protrusion of a viscus into an area in which it is not normally contained Incidence male:female = 9:1 lifetime r...
- protrusion of a viscus into an area in which it is not normally
contained
Incidence
- male:female = 9:1
- lifetime risk of developing hernia
- males 5%
- females 1%
- most common surgical disease of males
General types
- internal hernia - sac is within abdominal cavity
- external hernia - sac protrudes completely through abdominal wall
- strangulated hernia - vascular supply of protruded viscus is compromised
- incarcerated hernia - irreducible hernia, not necessarily strangulated
- Richter's hernia - contents of the sac consist of only one side of intestinal wall (usually antimesenteric)
- sliding hernia - part of wall of hernia
formed 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
- tends to affect males > females, but remains most common hernia in women
Indirect
- Etiology : persistent processus in 20% of adults
- Anatomy :
- originates in deep inguinal ring
- lateral to inferior epigastric artery
- often descends into scrotal sac
- complications : incarceration, strangulation
Direct
- Etiology
- aquired weakness in floor of Hesselbach's triangle (transversalis fascia)
- due to wear/tear, combined with increased intra-abdominal pressure
- Anatomy
- through Hasselbach's triangle
- medial to inferior epigastric artery
- often do not descend into scrotal sac
- Complications : incarceration rare
- pantaloon
- combined direct and indirect hernias
- peritoneum draped over inferior epigastric vessels
.
Femoral Hernia
- Epidemiology : affects mostly females
- Anatomy :
- into femoral canal, below inguinal ligament but
- may override it
- located medial to femoral vein
- Complications : tendency to strangulate since it has a narrow neck
Other
- incisional: ventral hernias - hernia at site of wound closure
- umbilical: usually congenital, passes through umbilical ring
- epigastric: defect in linea alba above umbilicus
- obturator: through obturator foramen
- spigelian: ventral hernia through defect in linea semilunaris
- lumbar: defect in posterior abdominal wall;
- superior - Grynfeltt's,
- inferior – Petit's
- Umbilical hernia Para-umbilical hernia.
Obturator hernia. Sciatic hernia.
