A detailed medical history can reveal the natural course of the disease and whether the defect is congenital or acquired. A through physical examination will also be an invaluable tool in the diagnosis. Patient may need to be examined in both upright and supine position for better results.

Hernias will initially present as a bulge in the abdomen as with ventral hernia or a bulge in the scrotal sac in the case of inguinal hernia. Palpation and probing of the hernia sac may reveal its direct or indirect nature.

Patients may present with large lumps in the ventral abdomen where the visceral organs seen may give one a clue on the herniating organ and how to manage it.

Incarcerated hernia will present with swelling, pain on palpation and the inability to manipulate the hernia sac. The associated systemic signs of fever, nausea and vomiting may be suggestive of a more urgent case of intestinal strangulation which merits immediate surgery.

• Pain

  Painful scar. Sometimes people experience sharp, tingling pain in a specific area near the incision after it has healed. The pain usually resolves with time. Medicine may be injected in the area if the pain continues. Injury to internal organs. [gi.surgery.ucsf.edu]

  Closing the defect may, however, cause tension and pain from the abdominal wall. Instead of closing the defect, the part of the peritoneum constituting the hernia sac may be used for closing the defect. [clinicaltrials.gov]

  Symptoms include pain in the abdomen, especially when lifting or straining. Treatment is with surgery, including open, laparoscopic and robotic hernia repair. [my.clevelandclinic.org]

  When tissue inside the hernia becomes stuck or trapped in abdominal muscle, it can cause pain, nausea, vomiting and constipation. [ucsfhealth.org]

• Weakness

  The weakness in the abdominal wall through which the intestine protrudes may be part of your body’s natural formation. [hopkinsmedicine.org]

  Weakness in an area of the abdominal wall that was present at birth. Weakness in the abdominal wall caused by conditions that put strain on the wall. [my.clevelandclinic.org]

  A ventral hernia is a bulge of tissues through an opening of weakness within your abdominal wall muscles. It can occur at any location on your abdominal wall. [healthline.com]

  A ventral hernia is a hernia that forms in the abdominal wall, along the midline, due to a weakness in the muscles that creates a gap. Typically, with a ventral hernia, abdominal tissues or a portion of the intestines protrude into the gap. [medstarwashington.org]

• Fever

  […] 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 Nausea, vomiting, fever [hopkinsmedicine.org]

  A strangulated ventral hernia causes severe abdominal pain, fever, rapid heart rate and abdominal tenderness. Vomiting often occurs because the strangulated area blocks passage of digested material. [livestrong.com]

  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]

  Postoperative complications occurred only with rIPOM and included urinary retention, seroma, and fever. [ncbi.nlm.nih.gov]

• Swelling

  The physician may recommend a surgery, when: The swelling becomes bigger during the period of 1-2 years (age of child) The swelling does not disappear by the age of 4 years If any complication (such as tender to touch, vomiting, or severe pain) develops [dovemed.com]

  It can cause severe swelling and bluish discoloration of the skin around the incision. Surgery may be necessary to open the incision and stop the bleeding. Bleeding is unusual and occurs in less than 2 percent of patients. Wound infection. [gi.surgery.ucsf.edu]

  These symptoms may include: Swelling Swelling is the most common and frequently recorded sign of Hernia. The engorgement caused internally is noticeable on the surface as well. [howshealth.com]

• Fatigue

  Is it the pain control, is there other help we can provide to get through the pain or through the fatigue for the time after surgery?” [newsnetwork.mayoclinic.org]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 12, 2019 [patientslikeme.com]

  You may also feel easily fatigued and “washed out” for a week or two following the surgery. These factors will put some limitations on your activity, but you will not cause any damage even if some soreness is experienced. [uhhospitals.org]

• Abdominal Pain

  Presentation Abdominal pain, nausea and vomiting. Patient Data Age: 70 years Gender: Female Loading images... Axial C+ portal venous phase A loop of ileum containing oral contrast material is seen extending into an incisional ventral hernia. [radiopaedia.org]

  The chronic pain was found to be the consequence of mesh migration and erosion into the sigmoid colon from a previous supraumbilical hernia repair. Hernia repair, use of mesh, and chronic abdominal pain are discussed. [ncbi.nlm.nih.gov]

  Peritonitis, infection of the lining that covers the abdominal wall and the abdominal organs, causes severe, continually worsening abdominal pain with muscle rigidity and tightness along with fever, vomiting and fast pulse. [livestrong.com]

• Chronic Abdominal Pain

  The chronic pain was found to be the consequence of mesh migration and erosion into the sigmoid colon from a previous supraumbilical hernia repair. Hernia repair, use of mesh, and chronic abdominal pain are discussed. [ncbi.nlm.nih.gov]

  Post inguinal hernia surgery chronic pain: chronic groin pain is seen in up to 13–20% of individuals undergoing inguinal hernia repair [25]. [insightsimaging.springeropen.com]

  Different authors have used different period for defining chronic postoperative pain. Sutures for mesh fixation may cause ischemic injuries to anterior abdominal wall musculature or neurovascular bundle which results in pain. [journalofmas.com]

  [Crossref] [PubMed] Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986;3:S1-226. [ales.amegroups.com]

• Skin Rash

  Shingles is a disease that causes a painful skin rash and can affect the nervous system. [vaccines.gov]

  It is spread by coughing and sneezing, direct contact, and the virus being released into the air from skin legions. The most common symptoms are a skin rash found mostly on the face, scalp and trunk. [maine.gov]

  The telltale sign of chickenpox is a super-itchy skin rash with red blisters. Over the course of several days, the blisters pop and start to leak. Then they crust and scab over before finally healing. [webmd.com]

  — Korin Miller, SELF, "9 Questions That Will Help You Decode That Skin Rash," 22 Mar. 2019 There are a few exceptions though - herpes simplex virus and varicella can cause a particular type of rash that resembles tiny blisters, are very contagious, [merriam-webster.com]

  You start to be contagious to those around you up to 48 hours before the skin rash starts to occur. [healthline.com]

• Cesarean Section

  Eight had umbilical hernias, gross diastasis of the recti and post-cesarean section vertical incisional hernias repaired by the Shoelace technique followed by 12 full-term pregnancies. [link.springer.com]

  Causes Ventral hernias are common especially following prior open abdominal surgeries such as laparotomy for a bowel resection, hysterectomy, or cesarean section. [surgeryspecialistsdallas.com]

  Nature of previous surgery included cesarean section, hysterectomy, and laparotomy for appendix or gut perforation. [ejs.eg.net]

• Irritability

  While you may feel fine, please see a surgeon as soon as possible if it causes any discomfort, pain, soreness or irritation. [atlsurgery.com]

  You may notice mild irritation or peeling of skin for a few days after treatment. Verruca Vulgaris (Warts) Doctors and Providers [childrens.com]

  Try adding oatmeal, baking soda or non-irritating moisturising bath lotion to the bath water. Pat dry, do not rub, after bathing Moisturise with non-irritating skin lotion. Calamine lotion is not recommended as it can dry out the skin. [immune.org.nz]

  Applied daily until mild irritation/inflammatory response develops then decrease to every other day or every few days to maintain irritation until warts resolve. [dermatologyadvisor.com]

  On examination in the hospital he appeared ill and mildly irritable; his temperature was 39°C with normal vital signs. A varicelliform rash was seen on the scalp, trunk, and extremities. [hindawi.com]

• Aura

  Aura T, Habib, Mekkaoui M, Brassier D, Elhadad A. Laparoscopic tension free repair of anterior abdominal wall incisional and ventral hernias with an intra-peritoneal gore-tex mesh: prospective study and review of literature. [ijsurgery.com]

  Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A. Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: Prospective study and review of literature. [journalofmas.com]

  Aura T, Habib E, Mekkaoui M, et al. Laparoscopic tension-free repair of anterior abdominal incisional and ventral hernias with an intraperitoneal Gore-Tex® mesh: prospective study and review of the literature. [laparoscopy.blogs.com]

Since the diagnosis of ventral hernia can be easily clinched by proper history taking and physical examination the need for laboratory workups may not no longer be necessary for it may only yield non-specific results.

Imaging studies like CT and MRI may only be necessary when determining the contents of the hernia sac within the abdomen or in determining the extent of the intestinal strangulation, otherwise it isn’t that necessary [7].

Laboratory workups may only be ancillary and may be used to rule out other differential causes. The urinalysis may rule out the pain of inguinal hernia against an impending urinary tract infection.

Culture from infected wound or stump may identify the pathogenic organism infecting the site. Complete blood count will not be specific but will show leukocytosis. Serum electrolytes will show the hydration status of the patients for proper management.

The main approach in the treatment of ventral hernia is surgical reduction which may require analgesia and sedation to lower the intraabdominal pressure [8].

The Single Port Access (SPA) prosthetic repair of incisional hernia gives promising results with rare events of recurrence [9]. Surgeons ascertain initially whether the hernia is already strangulated or incarcerated which will greatly influence the methods of surgical procedures and the morbidity of the case. Ventral hernia may be approached with minimal incisions like those with laparoscopic surgical procedures but risk factors should be identified like increased Body Mass Index, history of previous repair and size of hernia to prevent any complication during the surgery [10].

Inguinal hernias will benefit from the surgical repair (Bassini repair) of the weakened wall using synthetic meshes to prevent recurrence of the hernia.

Less invasive approach for topical treatment of ventral hernias employ the use of cauterization in removing the granuloma, scarring the sac of a giant omphalocele with use of agents like povidone iodine will reduce infection, and progressive compression dressing which locally prevents further evisceration of the hernia. Postoperative patients will be regularly monitored to avert the recurrence of the ventral hernia.

The prognosis of all abdominal hernia is greatly influenced by the early detection and treatment of the hernia. Morbidity and mortality rate also varies directly with the size of the herniated mass and the size of the defect of the abdominal hernia.

Morbidity correlates closely with the associated complications of the ventral hernia. Neglected incarcerated hernia may lead to bowel obstruction, bowel rupture and peritonitis which are all life-threatening medical conditions. The manner and conduct of the surgical operations may also influence the prognosis of the disease where iatrogenic subcutaneous emphysema and surgical site infections can also occur and increases morbidity.

Complications

There are a number of possible complications of an abdominal hernia, the following are the most common ones:

• Incarceration or strangulation of the trapped bowel loop: When the herniated viscera is trapped within the hernia ring, bowel obstruction and infarction may occur leading to lethal consequences.
• Hernia recurrence: Even with surgical repair, hernia may recur in the same site or proximal to the site of repair. Ventral hernia usually recurs within 2 years from the first repair operation [6].
• Iatrogenic injury: Subsequent hernia repair may inadvertently injure other organs in the process like the urinary bladder, vas deferens, and the intestines.
• Wound infection: Post-operative surgical site infection is common especially with poor wound care after the patient is discharged from the hospital. 
• Intestinal obstruction: Complete obstruction may lead to rupture and peritonitis while partial obstruction may cause malnutrition and growth failure.

Incisional hernia occurs at the site of a former abdominal surgery because it is weakened by several factors. Any strain to the abdominal walls like the Valsalva in constipated defecation, chronic coughing and lifting of heavy weights can propagate the herniation in the abdominal wall.

Pregnancy can inherently stretch and aggravate the abdominal hernia. An infected surgical wound can weaken and result to evisceration if the wounds dehisce. Diabetics and chronic steroid users are prone to surgical site infection and ventral hernia.

In the United States, over 1 million abdominal surgeries are performed to repair all forms of ventral hernia. More than three-fourths of these cases are inguinal type of hernia [1]. There is a male predominance for inguinal hernia with a 7:1 male to female ratio with more than half of the cases being indirect in in nature [2]. Inguinal hernia has a predisposition to the left side of the inguinal area.

Females are more prone to incisional hernia compared to men [3]. Congenital umbilical hernia often presents as ophalocele (herniated stump in navel) in the newborn. The incidence of omphalocele has currently risen with a prevalence rating of 1-2.5 cases per 5000 live births [4].

Older patients are prone to direct inguinal hernia due to the subsequent wall weakness. Premature infants born before 32 weeks of gestation have a 13% incidence of indirect hernia which are observable in the first month of life [5].

Bowel loops that protrude in the abdominal wall may be trapped and constricted causing a painful surgical emergency known as incarceration. Infants less than 6 months has twice the risk of incarcerated hernia than their older counterparts.

The pathophysiology of incisional hernia lies on the breakdown of the fascial closure of the abdominal surgical wound. The incidence of recurrence in incisional hernia is relatively high, ranging from 20-45%.

Umbilical hernia is a result of the failure of the umbilical ring to physiologically close. Children with congenital problems with collagen synthesis like Ehler-Danlos Syndrome and osteogenesis imperfecta have an increased risk for umbilical hernia.

Spigelian hernia occurs due to a defect in the spigelian fascia by the lateral edge of the rectus abdominis muscle (abdominal muscles).

The paralysis of the abdominal internal ring and the high lying abdominis aponeurosis may fail to prevent herniation of visceral organs in the inguinal ring causing the inguinal hernia.

Ventral hernia may appear at birth which should always be given attention to prevent incarceration of the herniated organ.

Abdominal hernia may be prevented if risks are identified early in the course of the disease. Patients identified with weakness in the abdominal wall should be restricted to strain or lift heavy objects.

Constipation may be prevented with the use of laxatives and chronic coughing may be controlled with antitussive preparations.

Patient who had prior surgical hernia repair should apply proper wound care to prevent infections and wound dehiscence. A regular visit to the surgeon to monitor hernia progression can be very beneficial.

Ventral hernia is any abnormal protrusion in the abdominal wall caused by a weakened point in the muscles or tissues due to prior incisions or defect. Because of its frequent occurrence in the incisional site, it is also referred to as an incisional hernia.

Protrusion in the umbilical area is sometimes coined as an umbilical hernia, a type of ventral hernia that may not precede any abdominal surgery. Abdominal protrusions in the ventral (anterior abdomen) is oftentimes caused by an intestinal loop or any abdominal tissue that makes its way through the wall defect.

Abdominal hernia with encroachment beneath rib cage at epigastrium is called epigastric hernia while hernia which develops within the colostomy or jejunostomy stoma is known as stomal hernia. Inguinal hernia are abnormal encroachment in the inguinal area or groin which occur more commonly in men.

Ventral hernia is a bulging of the belly wall caused by a weakened point in the muscles or tissues.

Patients with high risk of hernia should avoid all occasions of straining like lifting of heavy loads. Medical support devices like body truss and corsets may support the abdominal wall if there are abnormal masses that herniate in the ventral abdomen.

Athletes with high risk to inguinal hernia must wear groin supporters. Any suspicious lumps in the abdominal wall should be promptly brought for surgical consultation and immediate intervention.

1. Manthey DE. abdominal hernia reduction. In: Clinical Procedures in Emergency Medicine. Of of 2003. 
2. Katz DA. Evaluation and management of inguinal hernias and umbilical. Pediatr Ann. Dec. 2001, 30 (12): 729-35. 
3. Matthews RD, Neumayer L. Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg. April 2008, 45 (4): 261-312. 
4. Scherer LR 3rd, Grosfeld JL. Inguinal hernia and umbilical anomalies. Pediatr Clin North Am. Dec. 1993, 40 (6): 1121-31. 
5. Brandt ML. Pediatric hernias. Surg Clin North Am. February 2008, 88 (1): 27-43, vii-viii. 
6. Singhal V, Szeto P, VanderMeer TJ, B. Ventral hernia repair Cagir: outcomes change with long-term follow-up. JSLS. 2012; 16 (3): 373-9 
7. Matthews RD, Neumayer L. Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg. April 2008, 45 (4): 261-312. 
8. Inguinal hernia reduction S. Smith. In:. C. King, Henretig FM, eds . Procedures Textbook of Pediatric Emergency 2nd ed Philadelphia, PA :. Lippincott Williams and Wilkins; 2008: 840-847 / 87th
9. Bucher P, Pugin F, Morel P. Single-port access prosthetic repair for primary and incisional ventral hernia. toward less parietal trauma . Surg Endosc 2011; 25 (6): 1921-5 (ISSN: 1432-2218)
10. Jenkins ED, Yom VH, Melman L, Pierce RA, Schuessler RB, Frisella MM, Christopher Eagon J, Michael Brunt L, Matthews BD. Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study. Surg Endosc. 2010; 24 (8): 1872-7 (ISSN: 1432-2218)