IS THE RECOVERY PERIOD AFTER AN APPENDECTOMY?

Patients return home quickly, although full recovery may take up to three weeks. During recovery, the patient requires rest and then a gradual return to ordinary activities. A liquid or soft diet might be required to aid in the healing process.

ADDITIONAL RESOURCES

• MedlinePlus
• National Institutes of Health
• Centers for Disease Control and Prevention
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• U.S. Department of Health & Human Services
• U.S. National Library of Medicine
• WebMD

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