Hernias Flashcards
What is a hernia?
abnormal protrusion of an organ or part of an organ through its containing body wall
What is a Richter’s hernia?
where partial thickness of the bowel is trapped within the hernia
leads to partial bowel obstruction
What is a sliding hernia?
peritoneal covered structure such as colon or bladder slides down extra-peritoneally with the peritoneum adjacent to it and forms the wall of the hernia sac
What is a pantaloon hernia?
direct and indirect inguinal hernia occurring simultaneously
Direct vs Indirect inguinal hernia?
Indirect herniate through the inguinal canal (leaves abdomen through deep inguinal ring and exits through superficial inguinal ring)
Direct herniate directly through the Hesslebach’s triangle of transversalis fascia
Location of direct vs indirect inguinal hernia?
Direct occurs medially to the inferior epigastric vessels
Indirect occurs laterally to the inferior epigastric vessels
Where does the inguinal ligament run?
from the ASIS to the pubic tubercle
Borders of Hesslebach’s triangle?
Recuts sheath
Inferior epigastric artery
Poupart’s ligament (Inguinal ligament)
RIP
Contents of the inguinal canal?
3 vessels (testicular, vas deferens, cremasteric)
3 fasciae (external spermatic, internal spermatic, cremasteric)
3 others (spermatic cord, vas deferens, lymphatics)
4 nerves (cremaster, sympathetic, ilioinguinal, genitofemoral)
Examination of inguinal hernia?
examine lying and standing
cough impulse
direct/indirect -> reduce and apply pressure over deep inguinal ring
Mx of inguinal hernias?
strangulated/obstructed -> emergency repair
conservative -> elderly, significant co-morbidity, mild symptoms
surgical -> repair because of symptoms, not to prevent complications
tension-free or tension repair (tension-free preferred)
laparoscopic herniorrhaphy (if recurrent or bilateral)
Complications of inguinal hernia repair?
scrotal haematoma
wound infection
urinary retention
chronic pain/paraesthesia in scrotum or labia majora (ilioinguinal nerve damage)
testicular atrophy (testicular artery)
recurrence
Location of femoral hernia?
lateral and inferior to the pubic tubercle
Complications of hernias?
incarceration
strangulation
obstruction
What is a Maydl’s hernia?
two loops of bowel contained in the same hernia
Boundaries of the femoral canal?
FLIP
Femoral Vein
Lacunar ligament
Inguinal ligament
Pectineal ligament
Boundaries of femoral triangle?
SAIL
Sartorius
Adductor longus
Inguinal Ligament
Contents of femoral triangle?
Canal
Vein
Artery
Nerve
Contents of femoral canal?
lymphatics
Mx of femoral hernia?
all require surgical repair due to high risk of complications
Umbilical vs Para-umbilical hernia?
umbilical always congenital
para-umbilical always acquired
RFs for peri-umbilical hernia?
obesity
pregnancy
Umbilical vs Inguinal hernia in infants?
inguinal need urgent repair
umbilical do not (most self-resolve, if still present by 3 repair is needed)
RFs for incisional hernia?
post-op wound infection
abdominal obesity
poor muscle quality (smoking, anaemia)
multiple operations through same incision
poor choice of incision
inadequate closure technique
What is a Spigelian hernia?
defect between the lateral border of rectus abdominis and linea semilunaris
hard to diagnose clinically, US may be needed
What is diastasis recti?
not a hernia!!! (no actual protrusion)
widening of the linea alba, the connective tissue that separates the rectus abdominis muscles
congenital or acquired (pregnancy or obesity)
What is a Littre’s hernia?
herniation of Meckel’s diverticulum
