Dear Dr. Roach: My son had an ultrasound the other day for a hernia. I have had six hernias. His results showed an inguinal hernia, 2.2 centimetres and 鈥渞educible.鈥� Will he need surgery? Can he wear a truss? What does 鈥渞educible鈥� mean? Is this a risk for strangulation of the bowel?
B.E.
A hernia is a defect in the abdominal wall, through which an organ or part of one protrudes. We are all born with the potential for abdominal wall defects due to the way structures move during embryological development. The holes allow those structures to move. In the case of males, the testicle descends through the inguinal ring, which then normally closes. In your son鈥檚 case, it didn鈥檛 completely close, leaving a large enough defect for abdominal contents to come through. Hernias also can occur at the belly button or at sites of previous surgeries.
鈥淩educible鈥� is a good thing when it comes to hernias. It means that the contents of the abdomen can be pushed back into the abdomen (where they belong) with some gentle but firm pressure from the examiner鈥檚 hand. If a hernia is not reducible 鈥� meaning, part of the abdominal contents has gone through the abdominal wall and are trapped outside 鈥� it is called 鈥渋ncarcerated.鈥� This is dangerous, because with swelling of the abdominal contents, the blood flow to the incarcerated contents can decrease, leading to tissue death. This is 鈥渟trangulation鈥� and is a surgical emergency.
Surgery is often done to prevent these complications, even though the risk is low (less than one per cent per year, on average) for inguinal hernias. People who have symptoms from hernias should undergo surgical repair. People with no symptoms may choose to have it repaired; however, others can elect 鈥渨atchful waiting,鈥� but they need to know the warning signs of an incarceration: a nonreducible hernia and pain.
I seldom recommend a truss, because most people who need it for symptoms should be operated on, and people with no symptoms don鈥檛 need it. They are useful in people who are at high risk for surgery.
Dr. Roach Writes: A recent column on the risks of false positive mammograms generated much interest from readers. Many women wrote in to tell me how mammograms identified cancers, which were successfully treated. Others wrote to talk about how mammograms missed their cancer, leading to delays in treatment. Along with H.W.'s history, these stories indicate the need for a careful discussion with every woman, beginning in her 40s, about the benefits and risks of mammograms.
My previous column stated that the U.S. Preventive Services Task Force said there isn鈥檛 enough information to make a recommendation, but it does recommend an individualized discussion. After this discussion, a woman should consider the anxiety a false positive might cause, the delay a false negative might cause, the possibility of unnecessarily treating a cancer that is destined never to cause problems (this is called 鈥渙verdiagnosis,鈥� and there is intense controversy about how often it occurs) against the benefit of possibly finding and successfully treating a cancer that, if untreated, would have spread. No single decision is right for all women, especially in the age group of 40 to 50. Although a personalized decision is appropriate between 50 and 74, the Task Force recommends screening every other year in this age group.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
