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HERNIA Part 01

protrusion of a viscus into an area in which it is not normally
  • protrusion of a viscus into an area in which it is not normally
    contained 

 

Incidence

  1. male:female = 9:1
  2. lifetime risk of developing hernia
    • males 5%
    • females 1%
  3. most common surgical disease of males 

 

General types

  1. internal hernia - sac is within abdominal cavity
  2. external hernia - sac protrudes completely through abdominal wall
  3. strangulated hernia - vascular supply of protruded viscus is compromised Richter's hernia
  4. incarcerated hernia - irreducible hernia, not necessarily strangulated 
  5. Richter's hernia - contents of the sac consist of only one side of intestinal wall (usually antimesenteric) 
  6. sliding hernia - part of wall of hernia sliding herniaformed by protruding viscus (usually cecum or sigmoid colon) 

 

Locations and Anatomy

 

borders of Hasselbach's triangle (inguinal triangle) -

  • Rectus abdominis muscle (medially)
  • Inferior epigastric vessels (superior and laterally).
  • Inguinal ligament (inferiorly)

 

 

Inguinal Hernia

 

The inguinal canal.

  • tends to affect males > females, but remains most common hernia in women


Indirect

  1. Etiology : persistent processus in 20% of adults
  2. Anatomy :
    • originates in deep inguinal ring
    • lateral to inferior epigastric artery
    • often descends into scrotal sac
  3. complications : incarceration, strangulation

Direct

  1. Etiology
    • aquired weakness in floor of Hesselbach's triangle (transversalis fascia)
    • due to wear/tear, combined with increased intra-abdominal pressure
  2. Anatomy
    • through Hasselbach's triangle
    • medial to inferior epigastric artery
    • often do not descend into scrotal sac
  3. Complications : incarceration rare
  4. pantaloon
    • combined direct and indirect hernias
    • peritoneum draped over inferior epigastric vessels

.

Femoral Hernia

 

Femoral canal.

 

  1. Epidemiology : affects mostly females
  2. Anatomy :
    • into femoral canal, below inguinal ligament but
    • may override it
    • located medial to femoral vein
  3. Complications : tendency to strangulate since it has a narrow neck

 

Other

  1. incisional: ventral hernias - hernia at site of wound closure
  2. umbilical: usually congenital, passes through umbilical ring
  3. epigastric: defect in linea alba above umbilicus
  4. obturator: through obturator foramen
  5. spigelian: ventral hernia through defect in linea semilunaris
  6. lumbar: defect in posterior abdominal wall;
    • superior - Grynfeltt's,
    • inferior – Petit's
    Para-umbilical hernia.

    Umbilical hernia     

    Umbilical hernia                                  Para-umbilical hernia.


Obturator hernia. Sciatic hernia.
Obturator hernia.                                  Sciatic hernia.

HERNIA Part 01 HERNIA Part 01 Reviewed by Radiology Madeeasy on August 29, 2010 Rating: 5
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