Abdominal wall Hernia

Forth stage

surgery
Lec-2
د. سمير الصفار

27/10/2015

Abdominal Wall Hernia

Definition

A protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity

Introduction:

Hernias by themselves usually are harmless, but nearly all have a potential risk of
Obstruction if their content is part of bowel.
Cut off blood supply of their content ( becoming strangulated).


Aetiology
Acquired:
Any condition that increase intra-abdominal pressure;
Strong muscular effort
Chronic coughing
Straining
Obesity
Chronic smoking

Congenital:

Patent processus vaginalis

Composition of hernia

Each Hernia consist of
Defect or weak point
Peritoneal sac
Mouth
Neck
Body
Fundus
Covering of the sac
Contents of the sac
Contents of the sac
Omentum
Intestine
Portion of circumference of intestine “Richter “
Portion of bladder
Ovary with or without Fallopian tube
Meckel’s diverticulum “Littre “
Fluid


Anatomical types:
External
Interparietal
Internal
Sliding

Pathological Types :

Reducible
Irreducible
Obstructed ( Incarcerated )
Strangulated
Inflamed

Reducible

The hernia either reduces itself when the patient lies down, or can be reduced by the patient or the surgeon.
Irreducible
Here the contents cannot be returned to the abdomen, but there is no evidence of other complications.
Obstructed
This is an irreducible hernia containing an intestine which is obstructed but there is no interference of blood supply to the bowel.
Strangulated
A hernia becomes strangulated when the blood supply of its contents seriously impaired rendering the contents ischaemic.
Inflamed
Inflammation of its contents
Appendix
Fallopian tube
Inflammation of overlying wall

Locational Types:
Groin
Umbilicus
Epigastric (Linea alba )
Surgical incisions
Spigelian (Semi-lunar line)
Diaphragm
Lumbar triangles
Pelvis (Obturator)


Locational Types:
Groin
Umbilicus
Epigastric (Linea alba )
Surgical incisions
Spigelian (Semi-lunar line)
Diaphragm
Lumbar triangles
Pelvis (Obturator)

Groin hernia
Inguinal
Femoral

Inguinal Hernia

Inguinal hernia : Makes up 75% of all abdominal wall hernias and occurring up to 25 times more often in men than women.
Indirect
Direct


Anatomy of Groin
Anatomy of Groin

Anatomy of Inguinal Canal

3.75cm in length
1.25 cm cephalad and parallel to inguinal ligament
Extends from deep to superficial inguinal rings
In infants; the canal is almost not present as the DIR and SIR superimposed
Boundaries of Inguinal Canal
Anterior EOA, CT
Posterior C, TF
Upper (roof) CT
Lower (floor) IL

Contents of Canal

Spermatic cord in male and round ligament in female
Ileo-inguinal nerve
Genital br of genito-femoral nerve

Indirect Inguinal Hernia

Is the most common of all forms of hernia
Most common in young
Men > women
Right > left
10% of premature babies
5% of adult population
In adults:
65% of all inguinal hernia is indirect
55% right
12 % bilateral
Incomplete
Bubonocele
Funicular
Complete
Inguinoscrotal

Pathogenesis of Indirect Hernia

Indirect hernia
Congenital
Acquired
Congenital:
Persistent processus vaginalis
Within spermatic cord
Follows indirect course
Complete vs. incomplete sac
Acquired
Precipitating factors
Increased intra-abdominal pressure
Defects in collagen synthesis
Smoking
Clinical Features
Any age
Right < Left
Male < Female (20 times)


Presenting symptoms
Swelling appear on standing or coughing
Pain in the groin
Swelling in the groin
Swelling in the groin descended to scrotum
Examination
Apparent on standing
Expensile cough impulse
Controlled on pressing over the DIR