Chapter 84: Abdominal Wall Reconstruction and Hernias

Question 1

What is an auto-penetrating hernia?

Answer 1

A traumatic abdominal wall hernia caused by a fractured rib penetrating through abdominal musculature

Question 2

In the cranial, middle and caudal thirds of the abdomen, which aponeuroses are sitting superficial and deep to the rectus abdominis?

Answer 2

Cranial:
- External Abdominal Oblique - Superficial
- Internal abdominal oblique - Both
- Transverse Abdominis - Deep

Middle
- External Abdominal Oblique - Superficial
- Internal Abdominal Oblique - Superficial
- Transverse Abdominus - Deep

Caudal
- All superficial

Question 3

Where do the internal and external abdominal obliques and the transverse abdominis originate from?

Answer 3

External abdominal oblique
- Originates from 4/5th to 12th rib and from last rib and thoracodorsal fascia
- Runs in caudoventral direction

Internal Obdominal oblique
- Originates from thoracolumbar fascia caudal to last rib and from tuber coxae
- Runc cranioventrally

Transverse Abdominis
- Lumbar portion arising from the transverse processes of the lumbar vertebrae and thoracolumbar fascia
- Costal portion - Arising from medial sides of 12th and 13th rib as well as 8th-11th costal cartilages
- Runs in dorsoventral direction

Question 4

How can intestinal strangulation lead to rapid systemic illness?

Answer 4

• Bacterial transmigration
• Vasoactive substances release (arachidonic acid metabolites, cytokines, leucotrienes, kinins) from tissue and blood cell autolysis
• Redistribution of fluids and severe cardiopulmonary effects

Question 5

What is the embryological cause of ventral abdominal wall hernias?

Answer 5

Failure of fusion or delayed fusion of the lateral folds (primarily the rectus abdominis)

Question 6

List some nonautogenous repair methods for large abdominal wall defects

Answer 6

• Synthetic mesh (polypropylene - inert, woven, monofilament, porous)
• Tissue grafts or bioprosthetic mesh (porcine SIS)

Question 7

What is associated with PPDH?

Answer 7

Incomplete fusion of the caudal sternebrae and a substernal midline defect.

Question 8

What are the locations of abdominal hernias?

Answer 8

Epigastric (PPDH, umbilical, substernal)
Lateral wall defects are traumatic
Caudal abdominal hernias (scrotal and inguinal - congenital, prepubic and femoral - trauma)

Question 9

What are (4) pathophysiologies of hernias?

Answer 9

Genetic impairment of collagen formation
Wound healing deficiencies
Trauma
Iatrogenic

Question 10

What are 4 techniques to increase domain to provide abdominal closure?

Answer 10

Progressive pneumoperitoneum
Silastic expanders
Staged reduction
Prosthetic reconstruction with mesh

Question 11

What is a hernia?

Answer 11

A ring of tissue +/- a sac (absent in acute traumatics)