Hernias Flashcards
Risk factors for abdominal wall hernias
Obesity
Ascites
Increasing age
Surgical wounds
Features of abdominal wall hernias
Palpable lump
Cough impulse
Pain
Obstruction (more common in femoral hernias)
Strangulation (may compromise bowel blood supply leading to infection)
Complications
Incarceration
Obstruction
Strangulation
Incarceration
Where hernia cannot be reduced back into proper position
Can lead to obstruction and strangulation
Obstruction
Where hernia causes a blockage in passage of faeces through bowel
Presents with vomiting, generalised abdo pain and absolute constipation
Strangulation
Non-reducible and base of hernia becomes so tight it cuts off blood supply causing ischaemia
Presents with significant pain and tenderness
Surgical emergency
Inguinal hernias
75% of abdominal wall hernias
95% are male
Above and medial to pubic tubercle
Strangulation is rare
Femoral hernia
Below and lateral to pubic tubercle
More common in women, particularly multiparous
High risk of obstruction and strangulation
Surgical repair required
Umbilical hernia
Symmetrical bulge under the umbilicus
Common in neonates and can resolve spontaneously
Paraumbilical hernia
Asymmetrical bulge
Half the sac is covered by skin of the abdomen directly above or below the umbilicus
Epigastric hernia
Lump in midline between umbilicus and xiphersternum
Risk factors include extensive physical training or coughing (from lung disease), obesity
Incisional hernia
May occur in up to 10% of abdo operations
Spigelian hernia
Lateral ventral hernia
Rare and seen in older patients
Obturator hernia
Passes through obturator foramen
More common in females and typically presents with bowel obstruction
Richter hernia
Only antimesenteric border of bowel herniates through fascial defect
Can present with strangulation without symptoms of obstruction
Maydl’s hernia
Two different loops of bowel contained within the hernia
Conservative management
Most appropriate when hernia has wide neck and patients not good candidates for surgery
Tension free repair
Mesh over defect in abdominal wall
Mesh sutured to muscle and tissues, covering it and preventing herniation of the cavity contents
Over time tissues grow into mesh and provide extra support
Lower recurrent rate compared with tension repair
Tension repair
Surgical operation to suture muscles and tissue on either side of defect back together
Rarely performed and largely replaced by tension-free repair
Relatively high recurrence rate
Indirect inguinal hernia
Bowel herniates through inguinal canal
When reduced and pressure is applied to deep inguinal ring, the hernia will remain reduced
Deep inguinal ring
Mid-way point from ASIS to pubic tubercle
Direct inguinal hernia
Weakness at Hesselbach’s triangle
Hernia protrudes directly through abdominal wall
Pressure over deep inguinal ring will not stop herniation
Hesselbach’s triangle boundaries
Rectus abdominus muscle (medial border)
Inferior epigastric vessels (super/ lateral border)
Pourpart’s ligament (inguinal ligament) (inferior border)
