Hernia
Historical Hernia Hernia has been documented throughout history varying success at either reduction or repair
Trusses & Techniques
Abdominal wall hernia ◼ General consideration ◼ inguinal hernia ◼ femoral hernia ◼ incisional hernia ◼ umbilial hernia
General consideration Definition Hernia means a sprout, and protrusion External abdominal wall hernia is an abnormal protrusion of intra-abdominal tissue or the whole or part of a viscera through an opening or fascial defect in the abdominal wall. Most external abdominal wall hernia occur in the groin
Etiology 1. intensity of abdominal wall decreases Common factors: 1)site that some tissues pass through the abdominal wall, eg. spermatic cord – male ,round ligament of uterus – female (in the inguinal canal) 2) bad development of abdominal white line 3) incision, trauma, infection et al. defect in collagen synthesis or turnover 2. intra-abdominal pressure increases Chronic cough, chronic constipation, dysuria, ascites, pregnancy, cry
Pathological anatomy Composition: ⚫ Covering tissue: skin, subcutaneous tissue ⚫ Hernial sac: protrusion of peritoneum, ⚫ Neck of the sac: is narrow where the sac emerges from the abdomen body of the sac ⚫ Hernial contents: small intestine, major omentum
Clinical types 1. reducible hernia is one of in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent. 2. irreducible hernia is one whose content or part of content cannot be return to the abdomen, but without serious symptoms. Hernias are trapped by the narrow neck Sliding hernia is one in which the wall of a viscus forms a portion of the wall of the hernia of the hernia sac, it is may be colon(on the left), caecum(on the right) or bladder(on either side). Belongs to irreducible hernia
3. incarcerated hernia: is one whose content cannot be returned to the abdomen, with severe symptoms 4. strangulated hernia: denotes compromise to the blood supply of the content of the sac. Incarcerated hernia and strangulated hernia are the two stages of a pathologic course Richter’hernia (intestinal wall hernia): A hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen. Litter hernia: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum)