Abdominal Hernia Flashcards
Most common abdominal hernias
Inguinal
Femoral
Hiatus
Incisional
Explain epigastric hernia
Occurs in the upper midline through the fibres of linea alba
Usually secondary to raised chronic intra-abdominal pressure like obesity, pregnancy or ascites.
Prevalence up to 10% and usually asymptomatic.
Important dx of epigastric hernia
Divarication of the recti which is caused by the weakening and widening of linea alba.
Divarification of the recti has the linea alba stretched and weakened, but intact.
There is no discrete defect and therefor by definition -> no hernia
Explain paraumbilical hernia.
Herniation through the linea alba around the umbilical region but not through the umbilicus itself.
They are usually secondary to raised chronic intra-abdominal pressure
A lump can be felt around the umbilical region.
Common in obesity and pregnancy.
What does paraumbilical hernia contain?
Contain pre-peritoneal fat and occasionally bowel.
They do not commonly strangulate
Explain spigelian hernia
Rare form of abdo hernia that occurs at the semilunar line around the level of the arcuate line.
They present as a small tender mass at the lower lateral edge of rectus abdominus.
Why should spigelian hernias be repaired urgently?
High risk of strangulation
Explain obturator hernia
Through the obturator foramen into the obturator canal
More common in women due to a wider pelvis.
More common in elderly patients
Clinical features of obturator hernia
Upper medial thigh mass
Small bowel obstruction.
In around half of cases there is also compression of the obturator nerve.
This leads to a +ve Howship-Romberg sign
What is Howship-Romberg sign?
+ve = Hip and knee pain exacerbated by thigh extension, medial rotation and abduction.
Explain Littre’s hernia
A very rare form of herniation of a Meckel’s diverticulum
Commonly occurs in the inguinal canal and become strangulated.
Explain lumbar hernia
Rare posterior hernia
Occur spontaneously or iatrogenically following surgery (open renal surgery)
Present with a posterior mass and back pain
Explain Richter’s hernia
Partial herniation of bowel where the anti-mesenteric border becomes strangulated.
This means that only part of the lumen of the bowel is within the hernia sac.
It can occur at any of the sites discussed already.
Clinical presentation of Richter’s hernia
Tender irreducible mass
There is obstruction and often strangulation
This means that it is a surgical emergency often and needs urgent surgical intervention.
Where does epigastric hernia herniate
Upper midline through the fibres of linea alba
