Hernias is a topic covered in the 5-Minute Emergency Consult.

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  • Protrusion of bodily structure or organ through a defect in tissues normally containing it.
  • Classified as external (hernia protrudes visibly to outside), internal (herniated contents occur within body cavity), or interparietal (hernial sac contained within abdominal wall)
  • Abdominal wall hernia due to weakness or disruption of fibromuscular layer of abdominal wall
  • “Groin” hernias include femoral, direct, and indirect inguinal hernias
  • “Ventral” hernias include epigastric, umbilical, and spigelian hernias
  • External:
    • 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 abdominus medially
    • Incisional hernia:
      • Resultant breakdown of previous surgical fascial closure
    • 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
  • Other hernias:
    • Obturator (pelvic) hernia:
      • Passes through obturator membrane and exits beneath pectineal muscle
    • Epigastric hernia:
      • Midline between xiphoid and umbilicus
    • Spigelian hernia:
      • Protrusion through oblique fascia lateral to rectus abdominus muscle
    • 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
    • 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


  • Hernia repair (herniorrhaphy) extremely common general surgical procedure (>750,000 performed in US annually)
  • Prevalence: 5% of population
  • Groin and femoral hernias account for 85% of hernias:
    • Umbilical and incisional hernias account for additional 10%


  • 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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