This document defines and classifies different types of hernias. It discusses the anatomy of inguinal hernias and covers direct and indirect inguinal hernias. Other hernias mentioned include femoral, epigastric, umbilical, incisional, Spigelian, obturator, lumbar and rare types like Maydl's and Littre's hernia. Clinical features and management are also briefly covered. The document provides detailed information on the definition, classification, anatomy and types of various abdominal wall hernias.

1. Hernia
 SYED KHAJA

2. CONTENTS
• DEFINITION
• ANATOMY
• TYPES
• CLINICAL FEATURES
• MANAGEMENT

3. DEFINITION
• PROTRUSION OF WHOLE OR A PART OF VISCUS
THROUGH A WALL WHICH CONTAINS IT.
• ABDOMINAL HERNIAS ARE THE COMMONEST TYPES
OF HERNIAS.

4. CLASSIFICATION:
1]CLINICAL CLASSIFICATION:
• REDUCIBLE HERNIA.
• IRREDUCIBLE HERNIA.
• OBSTRUCTED HERNIA.
• INFLAMMED HERNIA.
• STRANGULATED HERNIA.
• OCCULT HERNIA.

5. 2] BASED ON CONTENT:
• OMENTOCELE-OMENTUM
• ENTEROCELE - INTESTINE
• CYSTOCELE- URINARY BLADDER
• LITTRE'S HERNIA- MECKEL'S DIVERTICULUM
• RICHTER'S HERNIA- PART OF BOWEL WALL IS
STRANGULATED.
• SLIDING HERNIA - MESENTERY, BOWEL , CEACUM,
BLADDER
• MAYDL'S HERNIA-LOOP OF BOWEL IN 'W' SHAPE

6. 3] BASED ON SITES:
• EPIGASTRIC
• INGUINAL
• FEMORAL
• OBTURATOR
• LUMBAR
• SPIGELIAN
• UMBILICAL

7. • CONGENITAL
• ACQUIRED

8. PARTS OF HERNIA
• COVERING
• SAC
• CONTENT

9. 1]COVERINGS:MAINLY THE LAYERS OF THE WALL THROUH
WHICH IT PASSES
2]SAC:(PEAR SHAPED) HAS A MOUTH, NECK, BODY AND
FUNDUS
• NECK IS NARROW IN INDIRECT SAC AND WIDE IN
DIRECT SAC.
• BODY IS THIN IN INDIRECT INGUINAL HERNIA AND THICK
IN DIRECT INGUINAL HERNIA.
• HERNIA WITHOUT NECK- DIRECT AND INCISIONAL
HERNIA
• HERNIA WITHOUT SAC- EPIGASTRIC HERNIA.

11. • 3] CONTENTS:
• OMENTUM(OMENTOCELE OR EPIPOCELE)
• INTESTINE(ENTEROCELE)
• URINARY BLADDER(CYSTOCELE)
• MECKEL’S DIVERTICULUM(LITTRE’S HERNIA)
• PART OF BOWEL(RICHTER'S HERNIA).

12. INGUINAL HERNIA
• MOST COMMONEST TYPE OF HERNIA
• ANATOMICAL CLASSIFICATION:
a) INDIRECT
b) DIRECT
• ACCORDING TO EXTENT:
a)INCOMPLETE
-BUBONOCELE-WITHIN INGUINAL CANAL
-FUNICULAR-DOES NOT REACH BOTTOM OF SCROTUM
b)COMPLETE

14. ANATOMY
1]INGUINAL CANAL- IT IS AN OBLIQUE PASSAGE IN LOWER PART
OF ABDOMINAL WALL, ABOUT 4CM LONG, EXTENDING FROM DEEP
INGUINAL RING TO SUPERFICIAL INGUINAL RING.
• BOUNDARIES:
ANTERIOR: EXTERNAL OBLIQUE APONEUROSIS & INTERNAL OBLIQUE
MUSCLE LATERALLY.
POSTERIOR: INFERIOR EPIGASTRIC ARTERY, FASCIA TRANSVERSALIS &
CONJOINT TENDON MEDIALLY.
SUPERIOR: ARCHED FIBERS OF INTERNAL OBLIQUE AND TRANVERSUS
ABDOMINIS.
INFERIOR: INGUINAL LIGAMENT AND LACUNAR LIGAMENT MEDIALLY.

15. • CONTENTS OF
INGUINAL CANAL:
1. SPERMATIC CORD IN
MALES.
2. ROUND LIGAMENT IN
FEMALES.
3. ILIO-INGUINAL NERVE.

16. • SUPERFICIAL INGUINAL RING: TRIANGULAR
OPENING IN THE EXTERNAL OBLIQUE
APONEUROSIS ABOVE THE PUBIC TUBERCLE.
• DEEP INGUINAL RING: OVAL SHAPED
CONDENSATION OF THE TRANSVERSALIS FASCIA ,
LIES 1.2 CM ABOVE MID INGUINAL POINT OF
INGUINAL LIGAMENT.

17. 2] HESSELBACH’S TRIANGLE:
BOUNDARIES-
• MEDIAL- LATERAL BORDER OF
RECTUS ABDOMINUS
• LATERAL- INFERIOR
EPIGASTRIC ARTERY
• BELOW- INGUINAL LIGAMENT

18. 3] SPERMATIC CORD:
COVERINGS-
• INTERNAL SPERMATIC FASCIA FROM FASCIA
TRANSVERSALIS
• CREMASTRIC FASCIA FROM CONJOINT TENDON
• EXTERNAL SPERMATIC FASCIA FROM EXTERNAL
OBLIQUE APONEUROSIS

19. CONTENTS:
• 3 ARTERIES- TESTICULAR , CREMASTRIC & ARTERY
TO DUCTUS DEFERANS
• 3 NERVES- GENITAL BRANCH OF GENITO FEMORAL
NERVE, SYMPATHETIC NERVE FIBRES , VISCERAL
AFFERENT NERVE FIBRES
• 4 OTHERS- DUCTUS DEFERANS , PAMPINIFORM
PLEXUS , LYMPH VESSELS FROM TESTIS, REMAINS
OF THE PROCESSES VAGINALIS.

21. 4] SCROTUM
LAYERS:
• SKIN
• DARTOS MUSCLE
• EXTERNAL SPERMATIC FASCIA FROM EXTERNAL
OBLIQUE MUSCLE
• CREMASTRIC MUSCLE AND FASCIA FROM INTERNAL
OBLIQUE
• INTERNAL SPERMATIC FASCIA FROM FASCIA
TRANSVERSALIS

22. INDIRECT INGUINAL HERNIA
• MOST COMMONEST INGUINAL TYPE OF HERNIA i,e
65%
• MORE COMMON IN YOUNGER AGE
• ENTERS FROM DEEP INGUINAL RING PASSES
THROUGH THE INGUINAL CANAL AND COMES OUT
FROM SUPERFICIAL INGUINAL RING
• HERNIA COMES OUT LATERALLY TO INFERIOR
EPIGASTRIC ARTERY
• HERE THE SAC LIES ANTEROLATERAL TO CORD
STRUCTURES

25. • COVERINGS OF INDIRECT HERNIA
1. EXTRAPERITONEAL TISSUE
2. INTERNAL SPERMATIC FASCIA
3. CREMASTRIC FASCIA
4. EXTERNAL SPERMATIC FASCIA
5. SKIN

26. DIRECT HERNIA
• 35% OF INGUINAL HERNIA ARE DIRECT
• MORE COMMON IN OLD AGE , DUE TO WEAK
POSTERIOR WALL OF INGUINAL CANAL
• HERNIA ARISES FROM HESSELBACH’S TRIANGLE
• HERNIA COMES OUT MEDIALLY TO INFERIOR
EPIGASTRIC ARTERY
• SAC LIES BEHIND THE CORD STRUCTURES

28. • COVERINGS OF DIRECT HERNIA
1. EXTRAPERITONEAL TISSUE.
2. FASCIA TRANSVERSALIS.
3. CONJOINT TENDON.
4. EXTERNAL SPERMATIC FASCIA.
5. SKIN.

29. FEMORAL HERNIA
• PROTRUSION OF EXTRAPERITONEAL TISSUE,
PERITONEUM & SOMETIMES VISCERA THROUGH
FEMORAL CANAL VIA., SAPHENOUS OPENING(4CM
BELOW & LATERAL TO PUBIC TUBERCLE)
• MORE COMMON IN FEMALE.
• FEMORAL CANAL IS 1.3CM LONG IN ANTERIOR
THIGH.
• CONTENT OF FEMORAL CANAL IS LYMPH NODE OF
ROSENMULLER OR CLOQUET.

31. • BOUNDARIES
1. SUPEROANTERIOR-INGUINAL LIGAMENT.
2. INFEROPOSTERIOR-PECTINEUS MUSCLE & PUBIC
RAMUS.
3. MEDIAL-LACUNAR LIGAMENT(GIMBERNAT’S)
4. LATERAL-FEMORAL VEIN

32. EPIGASTRIC HERNIA
• PROTRUSION OF EXTRA-PERITONEAL FAT &
SOMETIMES A SMALL PERITONEAL SAC THROUGH A
DEFECT IN LINEA ALBA.
• THE DEFECT IS BETWEEN THE XIPHISTERNUM &
THE UMBILICUS.

34. STRANGULATED HERNIA
• IRREDUCIBLE
HERNIA WITH
OBSTRUCTION &
ARREST OF BLOOD
SUPPLY.

35. UMBILICAL HERNIA
• DEVELOPS DUE TO
ABSENCE OF UMBILICAL
FASCIA OR INCOMPLETE
CLOSURE OF UMBILICAL
DEFECT.
• CONGENITAL OR ACQUIRED.
• ACQUIRED IS DUE TO WEAK
UMBILICAL SCAR.

36. PARAUMBILICAL HERNIA
• IT OCCURS COMMONLY IN
ADULTS AND THE
PROTRUSION IS THROUGH
LINEA ALBA, JUST
BELOW(INFRAUMBILICAL)
OR
ABOVE(SUPRAUMBILICAL)
THE UMBILICUS.

37. INCISIONAL HERNIA
• PROTRUSION THROUGH
PREVIOUS SURGICAL
SCAR.

38. SPIGELIAN HERNIA
• PROTRUSION THROUGH LINEA SEMILUNARIS AT
THE LEVEL OF ARCUATE LINE.

39. OBTURATOR HERNIA
• PROTRUSION THROUGH OBTURATOR FORAMEN
• VERY PAINFUL HERNIA

41. MAYDL’S HERNIA
• TWO LOOPS OF BOWEL
REMAIN IN
PROTRUDING SAC AND
THE CONNECTING
LOOP REMAINS WITHIN
ABDOMEN AND
BECOMES
STRANGULATED

42. LITTRE’S HERNIA
• MECKEL’S
DIVERTICULUM IN
PROTRUDING SAC

43. SLIDING HERNIA
• PROTRUSION OF
BOWEL , URINARY
BLADDER ,CAECUM
IN SAC

44. LUMBAR HERNIA
• HERNIATION THROUGH SUPERIOR OR INFERIOR
LUMBAR TRIANGLE.
• SUPERIOR LUMBAR TRIANGLE (GRYNFELT’S
TRIANGLE) IS BOUNDED BY
SACROSPINALIS(MEDIALLY), 12TH RIB (ABOVE)AND
POSTERIOR BORDER OF INTERNAL
OBLIQUE(LATERALLY).
• INFERIOR LUMBAR TRIANGLE(PETIT’S TRIANGLE) IS
BOUNDED BY LATISSIMUS DORSI(MEDIALLY) ,
EXTERNAL OBLIQUE(LATERALLY) AND ILIAC

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