Other Types Of Hernia

Question 1

Spigelian hernia

Answer 1

Occurs under the lower edge of the linea semilunaris/via the fibers of transversus abdominis and protrudes along the lateral border of the rectus sheath

Typically difficult to diagnose in the supine position

Has a high risk of complications
Treatment:
- repair via direct suture of the rectus sheath

Question 2

Obturator hernia

Answer 2

Occurs through the Obturator canal from the lateral wall of the pelvis with the sac protruding into the medial upper thigh

Clinical presentation
- pain/abdominal sensations in the distributions of the onbturator nerve in the skin of the inner medial thigh
Diagnosis
- usually very difficult
- high proportion presents with small bowel obstruction due to sac being hidden within muscles of the adductor compartment
-the neck is narrow and prone to strangulation
Treatment
- repair can be via exposure of the sac in the medial thigh/ laparotomy when complications occur

Question 3

Lumbar hernia

Answer 3

Occurs through either the inferior/superior lumbar triangles (bound by the lumbar muscles, limbo sacral fascia and bony features of the posterior abdominal wall)/rarely through lumbar incisions

Usually contains retro peritoneal fat and rarely bowel

Treatment
- repair by direct suture / mesh for larger defects

Question 4

Perineal hernia

Answer 4

Spontaneous perineal hernias occur through the greater/lesser sciatic foramen and are exceptionally rare

Present with acute complications and are diagnosed only during surgery

Post op perineal hernias occur through the pelvic floor muscles usually as a result of surgical procedures (particularly after abdominoperineal resection of the rectum)

Treatment
- repair may be via sutured closure of the defect/ more commonly filling the defect with prosthetic material (mesh)/biological tissue(muscle flap)