Hernia
Definition: “protrusion of a viscous or part of a viscous
through an abnormal opening in the wall of its containing
cavity” in abdominal hernia it is a viscous or omentum
through a defect in abdominal wall within a peritoneal
sac.
Etiology:
1- Increased intra abdominal pressure:
 Whooping cough in childhood, chronic cough and
straining in adults.
 Smokers; due to acquired collagen deficiency.
 Intra abdominal malignancy.
2- Obesity
 Stretched abdominal muscles.
 Fat weakens muscles and aponuroses and cause
paraumblical, inguinal & hiatus hernia.
3- Multiparity
 Starched pelvic ligament and femoral hernia.
4- Congenital abnormalities
 Congenital performed sac & indirect hernia.
 Congenital defect & congenital umbilical hernia
5- Peritoneal dialysis
 Enlargement of patent processus vaginalis.
Previous occult weakness
Parts & composition:
1- The sac “peritoneal pouch with mouth, neck, body
&fundus”
 Neck is wide except in femoral & paraumblical.
 Well defined except in some incisional & direct
inguinal.
2- The coverings: derived from abdominal wall layers
“may be fused together , through which the sac passes
3- contents:
Either:
Omentocele (epiplocele) with doughy sensation.
Intestine (enterocele) with gurgling sensation.
Portion of bladder or adenexae .
Fluid (hydrocele of hernial sac).
Ovary or fallopian tube
Types of hernia
a) pathological types
 Reducible: (either spontaneous or induced)
o Expancile impulse on cough.
 Irreducible: (either sole finding or with other
complications
o Either from adhesions or over crowding
within the sac.
 Strangulated hernia
o Definition “impedance of the blood supply pf
the content” gangrene ensues after 5-6 hours.
o clinical picture:
1. Colicky or may be stabling pain
mainly at umbilicus.
2. Nausea and vomiting & may be
constipation.
3. on examination:
 Bad general condition.
 Tense, tender, irreducible
hernia.
 No expansile impulse on
cough.
 obstructed hernia:
 Irreducible hernia containing intestine
which is obstructed from within or
without but no interference with blood
supply. Presentation is intestinal
obstruction
 inflamed hernia:
o inflamed content (acute appendicitis or
salpingitis) or external cause (e.g. truss or
trophic ulcer in large hernias)
treatment is treatment of the cause
B) Anatomical types of Hernia
1. Inguinal hernia:
It is a hernia which transverse the inguinal cana to
appear from the external ring.
Types
1. Congenital
Usually appears in infancy and young age
2. indirect Inguinal hernia
pass from the deep inguinal ring through canal
to superficial inguinal ring. ( commonest type
ntile umbilical hernia
3.direct Inguinal hernia
pass back to the inguinal canal then protrude
through the external ring.
Clinical picture
Incidence
70% of all hernias commonest in infants , children and
young adults
30% bilateral , males 20 times common than females
Symptoms and signs
Pain and swelling.
Intermittent expansile impulse with cough
Treatment
Operation
?? rule of truss
2. Umbilical hernia
a. Congenital ( Exomphalos)
Failure of return of mid gut to the
abdomin
b. Infantile
It is due to weak umbilicus obstruction or
strangulation is rare until 3 years
Ttt is operation at age of 2 years
c. paraumbilical
It is perfusion of linea alba just above or
may be just below umbilicus.
Clinical picture
Either round or oval shape. Women are
five times affected more than men.
Mainly in age of 35-50
Predisposing factors
Obesity
Rgging painepeated pregnancy
Colic , constipation , dragging pain , skin
laceration
Treatment
Operation
3. Incisional hernia (post operative hernia)
Predisposing factors :
a. preoperative cause
b. operative causes
c. post operative causes , mainly
smoking , obesity , straining , cough ,
wound infection , distention
Clinical picture
The hernia appears within months , weeks or
years after operation on a previous scar either through
the whole scar or part of the scar
Treatment
Rule of abdominal belt ?? because it has a wide neck ,
mainly at upper abdominal incisional hernias