Monday, December 19, 2016

Brief Description Of Abdominal Wall Hernias

Abdominal wall hernias: 
Definition: The classical surgical definition of a hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.

Risk factors for abdominal wall hernias include:

  • obesity
  • ascites 
  • increasing age 
  • surgical wounds

Clinical  Features include:

  • a palpable lump 
  • cough impulse 
  • pain 
  • obstruction: more common in femoral hernias 
  • strangulation: may compromise the bowel blood supply leading to infarction 

Types of abdominal wall hernias:

1. Inguinal hernia:

  • Inguinal hernias account for 75% of abdominal wall hernias. 
  • Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia. 
  • Above and medial to pubic tubercle Strangulation is rare

2. Femoral hernia
  • Below and lateral to the pubic tubercle 
  • More common in women, particularly multiparous ones 
  • High risk of obstruction and strangulation 
  • Surgical repair is required

3. Umbilical hernia : Symmetrical bulge under the umbilicus

4. Paraumbilical hernia: Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus.

5. Epigastric hernia: Lump in the midline between umbilicus and the xiphisternum. Most common in men aged 20-30 years

6. Incisional hernia: May occur in up to 10% of abdominal operations

7. Spigelian hernia
  • Also known as lateral ventral hernia.
  • Rare and seen in older patients 
  • A hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally)

8. Obturator hernia: A hernia which passes through the obturator foramen. More common in females and typical presents with bowel obstruction

9. Richter hernia: A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect

10. Congenital inguinal hernia: 
  • Indirect hernias resulting from a patent processus vaginalis 
  • Occur in around 1% of term babies. 
  • More common in premature babies and boys 60% are right sided, 10% are bilaterally 
  • Should be surgically repaired soon after diagnosis as at risk of incarceration

11.  Infantile umbilical hernia: 
  • Symmetrical bulge under the umbilicus 
  • More common in premature and Afro-Caribbean babies 
  • The vast majority resolve without intervention before the age of 4-5 years 
  • Complications are rare

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