Abdominal wall hernias
general consideration inguinal hernias femoral hernia incisional hernia umbilial hernia hernia of linea alba
general consideration
❖ Definition
Hernia means a sprout, and protrusion. External abdominal wall hernia is an abnormal protrusion of intra-
abdominal tissue or the whole or part of a viscera through an opening or fascial defect in the abdominal wall. most occur in the grion
Inguinal hernias
inguinal hernia: a protrusion of part of the contents of the abdomen through the inguinal region of the abdominal wall.
indirect inguinal hernia: the internal inguinal ring the inguinal canal external inguinal ring scrotum
Littre hernia: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum).
Reductive incarcerated hernia: reduction of the hernial contents ( intestine ) into abdominal cavity.
❖ Clinical types
1. reducible hernia is one in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent.
Sliding hernia is one in which the wall of a viscus forms a portion of the wall of the hernia sac. It is may be colon ( on the left), caccum (on the right) or bladder (on either side).
direct inguinal hernia: Hesselbach’s triangle
❖ Etiology
1. intensity of abdominal wall decreased common factors: 1) site that some tissues pass through the abdominal wall, eg. Spermatic cord, round ligament of uterus 2) bad development of abdominal white line 3) incision, trauma, infection et al. defect in collagen synthesis or turnover 2. any condition which increases intra-abdominal pressure chronic cough, chronic constipation, dysuria, ascites, pregnancy, cry
Belongs to irreducible hernia
3. incarcerated hernia: is one whose contents cannot be returned to the abdomen, with severe symptoms.
4. strangulated hernia: denotes compromise to the blood supply of the contents of the sac.
incarcerated hernia and strangulated hernia are the two stages of a pathologic course
Richter’s hernia (intestinal wall hernia )
a hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen.
2. irreducible hernia is one whose contents or part of contents cannot be returned to the abdomen, without serious symptoms.
hernias are trapped by the narrow neck
Hale Waihona Puke ❖ Pathological anatomy
composed of: covering tissue: skin, subcutanous tissue hernial sac: protrusion of peritonum,
neck of the sac: is narrow where the sac emerges from the abdomen body of the sac hernial contents: small intestine, major omentum