Surgical Decision Making in Geriatrics by Unknown

Surgical Decision Making in Geriatrics by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030479633
Publisher: Springer International Publishing


Inguinal Hernia in the Elderly Presents Differently from the Non-elderly

While considering the acuity of presentation, it is noteworthy that the elderly population is more likely to present with complicated inguinal hernia (incarceration or strangulation) as compared to young patients [7]. The overall risk of incarceration and strangulation approaches is up to 40% [3].

Studies have shown that time from diagnosis to inguinal hernia repair is usually higher in the elderly as compared to young patients [8]. This disparity is an active area of future research and intervention. The role of physicians practicing in the community is of paramount importance in early detection and post-operative care of the elderly undergoing IH repair [9].

Anatomically inguinal hernia is divided into two common types, indirect inguinal hernia when the hernial contents travel through the inguinal canal and exit via the superficial inguinal ring. Protrusion of the hernial contents through the weakened floor of the inguinal canal is known as direct inguinal hernia. An indirect hernia is more common in the young and direct hernia in the elderly [10].

The elderly generally present with larger indirect inguinal hernia than young adults. In the case of large indirect hernia, an acquired defect of the transversalis fascia is always present. Direct inguinal hernias are more often bilateral, and its occurrence is closely related to age [11]. These large hernias may contain large or small bowel (please refer to Figs. 1.​3 and 1.​5 in Chap. 1, as well as Fig. 16.1) and often are bilateral (Fig. 16.2), and are combined with umbilical hernia (Fig. 16.2).

Fig. 16.1(a) 73-year-old male with left incarcerated inguinal hernia containing sigmoid colon. (b) CT scan of the same patient with incarcerated sigmoid colon in scrotum (∗)



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