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The Scenario:
For a temporary job after college, Rick decided to work construction. His family had a friend who owned a small construction business building homes and small commercial projects. He was plenty strong, and actually thought the physical labor might be a nice change from all the brain work of the last few years.
Several weeks into the construction of a new house they were putting on the roof. Rick's job was to pick up bundles of asphalt shingles, each one about a hundred pounds, carry them up the ladder and drop them on the roof for the other guys to lay out and nail down. The day went OK except that towards the end he began to notice an aching in his right groin whenever he bent over. He didn't think much about it, but later that evening while he was sitting in a chair, it began to ache considerably. He slept all right, but the next morning, as he was just bending over to tie his shoe laces, the pain grabbed him quite hard. Although he went to work, he wasn't much help -- he couldn't manage to lift any of the shingles without a lot of pain.
The pain pretty much stayed located in the groin except for some aching in his right testicle. When lying down, he definitely felt better. Everything else seemed to be fine, but he could not work.
Questions:
Answer:
Congratulations! Almost everyone got the right answer. Rick has the typical symptoms of an inguinal hernia. The groin, or inguinal region, is an area of potential weakness in the abdominal wall. There is an opening called the inguinal canal that allows for the passage of blood vessels, nerves, the spermatic cord in men, and other structures.
With excessive intra-abdominal pressure, the contents of the abdomen can protrude into this canal forming a hernia. Typically the contents include a portion of intestine, or fatty tissue from within the abdomen. If large enough, it can migrate down the canal and into the scrotum. And many people learn that they can push it back in, at least temporarily.
While there is no urgency, it would be a good idea to get it checked, to confirm that it is a hernia, and to discuss the prospects for having it surgically repaired. There is one caution, however. There are occasions when the herniated tissue can strangulate by twisting within the canal. This shuts off blood supply to the tissue and can lead to serious problems requiring emergency surgery. Clues to this problem include unremitting pain, nausea and vomiting, and a hernia that can not be pushed back inside. Rick should get medical attention right away if these symptoms occur.
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