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Hernia

A hernia is the protrusion of an organ or tissue through a weakness in the wall of the cavity that normally contains it. Hernias are commonly caused by straining, obesity, or coughing and can be classified as reducible, irreducible, obstructed, or strangulated. The most common types are inguinal, femoral, umbilical, and incisional hernias.

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29 views

Hernia

A hernia is the protrusion of an organ or tissue through a weakness in the wall of the cavity that normally contains it. Hernias are commonly caused by straining, obesity, or coughing and can be classified as reducible, irreducible, obstructed, or strangulated. The most common types are inguinal, femoral, umbilical, and incisional hernias.

Uploaded by

shaza ewis
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Hernia

Section of General and


Oncology Surgery
Definition

• The protrusion of an organ or part of an


organ through a defecte in the wall of the cavity
normally containing it.
Aetiology

• Coughing
• Straining
• Obesity
Composition of a hernia

• Sac
• Covering
• Content
classification

• Reducable
• Irreducable
• Obstructed
• Strangulated
Types

• Inguinal
• Femoral
• Umbilical
• Paraumbilical
• Epigastric
• Incisional
• Spegalian
• Lumbar
Groin Hernia

• Inguinal
• femoral
Inguinal

• Most common form of hernia


• 65% indirect
• 55% right
• 12% bilateral
2 types

• Indirect:
peritoneal sac protrude through the deep
inguinal ring , inguinal canal can reach to the
testis

• Direct:
acquired
defect occur in the abdominal wall in hesselbach’s triangle
direct indirect
Weak posterior wall to Remnant of patent
the inguinal lgament processus vaginalis
Arise medial to the Arise lateral to inferior
inferior epigastric vessels epigastric vessels

Pass through the deep


inguinal ring travelling
through the inguinal canal
with spermatic cord
Bulge through the wall May reach the scrotum
Inguinal canal:
• Boundaries:
- anterior: ext. Oblique aponeurosis
- posterior: fascia transversalis, conjoined tendon
- Superior: internal oblique, and transversus
abdominus
- Inferior : inguinal ligament
• Content
- Male: spermatic cord
ileonguinal n
genital branch of genitofemoral

- Female: round ligament


Femoral hernia

• Sac protrude through the femoral canal


• More common in women
• High incidenco of strangulation
• Femoral canal
- Most medial component of femoral sheath
- Boundries:
anterior: inguinal ligament
posterior: ileopectineal lig., pubic bone
medial: lacunar lig.
lateral : femoral vein
C/F

• Symptoms
groin bulge
rarely dragging pain in the groin

• O/E
- side
- inguinal / femoral
- direct / indirect
- reducable / irreducable
- content
DDx
• LN
• Lipoma
• Sapheno-varix
• skin lesions
• Hernia
• Aneurysm dilatation of femoral artery
• Psoas abscess
• Ectopic or undescended testis
treatment

• Surgery
pediatric herniotomy
adult herniorrhaphy
Umbilical hernia

• d.t. defect through weak umbilicus


• F=M
• Often asymptomatic
• Treatment:
Pediatric: - less than 2 years conservative
- if persist herniorrhaphy
Adult: herniorrhaphy
Paraumblical hernia

• Occur through linea alba above or below the


umbilicus.
• Risk factor
- obesity
- multiparity
Treatment :
Herniorrhaphy
Epigastric Hernia

• Defect in linea alba anywhere from xyphoid to


umbilicus
Lumbar Hernia

• Inferior (triangle of petit)


ileac crest inferiorly
external oblique laterally
lattismus dorsi medially
• Superior
- 12th rib sup
- sacrospinalis medially
- posterior border of internal oblique
posteriorly
Spegalian hernia

• Defect at the level of arcuate ligament


Incisional hernia

• Extrusion of peritoneum and abdominal contents


through a weak scar
• Factors predisposing
- Preoperative:
age
immunocompromised (RF, DM, steroid)
obesity
malignancy
abdominal distention (ascitis/ obstruction)
malnutrition
- operative:
poor technical closure of the wound
( too small bites, inappropriate suture material)
- Post op:
wound infection
wound dehiscence
wound hematoma
post operative atelactasis or infection causing
cough
increase intrabdominal pressure( coughing,
constipation)
• Incarcerated hernia:
content fixed in the sac d.t size or adhesions, it’s
irreducable but not obstructed
• Maydl’s hernia
- 2 adjacent loops of bowel are in the sac.
- the intervening portion in the abdomen is the first
to suffer if neck of sac is tight (strangulated piece is
intra-abdominal)
• Sliding hernia:
- if bowel which is normally extraperitoneal forms
one side of the sac
• Strangulated hernia:
- blood supply of content is compromised
- Clinical features
symptoms:
- sudden pain over the hernia site then
generalized abdominal pain colicky often
localized to the umbilicus.
- N, V
- increase in hernia size
• O/E :
tense hernia
tender
irreducable
no cough impulse
• Treatment :
• IVF, NGT, Abx
emergency surgery
• Richter’s hernia:
part of the wall of small bowel is in the sac, causing
intestinal obstruction

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