Hernia (Inguinal and Incisional) Flashcards
ESSENCE
Weakness in body allows an organ (eg bowel) to pass through cavity wall
CLINICAL FEATURES
Typical features of abdominal wall hernias
- Presentation varies depending on kind of hernia, but typical features
- Soft lump protruding from abdominal wall
- May be reducible (can be pushed back in)
- May protrude on coughing
- Aching, pulling or dragging sensation
COMPLICATIONS
3 key complications
- Incarceration
- Obstruction
- Strangulation
What is key for risk of complication
Size of hernia neck, larger means less likelyhood for complication, always check neck on examination
What is incarceration
Hernia cannot be reduced back into proper position, can lead to obstruction and strangulation of hernia
What is strangulation
Hernia is non-reducible and the base is so tight that it cuts of blood suuply causing ischaemia
Surgical emergency
What are some examples of hernia
- Richter’s hernia
- Maydl’s hernia
- Inguinal hernia
- Femoral hernia
- Incisional hernia
- Umbilical hernia
- Epigastric hernia
- Spigelian hernia
- Diastasis recti
- Obturator hernia
- Hiatus hernia
What is Richters hernia
- Very specific situation that can occur in any abdominal hernia
- Part of bowel wall and lumen herniate through defect with other side still in peritoneal cavity
- Can become strangulated easily
What is Maydl’s hernia
Specific situation where 2 different loops of bowel are contained within hernia
MANAGEMENT
General options
- Conservative management
- Tension-free repair (surgery)
- Tension repair (surgery)
MANAGEMENT
Conservative
- Leaving hernia alone, most appropriate with wide neck hernia
MANAGEMENT
Tension-free repair
- Mesh over defect in abdominal wall and sutured to muscles and tissues on either side of defect
- Overtime tissues grow into mesh and provide additional support
MANAGEMENT
Tension repair
- Surgical operation to suture muscles and tissues on either side of defect back together
- Rarely performed, tension-free repair usually done
2 types of inguinal hernia
- Indirect inguinal hernia
- Direct inguinal hernia
What is indirect inguinal hernia
Bowel herniates through inguinal canal
ANATOMY
What is inguinal canal
- Tube that runs between deep inguinal ring and superficial inguinal ring
- In males allows spermatic cord and contents to travel from peritoneal caivity into scrotum
- In females round ligament travels through which attaches to uterus, through canal to labia majora
ANATOMY
Embryology of inguinal canal
- Processus vaginalis is a pouch of peritoneum that extends from abdominal cavity through inguinal canal
- Allows testes to descend from abdominal cavity into scrotum
- Normally deep inguinal ring closes and processus vaginalis obliterated
- Sometimes remains intract and can allow bowel to travel through in life causing indirect inguinal hernia
Findings to differentiate indirect inguinal hernia from direct
- When indirect hernia reduced and pressure applied with 2 fingertips at deep inguinal ring (halfway point from ASIS to pubic tubercle) the hernia will remain reduced
What is direct inguinal hernia
- Occur due to weakness in abdominal wall at Hasselbachs triangle (not along tract like indirect inguinal hernia)
- Pressure over deep inguinal ring will not stop the herniation
Boundaries of Hesselbachs triangle
- Remember RIP
- Rectus abdominal muscle - medial border
- Inferior epigastric vessels - superior/lateral border
- Pouparts ligament (inguinal ligament) - inferior border
What is femoral hernia
- Herniation of abdominal contents through femoral canal, occurs below inguinal ligament at top of thigh
Risk of complications with femoral hernia
High due to femoral ring leaving narrow opening for femoral hernias
Boundaries of femoral canal
- Remember FLIP
- Femoral vein - lateral
- Lacunar ligament - medial
- Inguinal ligament - anterior
- Pectineal ligament - posterior
Difference between femoral triangle and femoral ring
Femoral triangle is area at top of thigh that contains the femoral canal
