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