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A hernia is a protrusion ofa viscus (Plural - viscera) orpart of a viscus through anabnormal opening in thewalls of its containingcavity.an abnormal weakness orhole in an anatomicalstructure which allowssomething inside toprotrude through.
Hernias by themselves usually are harmless, butnearly all have a potential risk of having theirblood supply cut off (becoming strangulated).If the blood supply is cut off at the herniaopening in the abdominal wall, it becomes amedical and surgical emergency.
Any condition that increases the pressure of theabdominal cavity may contribute to the formationor worsening of a hernia. Obesity Heavy lifting Coughing Straining during a bowel movement or urination Chronic lung disease Fluid in the abdominal cavity Poor nutrition Ehlers-danlos and Marfan syndrome Congenital
A hernia consists of 3 parts The sac Mouth Neck Body and Fundus The covering of the sac Contents of the sac Omentum – omentocele Intestine – enterocele Fluid – ascites Sometimes part of bladder or ovary
Reducible – contents can be returned toabdomenIrreducible – contents cannot be returned butthere are no other complicationsObstructed – bowel in the hernia has goodblood supply but bowel is obstructedStrangulated – blood supply of bowel isobstructedInflamed – contents of sac have becomeinflamed
Most common (75 %) Inguinal Femoral UmbilicalIncisionalOthers (Rare – 1.5 %) Spigelian Hiatus (Diaphragmatic) Obturator Epigastric, Etc..
More common in men than women.Two types of inguinal hernias: indirect inguinalhernia and direct inguinal hernia. Indirect inguinal hernia In congenital form hernia follows pathway (processus vaginalis) that testicles made during prebirth development. This pathway normally closes before birth but remains a possible place for a hernia. Sometimes the hernial sac may protrude into the scrotum. Can occur at any age mainly at old age.
Direct inguinal hernia This occurs slightly to the inside of the sight of the indirect hernia, in a place where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. The direct hernia almost always occurs in the middle-aged and elderly because their abdominal walls weaken as they age.
The femoral canal is the way thatthe femoral artery, vein, andnerve leave the abdominal cavityto enter the thigh.Although normally a tight space,sometimes it becomes largeenough to allow abdominalcontents (usually intestine) intothe canal.This hernia causes a bulge belowthe inguinal crease in roughly themiddle of the thigh.Has risk of becoming irreducibleand strangulated.
A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn Although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 2-3 years Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in inguinal hernia They most often appear later in elderly people and middle-aged women who have had children.
Abdominal surgery causes a flaw in the abdominal wall that must heal on its own. This flaw can create an area of weakness where a hernia may develop. This occurs after 2-10% of all abdominal surgeries, although some people are more at risk. After surgical repair, these hernias have a high rate of returning (20-45%).
A hiatus hernia occurs when the upper part of the stomach, which is joined to the oesophagus (gullet), moves up into the chest through the hiatus in the diaphragm. It is common and occurs in about 10 per cent of people. It is most common in overweight middle-aged women and elderly people and can also occur during pregnancy.
Epigastric hernia Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, these hernias are composed usually of fatty tissue and rarely contain intestine.Richters hernia: Hernia involving only one sidewall of the bowel, which can result in bowel strangulation leading to perforation through ischemia without causing bowel obstruction or any of its warning signs.
Spigelian hernia Occurs along the edge of the rectus abdominus muscle, which is several inches to the side of the middle of the abdomen.Obturator hernia Rare; happens mostly in women. This hernia protrudes from the pelvic cavity through an opening in your pelvic bone (obturator foramen). wont show any bulge but can act like a bowel obstruction and cause nausea and vomiting
In irreducible hernia - advisable torepair, in order to preventcomplications as organdysfunction, gangrene and multiple organ dysfunction syndrome.Laparoscopy is preferredUncomplicated hernias areprincipally repaired by pushingback, or "reducing", the herniatedtissue, and then mending theweakness in muscle tissue (anoperation called herniorrhaphy).