Medical Legal Issues in the Development of an Inguinal Hernia

A 52-year-old gentleman who had been working on a farm developed a right inguinal hernia. He stated that as part of his job, he regularly had to lift large rocks and boulders from the fields, and also often carried large bales of hay and other feeds. Understanding the Medical Legal Issues in the Development of an Inguinal Hernia is crucial for evaluating potential claims and responsibilities.

The man attended his GP with a painless lump in his right groin, which was diagnosed as an inguinal hernia. He subsequently underwent a surgical repair, where it was shown he had what is termed an indirect hernia. He took an action against his employer, claiming the hernia to be a work-related injury. This highlights the importance of understanding Medical Legal Issues in the Development of an Inguinal Hernia.

Understanding the Medical Legal Issues in the Development of an Inguinal Hernia is crucial for evaluating potential claims and responsibilities.

Inguinal hernias are common, with a life-time incidence of more than one in four of the male population, particularly developing around middle age. An indirect hernia develops down a channel from the abdomen to the scrotum, through which the testicle emerged around the time of birth.

Four tests have been suggested to support a causal link between an event and the development of an indirect hernia. These are:

• A strenuous event officially reported;
• Severe groin pain at the time of the event;
• A diagnosis of an inguinal hernia made by a doctor;
• Within at most 30 days, but preferably much sooner.

Added to this would be that there was no previous history of an inguinal hernia on the other side. In the present case, the action was successfully defended, and the hernia was not regarded as being work related, as none of the above tests applied.

There is another form of inguinal hernia, called a direct hernia, which is due to weakness of the lower abdominal musculature, particularly in those who are overweight because of fatty infiltration of the musculature. This has a more direct association with a chronic increase in abdominal pressure and, in another case, frequent climbing up and down a high step was the alleged cause.

The medico-legal suggestion is that the structural failure represented by the hernia is precipitated by an increased intra-abdominal pressure and, therefore, in terms of work, could be caused by heavy lifting. Such a case would require an engineering report in relation to (a) abnormal loads and (b) abnormal abdominal pressures generated by faulty work practice, such as having to pull oneself up onto steps that are above the legislative codes of practice (ISO 14122–4, 2010) – or, in a recent case, more than two times the upper limit to the first rung.

The conclusion, therefore, is that for an action to succeed in terms of an acute, work-related indirect inguinal hernia, specific details must be present in terms of the history of onset. In the case of a direct hernia, the suggestion of a chronic increase in abdominal pressure would require a report from an investigative engineer to show any potential breach of the duty of care.

MDU figures for 2024 show that fewer than one in six actions in medical negligence actually succeed, with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is, therefore, essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to court with no chance of success. This is stressful for both the client and their legal adviser, and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases, contact Peyton Medico Legal Services now on +44 (0)28 87724177, or email rpeyton@rpeyton.com