Hernias

Question 1

What is an abdominal hernia?

Answer 1

A defect in the abdominal wall causing abnormal protrusion of intra-abdominal contents

Question 2

What type of hernia is most common?

Answer 2

Indirect inguinal (50%)
Direct inguinal (20-25%)
Ventral (8-10%)
Umbilical (3-8%)

Question 3

What are some risk factors for abdominal hernias?

Answer 3

• Increased intra-abdominal pressure (obesity, cough, asthma, COPD, Pregnancy, constipation, heavy lifting, ascites)
• Congenital abnormality
• Previous hernia repair
• Loss of tissue strength (aging, repetitive stress)

Question 4

Clinical features of hernia

Answer 4

• mass of variable size
• tender, worse at end of day and relieved with supine position and reduction
• abdominal fullness, vomiting, constipation
• transmits palpable impulse with cough or straining

Question 5

What is the difference between and incarcerated hernia and a strangulated hernia?

Answer 5

Incarcerated: irreducible

Strangulated: vascular supply is compromised (ischemia) requiring emergency repair

Question 6

What is Hesselbach’s triange?

Answer 6

Lateral: Inferior epigastric artery
Inferior: Inguinal ligament
Medial: Lateral margin of rectus sheath

Question 7

What is an indirect hernia?

Answer 7

Originate in deep inguinal ring LATERAL to epigastric artery. Often decents to scrotal sac or labia majora

Question 8

What is a direct hernia?

Answer 8

Through Hesselbach’s triangle MEDIAL to inferior epigastric artery, usually does not decent into scrotal sac

Question 9

Indirect inguinal hernia rule of 5’s

Answer 9

• 5x lifetime incidence males
• 5x more common than direct
• 5-10x more common in males
• generally occur by decade 5

Question 10

Complications of abdominal hernia?

Answer 10

• Incarceration/strangulation
• small/new hernias more likely to strangulate
• can cause obstruction gangrenous bowel or sepsis

Question 11

How are abdominal hernias treated?

Answer 11

Surgical treatment, open or laproscopic repair and may use meth for a tension free closure

Question 12

Post operative complications from abdominal hernia surgery?

Answer 12

-Recurrence (15-20%)
-Scrotal hematoma
-Nerve entrapment (ilioinguinal - numb inner thigh/lateral scrotum)
Stenosis of femoral vein
- Ischemic colitis

Question 13

What is a Richter hernia?

Answer 13

• Only the antimesenteric border of small bowel herniate through the facial defect.
• Does not cause bowel obstruction but can cause gangrene and perforation

Question 14

What is an umbilical hernia?

Answer 14

Herniation through the umbilical fibromuscular ring

- This is congenital, the ring typically closes by 2 years of age