ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 286

Occasionally—particularly in women—the hernia may be relatively unobtrusive, appear-
ing as a slight bulge below the groin crease—a femoral hernia. Some hernias develop in
surgicalincisions.Herniasaredetectablebyroutinephysicalexaminationandshouldbere-
paired before a substantial wilderness excursion, certainly before a major expedition. Her-
nias become important when the intestine within them cannot be reduced, that is, returned
to its proper location within the peritoneal cavity. Obstruction of the bowel can result and
is evidenced by pain and tenderness at the site. If the blood supply to the intestine caught
in the hernia is obstructed, the pain and tenderness become intense and the bowel can per-
forate, resulting in life-threatening peritonitis.
Figure 20-3. Anatomy of an inguinal hernia