INTRODUCTION TO HERNIA
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Hernia
A protrusion of an organ or tissue outside its
normal compartment
Anatomy of a Hernia
NORMAL
ABNORMAL
Types of
abdominal wall
hernia
Location
Congenital
Acquired
Epigastric
Upper midline
Umbilical
Umbilicus
Groin
Inguinal/femoral
Incisional
Anywhere
Petits
Interparietal
Lateral hypogastric
Obturator
Obturator foramen
Spigelian
Arcuate x semilunar
lines
Traumatic
Anywhere
Diastasis
Upper midline
Lumbar
*
Not a hernia
Not a hernia
The features of all hernia
Reduces on
lying down
Occurs at
weak spot
Has cough
impulse
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The causes of abdominal Hernia
1. An anatomical weakness where :
Structures pass through the abdominal wall
Muscles fail to overlap
Presents of scar tissue
2. An acquired weakness following trauma
3. High intra abdominal pressure
coughing
stains
abdominal distention
8
Basic Anatomy
Semilunar line
Acute line
Abdominal inguinalInguinal
ring
canal
Subcutaneous
Inguinal ring
Inguinal hernia
Most common
Most difficult to understand
Congenital ~ indirect
Acquired ~ direct or indirect
Indirect Hernia
has peritoneal sac
lateral to epigastric vessels
Direct Hernia
usually no peritoneal sac
through Hasselbach triangle, medial
to epigastric vessels
Anatomy and Classification of
Inguinal Hernia
The Inguinal Canal
The anatomic space beneath the external oblique
aponeurosis, between the internal and external inguinal
rings.
Ilioinguinal & other nerves are found in or on cremaster
and internal oblique muscles.
MEN
WOMEN
Cremaster muscle
Cremaster muscle
cord structures (vas deferens, testicular
vessels, and associated connective tissue
round ligament from the uterus, nerves
and some connective tissues.
Direct hernia
Indirect hernia
Bulges into inguinal canal as a result of weakness
posterior floor of the inguinal canal
Consists of peritoneal sac coming through internal
ring, antero-medial to the spermatic cord (or
round ligament) and into which omentum or
bowel can enter.
increasing frequency in males as they age.
occur at any age
Types of inguinal hernia
Usually low (but not zero) risk for
incarceration or strangulation.
Can develop anywhere in inguinal floor from
internal ring to pubic bone, and involve some or
all of floor.
Higher risk of incarceration/strangulation if
internal ring is small and hernia is large and
extends into scrotum.
Usually congenital, but may be acquired
Epigastric hernia
Very common
In midline between umbilicus
and xiphoid process
May be multiple
Small fascial defect (<1 cm)
Tongue of preperitoneal fat
through interlacing fibers of linea
alba
Peritoneal sac present only if
very large.
Umbilical Hernia
Common in infancy
Reacquired during
adulthood
Small ones of no
significance
Large ones contain
omentum, small or large
bowel
Typical Umbilical Hernia
Umbilical
&
Inguinal
&
Epigastric
Hernias
Scrotal hernia, 1682
Hernia strap, 1758
16th century hernia repair
Source: Undetermined
Source: Undetermined
Source: Undetermined
Femoral Hernia
Develops in femoral canal, medial to
femoral vein, below the inguinal
ligament
Occurs mainly in slender women,
young or old
Often has peritoneal sac
Frequently presents with
incarceration or strangulation
Can cause bowel obstruction
Source: Undetermined
Incisional Hernia
Can occur
ANYWHERE an
incision has been
made, no matter
how small.
Causes of Incisional Hernia
Technical failure or fascial dehiscence:
Sutures rip through, are placed improperly, or break
Weak tissue , tension, infection
Occurs within days or weeks after operation
FAILURE OF WOUND HEALING
Most common cause
Seen 6-12 months after operation
Incisional Hernia
Pressure on skin
can cause
ulceration
