Incisional Hernia Flashcards
What is an incisional hernia?
A protrusion of the contents of a cavity, usually the abdomen, through a previously made incision in the compartment’s wall
When do incisional hernias occur?
After an operation
How common are incisional hernias?
Extremely common, with a prevalence of 5% after 1 year and 25% after 2 years
How does surgery affect the anterior abdominal wall?
The layers of the anterior abdominal wall are normally strong, and act to maintain the integrity of the abdominal cavity, however once they are interrupted by a surgical incision, their continuity is disrupted and they are structurally weakened
What contributes to the development of an incisional hernia?
Increased intra-abdominal pressure or certain risk factors
What complications can occur with an incisional hernia?
- Incarceration
- Strangulation
- Bowel obstruction
What are the main risk factors for incisional hernias?
- Emergency surgery
- Wound type
- BMI >25
- Midline incision
- Wound infection
- Pre-op chemotherapy
- Intra-op blood transfusion
- Advancing age
- Pregnancy
What are the less common risk factors for incisional hernias?
- Chronic cough
- Diabetes mellitus
- Steroid therapy
- Smoking
- Connective tissue disease
What is the characteristic clinical feature of an incisional hernia?
Non-pulsatile, reducible, soft and non-tender swelling at or near the site of a previous surgical wound
How might an incarcerated incisional hernia present?
Painful, tender, and erythematous
How might an incisional hernia causing bowel obstruction present?
With symptoms of abdominal distention, vomiting, and/or absolute constipation
What may be found on examination on incisional hernia?
Mass palpable at or near the site of surgical incision, may be reducible
What should be assessed for on examination for incisional hernia?
Any signs of bowel ischaemia, such as rebound tenderness or involuntary guarding
What are the differential diagnoses of incisional hernias?
Not many tbh, but consider other causes of abdominal lymph such as lipoma
How is a diagnosis of incisional hernia usually made?
Clinical basis, with no lab or imaging studies required
