Abdominal Hernias

Question 1

Abdo hernia definition

Answer 1

Protrusion of bowel through abdominal wall defect

Question 2

Terminology describing hernia

Answer 2

Irreducible - can’t be pushed back into place
Obstructed - bowel contents can’t pass
Strangulated - ischaemia occurs so urgent surgery
Incarcerated - contents of hernial sack stuck by adhesions

Question 3

Femoral hernia presentation

Answer 3

Bowel enters femoral canal so presents as mass in upper medial thigh/above inguinal ligament
Points down leg unlike inguinal which points to groin

Question 4

Femoral hernia treatment

Answer 4

Herniotomy - ligation and excision of sac

Herniorrhaphy - repair of hernial defect

Question 5

Paraumbilical hernia and treatment

Answer 5

Occurs above or below umbilicus

Mayo (overlap)/mesh repair of rectus sheath

Question 6

Epigastric hernia

Answer 6

Pass through linea alba above umbilicus

Question 7

Incisional hernia repair types

Answer 7

Post-surgical inscision, mesh repair less recurrence but more infection than sutures

Question 8

Spigelian hernia

Answer 8

Through linea semilunaris, below and lateral to umbilicus

Question 9

Lumbar hernia

Answer 9

Through inferior/superior lumbar triangles on posterior abdo wall

Question 10

Richter’s hernia

Answer 10

Only involves bowel wall, not whole lumen

Question 11

Maydl’s hernia

Answer 11

Herniating double loop of bowel, strangulated single loop may stay inside abdominal cavity

Question 12

Littré’s hernia

Answer 12

Herniated sac containing strangulated Meckel’s diverticulum

Question 13

Obturator hernia

Answer 13

Through obturator foramen, pain on medial side of thigh for thin woman

Question 14

Sciatic hernia and presentation

Answer 14

Rare, passes through lesser sciatic foramen

Presents with GI obstruction and gluteal mass

Question 15

Sliding hernias

Answer 15

Contains partially extraperitoneal structure (e.g. caecum on right, sigmoid on left) so sac not around entire contents

Question 16

Paediatric hernias

Answer 16

Umbilical self-resolving usually by 3
Indirect inguinal in boys due to patent processus vaginalis
Gastroschisis - protrusion through defect to the right of umbilicus needs prompt surgical repair
Exomphalos - Abdo contents outside abdomen covered in 3 layer membrane, surgical repair less urgent

Question 17

Inguinal hernia direct and indirect differences

Answer 17

Indirect through deep (internal) inguinal ring, more common, strangulate more easily and lateral to epigastric vessels
Direct through posterior wall of inguinal canal through abdo defect, reduce easily and medial to epigastric vessels

Question 18

Differentiate between direct and indirect inguinal hernias on examination

Answer 18

Reduce hernia and 2 fingers on deep inguinal ring, if restrained then is indirect

Question 19

Treatment inguinal hernias

Answer 19

Reduce short-term to prevent strangulation
Weight loss
Stop smoking
Mesh repairs either transabdominal pre-peritoneal(TAPP)/totally extraperitoneal (TEP) (both 4-12 week recovery) or laparoscopically (2 week recovery)