4. hernia occur at sites of weakness
in the wall
• This weakness may be :
1 Normal (physiological) weakness, related to
the anatomical causes.
2 Congenital abnormality
3 Acquired : Traumatic ,Diseases.
8. Inguinal hernia
• Most common site of hernias
• two types :
1. Direct : does not pass the internal inguinal
canal ring. Inter the canal directly through its
weekend posterior wall.
2. indirect : go through the internal ring traveling
to the external ring. may enter the scroyum
9. Anatomy of the inguinal canal
• it is an oblique passage through the lower part
of the anterior abdominal wall.
• it is 1.5 inch passes from the deep inguinal ring
downward medially to the superficial ring.
• lies immediately above
the the inguinal ligament
10. anatomy of the inguinal canal
• the deep ring :oval opening in fascia transversalis
0.5 inch above the inguinal ligament midway between ASIS and
the symphsis pubis ,its margins gives attachment to the internal
spermatic fascia/internal covering of round ligament.
• The superficial ring triangular defect in the aponeurosis of external
oblique muscle immediately above and medial to the pubic
tubercle, its margins gives attachment to the external spermatic
fascia
• walls :
anterior :external oblique aponeurosis
posterior :conjoint tendon medially, fascia transversals laterally
superior: lower fibers of internal oblique and transverses
abodminos muscle
floor : inguinal and lacunar ligaments
12. Contents of the inguinal canal
• in males :spermatic cord[& its coverings + the ilioinguinal nerve.
the spermatic cord contains :
1 vas deferens and the artery to vas deferens
2 pampiniform plexus
3 testicular artery
4 cremasteric artery
5 fascial layers: external spermatic, cremasteric, and internal spermatic fascia
6 genital branch of the genitofemoral nerve
• in females : round ligament of the uterus + the ilioinguinal nerve.
13. Hesselbachs triangel
• triangular area in the lower abdominal wall , it is the site of direct
inguinal hernia its boundaries are
inferior : inguinal ligament
medial : rectus abdominos
lateral :inferior epigastric vessels
14. direct Indirect
Does not passthrough the internal
ring
passes through the internal
ring(controlled by pressure on the
internal ring
does not go down in the scortum
can (often does) descend in the
scortum
Reduced upward and backward
Reduced upward lately and back
ward
Rare in children and your adults all ages groups including children
less common most common
more medial more lateral
16. Femoral hernia
• it is a herniation through the
femoral canal
• they are more common in females
• The hernia appear below the
inguinal ligament and lateral to the
pubic tubercle . Directly behind the
skin crease of the groin
17. Anatomy of the femoral canal
• It is the small medial compartment in the femoral sheat that
contain the lymph vessels.
• it is 0.5inch long starts at : the femoral ring.to the saphenous
opening
18. Umbilical hernia
• May me congenital : the
umbilical scar fails to form .
or acquired: the umbilical
scar is stretched by an
increased intra-abdominal
pressure.
• may be from the umbilical
defect itself or come
through a defect adjacent
to the umbilical scar(may
be called paraumblical).
19. Epigastric hernia
• hernia in a defect in the lines alba
between the xiphisternum and the
umbilicus.
• Patient does not often notice the
underlying lump.
• it is common in children and
associated with divarication of the
rectus abdominis muscle.
20. Incisional hernia
• it is a hernia through a scar in
the abdominal wall caused by
a previous surgery or injury.
• More likely to happen in :
obese, infected wounds,
diabetic, chronic cough,steriod
therapy
21. Spigelian hernia
• is a hernia through the
Spigelian fascia, which is the
aponeurotic layer between the
rectus abdominis muscle
medially, and the semilunar line
laterally.
• below the umblicus and above
the inguinal area .
• rare. seen in obese patients,
difficult to diagnose.
22. Obturator hernia
• comes through the obturator foramen.
• Rarely a palpable mass.
• may compress the obturator nerve and cause pain in medial aspect of
thigh
23. Lumbar hernia
• Can be :
congenital
spontaneous
traumatic
incisional.
• Can pass through :
triangle of grynfeltt
inferior lumbar triangle of petit
previous incision
• Difficult to diagnose, usually by MRI
24. Triangle of grynfeltt
• triangle of grynfeltt (The superior
lumbar triangle)
Bounded by :
superiorly : 12th rib
anteriorly : the internal oblique muscle
floor by : quadrates lumborum muscle
• triangle of petit (the inferior lumbar
triangle) :
bounded by :
posterior :latissimus dorsi muscle
anteriorly : external oblique muscle
inferiorly iliac crest
floor : fiber of internal oblique and
transverses abdomens.
25. Esophageal hiatal hernia
• Herniation through the esophageal hiatus of
the diaphragm.
• 3 types are :
type 1: sliding hernia : award dislocation of
cardia in the posterior mediastinum
type 2 : rolling paraesophgeal hernia :upward
dislocation of gastric fundus with normal
cardia.
type 3: combined sliding rolling. Upward
dislocation of both cardia and funds
27. hernias may be :
• Irreducible :contents cannot be replaced into the
abdomen.
• Incarcerated : contents are imprisoned in the
hernia. Usually by adhesion. they are alive and
functioning normally.
• Obstructed : the lumen in obstructed but the blood
supply is not.
• Strangulation: obstruction of blood supply, leads to
ischemia and infarction
