Hernias

Question 1

Inguinal hernia - proportion of abdominal hernias, population affected, location, how common is strangulation

Answer 1

75% of abdominal wall hernias
95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia.
Direct inguinal hernia enters through a weak point in the fascia of the abdominal wall. The sac is medial to the inferior epigastric vessels and superior and medial to pubic tubercle
Indirect inguinal hernia results from the failure of embryonic closure of the deep inguinal ring after the testicle has passed through it
Strangulation is rare (<5%)

Question 2

Femoral hernia - location, population affected, complications, is surgery needed

Answer 2

Below and lateral to the pubic tubercle
More common in women, particularly multiparous ones
High risk of obstruction and strangulation
Surgical repair is required

Question 3

Umbilical hernia

Answer 3

Symmetrical bulge under the umbilicus

Question 4

Paraumbilical hernia

Answer 4

Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus

Question 5

Epigastric hernia - location, population affected

Answer 5

Lump in the midline between umbilicus and the xiphisternum

Most common in men aged 20-30 years

Question 6

Incisional hernia

Answer 6

May occur in up to 10% of abdominal operations

Question 7

Spigelian hernia - other name, population affected, location

Answer 7

Also known as lateral ventral hernia
Rare and seen in older patients
A hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally)

Question 8

Obturator hernia - location, population affected

Answer 8

A hernia which passes through the obturator foramen.

More common in females and typical presents with bowel obstruction

Question 9

Richter hernia

Answer 9

A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect

Question 10

Congenital inguinal hernia - location, population affected, do they need surgery and why

Answer 10

Indirect hernias resulting from a patent processus vaginalis - 60% are right sided, 10% are bilaterally
Occur in around 1% of term babies. More common in premature babies and boys
Should be surgically repaired soon after diagnosis as at risk of incarceration

Question 11

Infantile umbilical hernia - location, population affected, what needs to be done, how common are complications

Answer 11

Symmetrical bulge under the umbilicus
More common in premature and Afro-Caribbean babies
The vast majority resolve without intervention before the age of 4-5 years
Complications are rare

Question 12

Hiatus hernia

Answer 12

Sliding - 95% of hiatus hernias, the gastroesophageal junction moves above the diaphragm
Rolling (paraoesophageal) - the gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus

Question 13

Walls of the inguinal canal

Answer 13

Superior - transversalis fascia, internal oblique and transversus abdominis
Anterior - aponeurosis of the external oblique
Inferior - inguinal ligament
Posterior - transversalis fascia