Hernias

Question 1

Risk factors for abdominal wall hernias

Answer 1

Obesity

Ascites

Increasing age

Surgical wounds

Question 2

Features of abdominal wall hernias

Answer 2

Palpable lump

Cough impulse

Pain

Obstruction (more common in femoral hernias)

Strangulation (may compromise bowel blood supply leading to infection)

Question 3

Complications

Answer 3

Incarceration

Obstruction

Strangulation

Question 4

Incarceration

Answer 4

Where hernia cannot be reduced back into proper position

Can lead to obstruction and strangulation

Question 5

Obstruction

Answer 5

Where hernia causes a blockage in passage of faeces through bowel

Presents with vomiting, generalised abdo pain and absolute constipation

Question 6

Strangulation

Answer 6

Non-reducible and base of hernia becomes so tight it cuts off blood supply causing ischaemia

Presents with significant pain and tenderness

Surgical emergency

Question 7

Inguinal hernias

Answer 7

75% of abdominal wall hernias

95% are male

Above and medial to pubic tubercle

Strangulation is rare

Question 8

Femoral hernia

Answer 8

Below and lateral to pubic tubercle

More common in women, particularly multiparous

High risk of obstruction and strangulation

Surgical repair required

Question 9

Umbilical hernia

Answer 9

Symmetrical bulge under the umbilicus

Common in neonates and can resolve spontaneously

Question 10

Paraumbilical hernia

Answer 10

Asymmetrical bulge

Half the sac is covered by skin of the abdomen directly above or below the umbilicus

Question 11

Epigastric hernia

Answer 11

Lump in midline between umbilicus and xiphersternum

Risk factors include extensive physical training or coughing (from lung disease), obesity

Question 12

Incisional hernia

Answer 12

May occur in up to 10% of abdo operations

Question 13

Spigelian hernia

Answer 13

Lateral ventral hernia

Rare and seen in older patients

Question 14

Obturator hernia

Answer 14

Passes through obturator foramen

More common in females and typically presents with bowel obstruction

Question 15

Richter hernia

Answer 15

Only antimesenteric border of bowel herniates through fascial defect

Can present with strangulation without symptoms of obstruction

Question 16

Maydl’s hernia

Answer 16

Two different loops of bowel contained within the hernia

Question 17

Conservative management

Answer 17

Most appropriate when hernia has wide neck and patients not good candidates for surgery

Question 18

Tension free repair

Answer 18

Mesh over defect in abdominal wall

Mesh sutured to muscle and tissues, covering it and preventing herniation of the cavity contents

Over time tissues grow into mesh and provide extra support

Lower recurrent rate compared with tension repair

Question 19

Tension repair

Answer 19

Surgical operation to suture muscles and tissue on either side of defect back together

Rarely performed and largely replaced by tension-free repair

Relatively high recurrence rate

Question 20

Indirect inguinal hernia

Answer 20

Bowel herniates through inguinal canal

When reduced and pressure is applied to deep inguinal ring, the hernia will remain reduced

Question 21

Deep inguinal ring

Answer 21

Mid-way point from ASIS to pubic tubercle

Question 22

Direct inguinal hernia

Answer 22

Weakness at Hesselbach’s triangle

Hernia protrudes directly through abdominal wall

Pressure over deep inguinal ring will not stop herniation

Question 23

Hesselbach’s triangle boundaries

Answer 23

Rectus abdominus muscle (medial border)

Inferior epigastric vessels (super/ lateral border)

Pourpart’s ligament (inguinal ligament) (inferior border)