To the Editor.
—I enjoyed the Clinical Crossroads article by Dr Wantz,1 but additional information can be helpful in dealing with patients with inguinal hernia and in teaching students and house staff.Patients generally are predisposed to a groin hernia either from an area of weakness (aggravated by aging) or by a congenital defect, factors mentioned by Wantz. A useful question is, "Why did this patient develop this hernia at this time?" because directed questions can uncover other salient problems that need attention. In older men, 4 questions are relevant: (1) Inquire about smpking, because a chronic cough in a smoker can not only precipitate a hernia but compromise the repair if the patient develops pulmonary problems postoperatively. I obtain a chest x-ray in heavy smokers and have discovered lung cancer in 2 patients this way. (2) Ask about precipitating events. Often in an older man, heavy lifting has set the scene
Vander Veer JB. Clinical Crossroads: A 65-Year-Old Man With an Inguinal Hernia. JAMA. 1997;277(21):1679. doi:10.1001/jama.1997.03540450035022