Abdominal Wall

Question 1

Indirect Inguinal Hernia

Answer 1

protrusion through internal inguinal ring within patent processus vaginalis.
“lateral to epigastric vessels”
Features: bulge in groin, common in babies and kids, usually appears after straining, commonly on the right side
Tx: reduction, obliterate processus vaginalis, repair

Question 2

Direct Inguinal Hernia

Answer 2

protrusion through posterior inguinal wall (Hasselbach’s triangle).
“medial to epigastric vessels”
from pressure and tension on fascial layers
Features: bulge in groin, more common in older men, broad based.
Less likely to strangulate.
Tx: reduction, repair

Question 3

Hasselbach’s Triangle

Answer 3

Associated with direct inguinal hernias.
boundaries:
1. linea semilunaris muscle medially
2. inferior epigastric vessals superolaterally
3. inguinal ligament inferiorly

Question 4

Femoral Hernia

Answer 4

Passes through femoral canal (lacunar ligament medially to femoral vein laterally).
Cause: short medial attachment of transversus abdominis muscle onto Cooper’s ligament.
Features: bulge low in groin (on anteromedial thigh), can be mistaken for lipoma or enlarged LN
More likely to incarcerate.
Tx: reduce, obliterate femoral space or cover with tissue/mesh, repair

Question 5

Complications of Groin Hernia Repair

Answer 5

1. seroma or hepatoma
   features: focal, firm swelling within 2-3 days after surgery.
   tx: goes away in a few weeks
2. infection of wound or mesh
3. ischemic orchitis
4. nerve injury causing numbness or neuralgia

Question 6

Umbilical Hernia

Answer 6

protrusion through umbilicus from incomplete umbilical closure.
Tx: surgery if doesn’t go away during childhood (by age 5yr). reduce then repair abdominal wall
1.5cm = mesh repair.

Question 7

Omphalocele

Answer 7

portion of abdominal contents herniates into umbilical cord.
separated from outside by peritoneum and amnion.
Tx: emergent surgery

Question 8

Gastroschisis

Answer 8

full thickness abdominal wall defect lateral to the umbilicus.
protruding intestinal contents not covered by anything.
Tx: emergent surgery

Question 9

Incisional (Ventral) Hernia

Answer 9

protrusion through previous scar site.
Cause: deep wound infection most commonly
Features: bulge with palpable fascial defect, pain, discomfort, bowel obstruction
Dx: CT
Tx: mesh repair

Question 10

Pantaloon Hernia

Answer 10

both direct and indirect hernia

Question 11

Sliding Hernia

Answer 11

any hernia in which part of wall of protruding peritoneal sac is made of intra-abdominal organ (sigmoid or cecum)
Features: incompletely reducible hernia, colon in scrotum on barium enema

Question 12

Richter’s Hernia

Answer 12

hernia at any site where only part of small bowel incarcerates/strangulates.

Question 13

Spigelian Hernia

Answer 13

herniation through semilunar line near junction with semicircular line of Douglas.
predisposed to incarceration

Question 14

Grynfelt’s Hernia

Answer 14

wide-mouthed hernia through superior lumbar triangle (sacrospinalis, internal oblique, and inferior margin of 12th rib)

Question 15

Petit’s Hernia

Answer 15

protrusion through inferior lumbar triangle (lateral margin of latissimus dorsi, medial margin of external oblique, and iliac crest)
Don’t incarcerate

Question 16

Littre’s Hernia

Answer 16

groin hernia containing Meckel’s diverticulum

Question 17

Amyand’s Hernia

Answer 17

groin hernia with appendix involved.

Question 18

Obturator Hernia

Answer 18

protrude through obturator canal.
more common in women in 60-80yrs.
Dx: internittent bowel obstruction and paresthesias on anteromedial aspect of thigh, mass on rectal exam.
High mortality rate.

Question 19

Hesselbach’s Hernia

Answer 19

protrudes into thigh beneath inguinal igament, lateral to femoral vessels.

Question 20

Epigastric Hernia

Answer 20

congenital or acquired weakness of midline linea abla, protrusion through crossing midline fibers above umbilicus.
usually multiple

Question 21

Diastasis Recti

Answer 21

midline fascial weakness making wide linea alba
confused with epigastric hernia.
Features: rapid weight change
not true hernia