Hernias
Basics
Description
Description
- Protrusion of bodily structure or organ through a defect in tissues normally containing it
- Abdominal wall hernia due to weakness or disruption of fibromuscular layer of abdominal wall
- Classified by region (ventral, groin, pelvic, flank) or etiology such as external (hernia protrudes visibly to outside), internal (herniated contents occur within body cavity), or interparietal (hernial sac contained within abdominal wall)
- Groin:
- Indirect inguinal hernia:
- Results from persistent process vaginalis
- Peritoneal contents herniate through internal ring
- Right side more common than left
- 27% lifetime risk of repair for men; 3% for women
- Direct inguinal hernia:
- Due to weakness or defect in transversalis area in Hesselbach triangle:
- Inguinal ligament inferiorly
- Inferior epigastric vessels laterally
- Lateral border of rectus abdominis medially
- Femoral hernia:
- Peritoneum herniates into femoral canal beneath inguinal ligament
- Incarceration frequent due to protrusion through small orifice
- Internal: Diaphragmatic, hernias from mesenteric/omental tears, foramen of Winslow
- Indirect inguinal hernia:
- Flank:
- Lumbar hernia:
- Occur in superior and inferior lumbar triangle of posterior abdominal wall (incarcerate in 25% cases)
- Usually middle-aged men, chronic low back pain with palpable mass
- Lumbar hernia:
- Pelvic:
- Obturator hernia:
- Passes through obturator membrane and exits beneath pectineal muscle
- Obturator hernia:
- Ventral:
- Incisional hernia:
- Resultant breakdown of previous surgical fascial closure
- Epigastric hernia:
- Midline between xiphoid and umbilicus
- Spigelian hernia:
- Protrusion through oblique fascia lateral to rectus abdominis muscle
- Umbilical hernia:
- Congenital failure of umbilical ring to close
- Protrusion through fibromuscular umbilical ring/umbilicus
- Often incarcerate in adults, although rarely in infants (often spontaneously close)
- 20–45% recurrence rate
- Incisional hernia:
Epidemiology
Epidemiology
- Hernia repair (herniorrhaphy) extremely common general surgical procedure (>750,000 performed in the U.S. annually)
- Prevalence: 5% of population
- Groin and femoral hernias account for 85% of hernias:
- Umbilical and incisional hernias account for additional 10%
Etiology
Etiology
- Reducible hernia:
- Protruding structures can be returned to abdominal cavity
- Incarcerated hernia:
- Contents of hernia cannot be manipulated back into abdominal cavity
- Strangulated hernia:
- Vascular compromise of entrapped bowel contained within hernia leading to ischemia and gangrene (skin color changes may be apparent)
- Higher risk in hernias with small openings and large sacs
- Signs and symptoms of bowel obstruction or ischemia may occur (nausea/vomiting, fever, leukocytosis)
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Citation
Schaider, Jeffrey J., et al., editors. "Hernias." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307635/all/Hernias.
Hernias. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307635/all/Hernias. Accessed December 7, 2024.
Hernias. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307635/all/Hernias
Hernias [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307635/all/Hernias.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Hernias
ID - 307635
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
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ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307635/all/Hernias
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
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