Imputabilité d'une hernie inguinale à un effort inhabituel survenu au cours du travail : à propos d'un cas

Inguinal hernia is one of the most frequent causes of digestive surgery in France. While its pathophysiology is not precisely determined, several risks factors are acknowledged: weakness of tranversalis fascia, acute and/or chronic high intra-abdominal pressure. We report the case of a 24-year-old man, with no medical or surgical history, who experienced a sudden right-sided inguinal pain while at work (carrying heavy loads). That led him to consult a general practitioner 3 days later who diagnosed a right inguinal hernia, which was confirmed by a visceral surgeon who subsequently treated the lesion surgically. A medical officer of the health insurance company did not acknowledge the link between the work effort and the apparition of the lesion. The victim contested that decision. The role of the expert was, according to the mission, to adjudicate causal association. In common law, causality assessment responds to several criteria: absence of anterior state, pathological likelihood, and time between trauma and occurrence of the lesion. However, in occupational medicine, causality is presumed, so that the employer or the health insurance company has to prove the absence of link between lesion and trauma. In this case, assessment of facts and comparison to literature data led to the acknowledgement of the causality between the inguinal hernia in this patient without pathological history and the strenuous work effort.