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].

• Inflammation

  A strangulated hernia is one in which the circulation of blood through the hernia is impeded by pinching at the narrowest part of the passage; congestion is followed by inflammation, infection, and gangrene. [britannica.com]

  A strangulated hernia is a surgical emergency because part of the bowel may become necrotic (dead), resulting in life-threatening peritonitis (inflammation of the abdominal cavity) needing surgical removal of part of the bowel. [jamanetwork.com]

  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. [symptoma.com]

  Avoid consuming alcohol as it can cause gastrointestinal pain, bloating and inflammation. If you are exercising, make sure you are not doing it on a full stomach. Try not to lie down or bend over soon after eating. [braceability.com]

• Chronic Cough

  A case of traumatic abdominal hernia is reported in a patient with a history of chronic cough. After a bout of coughing 3 months prior to her presentation, the patient developed a large herniation on the left lateral side of the abdomen. [ncbi.nlm.nih.gov]

  Persistently raised intra-abdominal pressure (e.g., due to ascites, pregnancy, intra-abdominal tumors, chronic cough, etc.) increases the risk of developing an abdominal hernia. [amboss.com]

  These include heavy lifting, pregnancy or chronic coughing but can also result from injury or surgery. Treatment for ventral hernias consists of one of two types of surgeries: herniorrhaphy (open hernia repair) or laparoscopy (minimally invasive). [hopkinsmedicine.org]

• Sneezing

  A dull aching pain may also be experienced which typically becomes more pronounced when you are active, bend over, sneeze, cough or laugh intensely. [americanpregnancy.org]

  Pressure may come from: constant coughing or sneezing being overweight lifting, carrying or pushing heavy loads constipation, leading to straining on the toilet pregnancy. [healthnavigator.org.nz]

  Here are the common causes of abdominal wall hernias: Surgery – can damage or weaken the muscles Injury – can damage or weaken the muscles Age – wear and tear Coughing or sneezing – chronic or intense coughing and sneezing can weaken muscles Congenital [belmarrahealth.com]

  Really anything that causes an increase in pressure can cause a hernia: the improper lifting of heavy objects, repeated coughing or sneezing, diarrhea or constipation. [braceability.com]

  The symptoms may be more noticeable when sneezing, coughing, lifting, or during activities causing exertion. Hernia Symptoms, Treatments & Timing All hernias should be addressed at the first signs of onset. [abdominalsurgeryspecialists.com]

• Pneumonia

  More serious problems include heart attack, stroke, pneumonia, and blood clots in the legs. Getting out of bed after surgery and moving as soon as the doctor allows will help reduce the risk of complications such as pneumonia and blood clots. [herniacenter.surgery.ucsf.edu]

  Walking boosts blood flow and helps prevent pneumonia and constipation. If your doctor gives you an abdominal binder to wear, use it as directed. This is an elastic bandage that wraps around your belly and upper hips. [myhealth.alberta.ca]

  Increased activity reduces the risk of blood clots, and improves breathing to prevent pneumonia. Avoid lifting more than 10 pounds for 4 weeks and excessive bending or twisting for 1-2 weeks following surgery. [augusta.edu]

  Other possible problems include pneumonia, blood clots or heart problems. If an infection occurs in the mesh, it may need to be removed or replaced. Also, any time a hernia is repaired it can come back. [sages.org]

• Constipation

  Pressure may come from: constant coughing or sneezing being overweight lifting, carrying or pushing heavy loads constipation, leading to straining on the toilet pregnancy. [healthnavigator.org.nz]

  You are constipated. You have questions or concerns about your condition or care. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

  If blood stops flowing through an incarcerated bowel, this results in strangulation, which is accompanied by pain, often with nausea, vomiting, or constipation. [jamanetwork.com]

  April-June 2019| Vol 2| Issue 2 Review Article The breakthrough on evaluation and treatment in incisional hernia with loss of domain Part of the patients with incisional hernia (IH) suffered from constipation or even circulatory impairment, which is called [herniasurgeryjournal.org]

  The provider will inquire about and/or look for: Constipation, "narrow" or "thin" stool Lump or protrusion in the abdomen; you may be asked to stand and cough, which increases abdominal pressure and makes the hernia more pronounced and easier to diagnose [hopkinsmedicine.org]

• Nausea

  You may also be given nausea medication if you have experience nausea or vomiting from taking your pain medication. It is common to have some constipation after surgery, especially when taking narcotic pain medications. [augusta.edu]

  Nausea and vomiting are atypical symptoms of epigastric hernia. If nausea and vomiting occur along with increasing pain or fever, you should seek immediate medical care. Nausea and vomiting are signs of a serious complication of epigastric hernia. [livestrong.com]

  The usual history is of repeated attacks of abdominal pain or discomfort, usually accompanied by distention, varying in periodicity and intensity, with or without nausea or vomiting, and not accompanied by laboratory data or clinical signs indicative [ncbi.nlm.nih.gov]

  If you have a hernia and significant abdominal pain, pain over the hernia, or nausea or vomiting, you should seek medical care immediately. [jamanetwork.com]

• Abdominal Pain

  Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem … Wikipedia Abdominal wall — Body cavities Diagram of sheath … Wikipedia [medicine_en_ru.academic.ru]

  Patients suffering from crampy, intermittent abdominal pain whose routine radiographic gastrointestinal studies are unrevealing often are labeled as having psychogenic disorders. [ncbi.nlm.nih.gov]

  The pains subsided, and he was discharged the same evening with an agreement for open readmission. Following discharge from the hospital, the pains were moderate for the first two days. On the third day he awoke with severe abdominal pain. [tidsskriftet.no]

  Symptoms of a hiatal hernia may include heartburn and upper abdominal pain. See Your Doctor About a Hernia If: You suspect that you have a hernia. [webmd.com]

• Abdominal Mass

  In the investigation of an abdominal mass, the presence of changing cystic or tubular internal components and a surrounding membrane should arouse suspicion of an internal hernia. [ncbi.nlm.nih.gov]

  US imaging, like CT, largely finds a mass in the abdominal wall corresponding to the contents of the hernia sac and distinguishes it from other masses such as cysts, hematomas, neoplasms or varicoceles[ 7 ]. [wjgnet.com]

  Risk factors for the development of adult umbilical hernias include obesity, multiparity, ascites, and large abdominal masses. Adult umbilical hernias exhibit a female-to-male predominance and occur most commonly in those aged 50 to 70. [ahcmedia.com]

• Severe Abdominal Pain

  The pains subsided, and he was discharged the same evening with an agreement for open readmission. Following discharge from the hospital, the pains were moderate for the first two days. On the third day he awoke with severe abdominal pain. [tidsskriftet.no]

  Other symptoms of a strangulated hernia include severe abdominal pain, profuse sweating, rapid heartbeat, severe nausea, vomiting and high fever. In many cases, a hernia can be diagnosed through a physical examination of the abdomen. [ucsfhealth.org]

  You have severe abdominal pain with nausea or vomiting. You stop having bowel movements and passing gas. You have blood in your bowel movement. When should I contact my healthcare provider? You have a fever. You have nausea or are vomiting. [drugs.com]

  Identification of the presence of incarceration: incarcerated hernia is associated with poor prognosis, and it should be thus suspected with any of the following clinical manifestations: (I) severe abdominal pain, with persistent pain during the interim [ncbi.nlm.nih.gov]

• Thrombosis

  You have signs of a blood clot in your leg (called a deep vein thrombosis), such as: Pain in your calf, back of the knee, thigh, or groin. Redness and swelling in your leg or groin. [myhealth.alberta.ca]

• Confusion

  Although uncommon, this variant of mesothelioma is important to recognize because it can be easily confused with other clear cell tumors involving the serosal membranes. [ncbi.nlm.nih.gov]

  Problem Some call it a ‘ventral hernia’ – this worries and confuses patients and makes them think they need an operation. A prime example of the need for an expert diagnosis and sound advice. [hernia.org]

  […] there are similarly as many confused mothers that asked “what’s that funny bulge on my tummy?” And then, of course, there are the unlucky moms that got the dual diagnosis, “surprise! You have both hernia and diastasis!” That sucks; as I well know. [abdominalconnections.com]

  The term “sports hernia” is confusing, even to physicians, because by definition the patient doesn't actually have a hernia. [gustrength.com]

  A femoral hernia is rare in kids and can be confused with an inguinal hernia. It consists of tissues that have pushed in alongside an artery into the top of the thigh. It appears as a bulge at the top of the thigh, just below the groin. [kidshealth.org]

• Irritability

  Symptoms of an incarcerated hernia can include pain, vomiting, and irritability. If you touch the bulge it has created, it may feel hard. [kidshealth.org]

  We put in seven car insurance claims in as many months due to minor accidents, for the condition does not just cause a week of irritability, but has symptoms such as clumsiness and changes in perception. [dailymail.co.uk]

  If the binder is irritating to your skin or causes itching, placing the binder over another T-shirt may help. You should avoid sexual intercourse for 10-14 days or until cleared by your doctor. [augusta.edu]

• Swelling of the Scrotum

  A swelling in the scrotum may be a varicocele (a condition in which the veins that carry blood from a testis widen), a spermatocele (a cyst in a sac that develops next to the coiled tube where sperm are stored until they mature [epididymis]), or a tumor [merckmanuals.com]

  A painful dragging sensation may be felt, as well as pain and swelling in the scrotum and testicles. [news-medical.net]

  Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the scrotum around the testicular area. [8] Irreducible abdominal hernias or incarcerated [en.wikipedia.org]

• Flank Pain

  The first involves a male who presented with left flank pain and a reducible left inguinal hernia. An ultrasound showed left hydronephrosis. [ahcmedia.com]

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].

• Pneumoperitoneum

  The pneumoperitoneum is thus exhausted, and the inferior umbilical incision sutured to complete the surgery ( 1 ). [ncbi.nlm.nih.gov]

  Extremely large ventral hernias require a procedure called progressive pneumoperitoneum. Laparoscopic Repair In this approach, surgeons use a laparoscope, a tiny telescope with a television camera attached, to view the hernia from the inside. [ucsfhealth.org]

  The UCSF Hernia Center provides the latest treatments for complex ventral hernias, such as the progressive pneumoperitoneum procedure, a specialized approach for treating particularly large ventral hernias. [herniacenter.surgery.ucsf.edu]

  Persistent post-laparoscopy pneumoperitoneum. Surg Endosc. 2003;17:296-299. Toy FK, Bailey RW, Carey S, CW, et al. Prospective, multicenter study of laparoscopic ventral hernioplasty. Surg Endosc. 1998;12:955-959. [laparoscopy.blogs.com]

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.

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].

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].

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.

• 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].

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].

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].

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.

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