2. Definition
*A hernia is defined as the protrusion of part or
whole of an organ or tissue through the wall of
the cavity that normally contains it.
*There are numerous types of abdominal
hernia, the most common of which are hiatus,
inguinal, femoral, and incisional hernia.
5. Inguinal Hernia
●An inguinal hernia occurs when
abdominal cavity contents enter into the
inguinal canal.
●They are the most common type of
hernia and account for around 75% of all
anterior abdominal wall hernias.
6. Classification- Inguinal Hernia
● Direct inguinal hernia (20%) – Bowel enters
the inguinal canal “directly” through a weakness
in the posterior wall of the canal, termed
Hesselbach’s triangle.
They occur more commonly in older patients.
● Indirect inguinal hernia (80%) – Bowel enters
the inguinal canal via the deep inguinal ring.
7. Risk Factors
The main factors that increase the risk of
developing an inguinal hernia:
● Male
● Increasing age
● Raised intra-abdominal pressure
● Chronic cough, heavy lifting,
● chronic constipation
● Obesity
8. Clinical Features
● common presenting symptom is a lump in
the groin, which (for reducible hernia) will
initially disappear with minimal pressure
or when the patient lies down.
● If the hernia becomes incarcerated, it can
become painful, tender, and
erythematous
9. Femoral Hernia
● Femoral hernia occur when abdominal
viscera or omentum passes through the
femoral ring and into the potential space of
the femoral canal.
● more common in women than men (ratio
3:1), because of the wider anatomy of the
female bony pelvis.
10. Risk Factors
The main risk factors for developing a femoral
hernia include:
* Female
* Pregnancy (higher incidence in multiparous
women)
* Raised intra-abdominal pressure (e.g. heavy
lifting, chronic constipation)
* Increasing age
11. Clinical manifestations
● Small and moderate-sized hernias don’t usually
cause any symptoms.
● bulge near the groin or thigh.
● Femoral hernias are often located very close to
the hip bone and as a result may cause hip
pain.
● Severe symptoms of a femoral hernia include:
- severe stomach pain
-sudden groin pain
- nausea and vomiting
12. Umbilical hernia
An umbilical hernia is a bulge through the
abdominal wall near umbilicus (belly
button). The hernia may contain tissue
from the abdomen, part of an organ (such
as the intestine), or fluid.
13.
14. Risk factors
● Being overweight
● Age older than 60
● Fluid in abdomen (ascites)
● A large growth in abdomen
● Pregnancy, especially more than 1 pregnancy
● Chronic constipation or straining to have bowel
movements
● Repeated coughing caused by lung disease such
as COPD
15. Clinical Features
● A bulge or swelling in or near belly button
● A bulge that gets bigger when cough,
strain to have a bowel movement, or sit
up
● Umbilical hernias usually do not cause
any pain.
17. Pathophysiology
●The layers of the anterior abdominal wall are
normally strong, and act to maintain the integrity of
the abdominal cavity. However, once these layers
are interrupted by a surgical incision, their
continuity is disrupted and they are structurally
weakened.
●In the presence of increased intra-abdominal
pressure and/or certain risk factors (such as
smoking, infection or emergency surgery), the
contents of the abdomen are able to herniate
through the weakness, forming an incisional hernia.
19. Clinical Features
● non-pulsatile, reducible, soft and non-tender
swelling at or near the site of a previous
surgical wound.
● If the hernia is incarcerated, it can become
painful, tender, and erythematous.
● In cases of bowel obstruction, the patient may
also present with symptoms of abdominal
distention, vomiting, and/or absolute
constipation.
21. Management of Hernia
Surgical management
●Herniotomy (removal of the hernial sac only)
●Herniorrhaphy (tissue repair) : It involves a
surgeon making a long incision directly over
the hernia then tissues or a displaced organ
are returned to their original location, and the
hernia sac is removed.
22. Cont...
● Hernioplasty (mesh repair) : In
hernioplasty, instead of stitching the
muscle opening shut, the surgeon covers it
with a flat, sterile mesh, usually made of
flexible plastics, such as polypropylene, or
animal tissue.
