Abdominal Wall Hernia

Ghisa Anindya Widyatami

20194010103
 Introduction
Abdominal wall hernias are among the most common of all
1. surgical problems.

Hernias occur when part of the intestine or peritoneum pushes

2.
through a gap in the abdominal wall.

The protruding pouch, called the hernia sac may contain part of
3.
the peritoneum, intestine or stomach, as well as belly fat.

Hernias may be detected on routine physical examination, or

4. patients with hernias may present because of a complication
associated with the hernia.
 Symptoms
Seen as bulges, pain, burning, pulling sensation, nausea and
vomitting

Causes and Risk Factors

- Weak abdominal muscles and weak connective tissue
- Being very overweight
- Pregnant woman
- Lifting heavy objects, coughing

Prevalence
The most common is inguinal hernias. The second most common
types is umbilical and incisional hernia. The less common are
Epigastric hernias, femoral hernias and diaphragmatic hernias
 Classification
Based on Place
Based on Clinical Manifestation

• Reponible
• Irreponible

Based on causes

• Congenital
• Aquisita Based on Complication

• Incarserated
• Strangulated
Hernia Femoralis
• Common in females (ratio 2:1), common
in multipara. Rare occurs before puberty,
more common in right side.
• Presents as a swelling in the groin below
and lateral to the pubic tubercle
• obstruction and strangulation occurs
which is more common, presents with
features of intestinal obstruction—
painful, tender, inflamed, irreducible
swelling without any impulse
 A femoral hernia follows the tract below the inguinal ligament through the
femoral canal. Because femoral hernias protrude through such a small defined
space, they frequently become incarcerated or strangulated
Hernia Umbilicalis

• Develops due to absence of umbilical

fascia or incomplete closure of umbilical
defect
• It can be congenital or acquired
• Congenital  few months after birth
which presents as a swelling in the
umbilical region which increase during
crying
• Treatment: Initially conservative (< 2cm)
and indication for surgery after two years
of age and >2 cm
Hernia Paraumbilicalis (Supra / Infra – umbilicalis)

• It occurs commonly in adults. It is a

protrusion or herniation through linea
alba, just above or below the umbilicus
• The contents are usually omentum,
small bowel, sometimes large bowel.
• It has got tendency to go for adhesion,
irreducibility and obstruction
• Surgery is the treatment of choice
 Hernia Incisional
Definition
It is herniation through a weak abdominal scar of
previous surgery
Predisposing Factors
• Vertical scar, midline scar, lower abdominal scar
may injure the nerves of the abdominal muscles
• Scar of emergency surgeries (peritonitis, acute
abdomen)
• Faulty technique of closure
• Poor nutritional status of the patient
• Presence of cough , hypoproteinaemia,
malignancy, immunosuppression
 Hernia Epigastric
(Fatty hernia of line alba)
• Occurs through the linea alba
anywhere between the xiphoid
process and the umbilicus
• Its usually as a protrusion of
extraperitoneal fat.
• The patients are often manual
workers between 30 and 45 years
of age.
Hernia Inguinalis (Anatomical classification)

1. Indirect Hernia

It comes out through internal ring

along with the cord lateral to the
inferior epigastric artery
 2. Direct Hernia
It occurs through the posterior wall
of the inguinal canal through
‘Hesselbach’s triangle medial to the
inferior epigastric artery
Zieman’s test
• The examiner places his index finger on the
deep inguinal ring and middle finger on the
superficial inguinal ring, ring finger over
saphenous
• Patient is asked to cough or to hold the nose
and blow If the impulse is felt on
 index finger it is indirect hernia,
 middle finger its direct hernia,
 Ring finger femoral hernia
 Finger Test
• Using the 2nd or 5th of finger
• The examiner’s finger entering the
inguinal canal, ask the patient to cough:
• - hernia bulges can be felt in the side of
finger: Hernia Inguinalis Direct
• - hernia bulges can be felt on the tip of
finger: Hernia Inguinalis Indirect
Thumb Test
- Pressing the anulus
internus with thumb’s
examiner
- Ask the patient to cough:
bulges can be feel on
hernia inguinalis
medialis
 Hernia Complication
1. Irreponible (Irreducible)
If contents cannot be returned but there is no other complication
2. Incarcerated
An irreducible hernia which the intestinal flow is completely
obstructed
3. Strangulated
An irreducible hernia which the blood and intestinal flow are
completely obstructed. Occurs when the loop of intestine in the
sac becomes twisted and constriction (ischemia)  emergency
surgery
Strangulata-ischemia

Inkarserata
Sources
Goethal, Andrea, Curtis Adams. 2018. Femoral Hernia.
Available from:
https://www.ncbi.nlm.nih.gov/books/NBK535449/
Institute for Quality and Efficiency in Health Care. 2016.
Hernia: Overview. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK395554/
Pearson, Robert. 2018. Hernia Explained. Available from:
https://geekymedics.com/hernias-explained/
Rather, Assa, et cal. 2019. Abdominal Hernias. Available
from: https://emedicine.medscape.com/article/189563-
overview#a4
Thank You