Chapter 35: Hernias Flashcards
What is hernia?
(L.rupture) Protrusion of a peritoneal sac through a musculoaponeurotic barrier(e.g., abdominal wall); a fascial defect
What is the incidence?
5% to 10% lifetime
- 50% are indirect inguinal
- 25% are direct inguinal
- ≈5%are femoral
What are the precipitating factors?
- Increased intra-abdominal pressure:
- straining at defecation or urination
- rectal cancer
- colon cancer
- prostatic enlargement
- constipation
- straining at defecation or urination
- obesity
- pregnancy
- ascites
- valsavagenic (coughing) COPD
- an abnormal congenital anatomic route(i.e., patent processus vaginalis)
Why should hernias be repaired?
To avoid complications of incarceration/strangulation, bowel necrosis, SBO,pain
What is more dangerous: a small or large hernia defect?
Small defect is more dangerous because a tight defect is more likely to strangulate if incarcerated
Reducible
Ability to return the displaced organ or tissue/hernia contents to their usual anatomic site
Incarcerated
Swollen or fixed within the hernia sac (incarcerated = imprisoned); may cause intestinal obstruction (i.e., an irreducible hernia)
Strangulated
Incarcerated hernia with resulting ischemia; will result in signs and symptoms of ischemia and intestinal obstruction or bowel necrosis (Think: strangulated= choked)
Complete
Hernia sac and its contents protrude all the way through the defect
Incomplete
Defect present without sac or contents protruding completely through it
What is reducing a hernia “en masse”?
Reducing the hernia contents and hernia sac
Sliding hernia
Hernia sac partially formed by the wall of a viscus (i.e., bladder/cecum)
Littre’s hernia
Hernia involving a Meckel’s diverticulum (Think alphabetically: Littre’sMeckel’s = LM)
Spigelian hernia
Hernia through the linea semilunaris (or spigelian fascia); also known as spontaneous lateral ventral hernia (Think: Spigelian = Semilunaris)
Internal hernia
Hernia in or involving intra-abdominal structure
Petersen’s hernia
Seen after bariatric gastric bypass—internal herniation of small bowel through the mesenteric defect from the Roux limb
Obturator hernia
Hernia through obturator canal (females > males)
Pantaloon hernia
Hernia sac exists as both a direct and indirect hernia straddling the inferior epigastric vessels and protruding through the floor of the canal as well as the internal ring (two sacs separated by the inferior epigastric vessels [the pantcrotch] like a pair of pantaloon pants)
Incisional hernia
Hernia through an incisional site; most common cause is a wound infection
Ventral hernia
Incisional hernia in the ventral abdominal wall
Parastomal hernia
Hernia adjacent to an ostomy (e.g., colostomy)
Richter’s hernia
Incarcerated or strangulated hernia involving only one sidewall of the bowel,which can spontaneously reduce, resulting in gangrenous bowel and perforation within the abdomen without signs of obstruction
Epigastric hernia
Hernia through the linea alba above the umbilicus
Umbilical hernia
- Hernia through the umbilical ring
- in adults associated with:
- ascites
- pregnancy
- obesity
Femoral hernia
Hernia medial to femoral vessels (under inguinal ligament)
Indirect inguinal
Inguinal hernia lateral to Hesselbach’s triangle
Direct inguinal
Inguinal hernia within Hesselbach’s triangle
Hiatal hernia
Hernia through esophageal hiatus
What are the boundaries of Hesselbach’s triangle?
- Inferior epigastric vessels
- Inguinal ligament (Poupart’s)
- Lateral border of the rectus sheath
- Floor consists of internal oblique and the transversus abdominis muscle
What are the layers of the abdominal wall?
- Skin
- Subcutaneous fat
- Scarpa’s fascia
- External oblique
- Internal oblique
- Transversus abdominus
- Transversalis fascia
- Preperitoneal fat
- Peritoneum
Note: All three muscle layer aponeuroses form the anterior rectus sheath, with the posterior rectus sheath being deficient below the arcuate line
What is the differential diagnosis for a mass in a healed C-section incision?
Hernia, ENDOMETRIOMA
