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    Abdominal Hernia (Hernia of Abdominal Cavity)

    Abdominal hernias are one of the most common surgical problems. By definition, a hernia is an abnormal protrusion from one anatomic space to another, with the protruded parts generally contained in a saclike structure formed by the membrane that naturally lines the cavity. They are a one of the leading causes of morbidity and can be lethal.

    The disorder emerges due to the following process: anatomic/foreign.

    Presentation

    The hernia presents as a protrusion that gets bigger with increased intraabdominal pressure such as during coughing. They patient may present in an emergency situation with a strangulated hernia, or it may be found on routine examination. The protrusion may be intermittent or constant.

    If strangulated, there is pain, swelling and erythema at the hernia site. There may be associated symptoms of intestinal obstruction like abdominal pain, vomiting and nausea. There may be peritonitis if the bowel gets gangrenous and perforates [7].

    Entire body system
    Localized Pain
    • This usually will cause pain directly at the site of the hernia and is Localized Pain .[hernia.tripod.com]
    • […] hernia types include the following: Inguinal hernia - Bulge in the inguinal region or scrotum, sometimes intermittent; may be accompanied by a dull ache or burning pain, which often worsens with exercise or straining (eg, coughing) Spigelian hernia - Local[emedicine.medscape.com]
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  • neurologic
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  • Skin
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  • respiratoric
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  • gastrointestinal
    Abdominal Mass
    • Advantages of CT include more accurate identification of hernias and their contents and differentiation of hernias from other abdominal masses (tumors, hematomas, abscesses, undescended testes and aneurysms)[ 8 ].[wjgnet.com]
    • Some risk factors include the following: Chronic constipation Chronic cough Recurrent vomiting Obesity Ascites (an abnormal collection of fluid in the abdominal cavity) Peritoneal dialysis Abdominal masses Pregnancy Abdominal surgeries (a risk for incisional[medicinenet.com]
    • Risk factors for the development of adult umbilical hernias include obesity, multiparity, ascites, and large abdominal masses.[ahcmedia.com]
    Abdominal Pain
    • Symptoms of a hiatal hernia may include heartburn and upper abdominal pain .[webmd.com]
    • Other symptoms of a strangulated hernia include severe abdominal pain, profuse sweating, rapid heartbeat, severe nausea, vomiting and high fever.[ucsfhealth.org]
    • Seek immediate medical care (call 911) if you, or someone you are with, have symptoms such as severe abdominal pain; increased swelling of a known hernia; a painful new bulge or mass; severe nausea and vomiting; inability to have bowel movements or pass[healthgrades.com]
    • Case Summary An 8-year-old boy presented to the emergency department with right upper-quadrant abdominal pain and a laceration after falling onto the handlebars of his bicycle.[appliedradiology.com]
    • If you have a hernia and significant abdominal pain, pain over the hernia, or nausea or vomiting, you should seek medical care immediately.[jama.jamanetwork.com]
    Acute Abdomen
    • This exam is mandatory in the study of the acute abdomen and is fundamental in deciding what type of treatment is best, surgical or conservative, and is also useful in evaluating post surgical patients, especially those with enlarged masses or exuberant[wjgnet.com]
    Colic
    • Inguinal hernias also occur in stallions after castration and may cause severe colic.[en.wikivet.net]
    • In described cases, the presenting complaint was colic, and the diagnosis was made during exploratory celiotomy.[merckvetmanual.com]
    • The superior mesenteric artery and the right colic vein are in the free edge of the hernia[ 23 ].[wjgnet.com]
    Severe Abdominal Pain
    • Other symptoms of a strangulated hernia include severe abdominal pain, profuse sweating, rapid heartbeat, severe nausea, vomiting and high fever.[ucsfhealth.org]
    • Seek immediate medical care (call 911) if you, or someone you are with, have symptoms such as severe abdominal pain; increased swelling of a known hernia; a painful new bulge or mass; severe nausea and vomiting; inability to have bowel movements or pass[healthgrades.com]
    • You have severe abdominal pain with nausea or vomiting.[drugs.com]
    • When these become strangulated they cause severe abdominal pain and acute local swelling.[medical-dictionary.thefreedictionary.com]
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  • urogenital
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  • Workup

    Laboratory diagnosis

    There are no specific laboratory studies specific for hernia, but they may help in toxic patients.

    Imaging

    CT scan, ultrasound and radiographs are not usually required but may be used to confirm the diagnosis if there is doubt. The bulk of the diagnosis is clinical. In acquired hernias, workup of the underlying cause will have to be searched for, for example ascites [8].

    Treatment

    In adults most hernias should be repaired to prevent complications. Reduction should be avoided if there are signs of inflammation or strangulation. Usually all inguinal hernias should be repaired. Umbilical hernia repair should be carried out in adults. In children most will close by the age of five, unless they are large. Elective repair is preferred to acute repair. There are number of methods that can be used, for example the use of meshes and special suturing techniques.

    Prognosis

    This is dependent on the type of hernia present and its size and location. The largest risk is strangulation of intestines and if not repaired in time, it may lead to mortality rates as high as 10%. Uncomplicated hernias have a good prognosis if repaired appropriately [6].

    Complications

    Appendicitis
    • In fact, they are the second most common indication for surgery after acute appendicitis in Europe and the United States[ 5 ].[wjgnet.com]
    Cardiomyopathy
    • Care Professionals Patient Resources Overview Make an Appointment Find a Doctor Patient Forms Community Programs Columbia Asian Health Program Newsletters Location & Directions Contact Us Surgical Specialties Overview Adrenal Aorta Breast Cardiac Tumor Cardiomyopathy[columbiasurgery.org]
    Constipation
    • They may develop as a result of obesity, chronic constipation, or too much coughing or screaming—anything that increases pressure inside the abdomen.[parents.com]
    • If blood stops flowing through an incarcerated bowel, this results in strangulation , which is accompanied by pain, often with nausea, vomiting, or constipation.[jama.jamanetwork.com]
    • Related Reading: Know all about bowel sounds/abdominal sounds 10 Natural remedies for constipation Sources: Popular Stories[belmarrahealth.com]
    • A heavy feeling in the abdomen that is sometimes accompanied by constipation or blood in the stool.[webmd.com]
    Pulmonary Contusion
    • The lungs might also be bruised, called pulmonary contusion.[lbah.com]
    Richter's Hernia
    • […] abdominal hernias dorsal groin: most common diaphragmatic herniation internal herniation Subclassification anterior abdominal wall herniation Spigelian hernia parastomal hernia umbilical hernia paraumbilical hernia incisional hernia epigastric hernia Richter[radiopaedia.org]
    • Richter's hernia is a rare form of hernia in which only one wall of the small intestine is trapped in the hernial sac, resulting in a partial intestinal obstruction.[en.wikivet.net]
    • Richter hernia A Richter hernia occurs when only the antimesenteric border of the bowel herniates through the fascial defect.[emedicine.medscape.com]
    • Richter's hernia A hernia in which only a portion of intestinal wall protrudes, the main portion of the intestine being excluded from the hernial sac and the lumen remaining open.[medical-dictionary.thefreedictionary.com]
    Somatization
    • ., a persistent omphalomesenteric vein; or (4) somatic, e.g., faulty development of the abdominal wall, including ventral herniae, such as omphalocele (or exomphalos), which involves a protrusion of intestine through a large defect at the umbilicus.[dartmouth.edu]
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  • Etiology

    The congenital hernias are caused by small defects that occur during embryogenesis. Acquired hernias are caused by an increase in the abdominal cavity pressure that may weaken the wall and cause the protrusion. Risk factors for this include ascites, weight lifting, coughing, peritoneal dialysis and obesity [2] [3].

    Epidemiology

    As many as 10 to 13% of people will have a hernia at one time in their life. The most common hernia being inguinal taking up about 75% of all hernias of which 50% are indirect, 14% are umbilical, 10% are ventral and 3 to 5% femoral [4]. Inguinal hernias are more common in males, with 25% of males having one in their life time.

    Sex distribution
    Age distribution

    Pathophysiology

    • Groin hernias are the commonest hernias of the abdominal wall. The inguinal hernia is caused by weakened musculature that usually causes a shutter effect during straining. Repeated straining that increases the intraabdominal pressure causes protrusion. Direct inguinal hernia is caused by weakness in the transversalis fascia area of the Hesselbach triangle. An indirect hernia follows the tract of the inguinal canal and it is caused by a persistent processus vaginalis.
    • Epigastric hernias are located in the midline between the umbilicus and the xiphoid process and are usually >1cm. The cause of this may be a combination of congenital and acquired factors such as muscle weakens or increased intraabdominal pressure. These are usually asymptomatic and bowel strangulation is rare.
    • Flank hernias, even being outside the anatomical abdominal wall, are still classified as such. There are two types, the superior and inferior triangle hernias. These can be acquired; usually after surgeries such as nephrectomies.
    • Umbilical hernias in adults are usually acquired and associated with obesity, ascites, and pregnancy. This may present with strangulation of intestinal contents [5].

    Prevention

    There is no prevention of congenital hernias. Avoidance of chronic increased intraabdominal pressure is key. Thus patients with the risk factors for this should be treated promptly and appropriately [9] [10].

    Summary

    There are a number of different abdominal hernias and they are classified by their anatomical locations:

    • Groin hernia is a hernia that occurs in the lower part of the abdomen where the thigh and the hip meets. There can be inguinal and femoral hernias.
    • Pelvic hernias are protrusions through the foramina of the pelvis.
    • Flank hernias protrude through weakened areas of back muscles. Included in this are the inferior and superior lumbar triangle hernias.
    • Ventral hernias occur anteriorly, such as umbilical and epigastric hernias.

    The hernias may also be classified as congenital such as an indirect inguinal hernia or acquired [1].

    Patient Information

    Definition

    The internal organs are held in a cavity with a wall (abdominal). Defects in the wall may cause protrusion of the contents of the cavity. This causes a visible bulge in the defect. There many different types of abdominal wall hernias. The most common being inguinal hernia, which are more common in men. These occur around the groin area.

    Cause

    They are two types; defects in the wall that you are born with, so when the pressure in the abdomen increases the contents are pushed through this defect. The second are caused by having conditions that weaken the abdominal wall and increase the pressure within, like a chronic cough, or chronic straining while urination.

    Symptoms

    These may present as a bulge in the trunk of the body that increases in size on coughing or straining. The protrusion may balloon out into a sac that may hold intestines. The intestines may get jammed up in the sac and swollen and compressed. This is an emergency and can be fatal.

    Diagnosis

    Hernias are diagnosed by your doctor just by examination, the doctor may order some scans, but this is not routinely done.

    Treatment

    Hernias are repaired by surgery. There are two ways this may be done. Open surgery and laparoscopic or keyhole surgery. This will depend on the size and location of the hernia. They may also use meshes to strengthen the defect in the wall to prevent it coming back again.

    Self-assessment

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    References

    1. Steinke W, Zellweger R. Richter's hernia and Sir Frederick Treves: an original clinical experience, review, and historical overview. Ann Surg 2000; 232:710.
    2. Murphy KP, O'Connor OJ, Maher MM. Adult abdominal hernias. AJR Am J Roentgenol 2014; 202:W506.
    3. Bobrow RS. The hernia. J Am Board Fam Pract. Jan-Feb 1999;12(1):95-6
    4. Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. May 15 2007;165(10):1154-61
    5. Matthews RD, Neumayer L. Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg. Apr 2008;45(4):261-312
    6. Mizrahi H, Parker MC. Management of asymptomatic inguinal hernia: a systematic review of the evidence. Arch Surg. Mar 2012;147(3):277-81.
    7. Wants GE. Abdominal wall hernias. In: Schwartz SI, Shires GT, Spencer FC, eds. Principles of Surgery. 6th ed. 1994
    8. Eubanks S. Hernias. In: Sabiston DC Jr, ed. Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 1997
    9. Smith S. Inguinal hernia reduction. In: King C, Henretig FM, eds. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008:840-847/87
    10. Collaboration EH. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg. Jul 2000;87(7):860-7

    • Hernias in trocar ports following abdominal laparoscopy - H Lajer, S Widecrantz - Acta obstetricia et , 1997 - Wiley Online Library
    • Abdominal musculature abnormalities as a cause of groin pain in athletes Inguinal hernias and pubalgia - DC Taylor, WC Meyers, JA Moylan - The American journal , 1991 - ajs.sagepub.com
    • Abdominal hernias: CT findings. - NP Zarvan, FT Lee Jr, DR Yandow - American Journal of , 1995 - Am Roentgen Ray Soc
    • Abdominal pain: a surgical audit of 1190 emergency admissions - TT Irvin - British Journal of Surgery, 1989 - Wiley Online Library
    • A Decision Support System For The Management Of Acute Abdominal Pain (user's Manual). - DG Southerland, K Fisherkeller - 1987 - archive.rubicon-foundation.org
    • Abdominal wall hernias: MDCT findings - DA Aguirre, G Casola, C Sirlin - American Journal of , 2004 - Am Roentgen Ray Soc
    • A Grynfeltt hernia: report of a case - G Skrekas, VK Stafyla, VE Papalois - Hernia, 2005 - Springer
    • Abdominal hernias: CT findings. - NP Zarvan, FT Lee Jr, DR Yandow - American Journal of , 1995 - Am Roentgen Ray Soc
    • Abdominal-wall tenderness: a useful sign in the acute abdomen - H Thomson, DMA Francis - The Lancet, 1977 - Elsevier
    • Amyand's hernia: prospective CT diagnosis - JS Luchs, D Halpern, DS Katz - Journal of computer assisted , 2000 - journals.lww.com

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