Miscellaneous hernias

Question 1

Define:

Answer 1

Incisional

epigastric

para/umbilical

spigelian

obturator

lumbar

Question 2

Aetiology/risk factors:

Answer 2

Incisional - 10% of midline laparotomy. 25% of wound infection.

Epigastric - attenuated tissue mainly in obesity.

para/umbilical - true umbilical are congenital. OR abdo girth, pregnancy,pressure

spigelian @ semilunar line

lumbar - 25% risk of incaceration

obturator - pelvic floor hernia. very rare. occurs when there is lax pelvic floor. Common in females who are multiparous, poor nutrition and increased abdo pain. Usually in thin elderly women.

Question 3

symptoms:

Answer 3

spigelian - painless lump

lumbar - asymmetric bulge, may present with obstruction

obturator - external rotation and extension may cause pain. may present with obstruction.

Question 4

Investigations:

Answer 4

US
CT
MRI

Question 5

Management:

Answer 5

epigastric - mesh

umbilical - mesh

spigelian - reduce + ligate or mesh

obturator - laparotomy + mesh repair

lumbar - mesh