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Etiology
Weakness or defect of abdominal wall: Site of tissue pass through abdominal wall: spermatic cord, round ligament, femoral vessels, umbilical vessels. Linea alba dysplasia poor wound healing, wound infection, nerve injury of abdominal wall, eldly, obesity
腹外疝
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概述
Hernia：体内某个脏器或组织离开其正常解 剖部位，通过先天或后天形成的薄弱点、缺 损或孔隙进入另一部位. Hernia is derived from the Latin word for rupture. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls.
Abdominal external hernia: protrudes through all layers of the abdominal wall. 由腹腔内的脏器或组织连同壁腹膜,经腹壁薄弱 点或孔隙，向体表突出而致.
Abdominal internal hernia: a protrusion of intestine or tissue through a defect within the peritoneal cavity.
Pathoanatomy
Hernia sac : Neck or orifice of a hernia,
hernia ring (疝囊颈、疝环、 疝门)，named according to the site of hernia ring. Hernia body
Content: mainly are intestine， omentum, cecum, colon, sigmoid colon, appendix, bladder.
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• Sciatic hernia：extremely unusual and difficult to diagnose and frequently are asymptomatic until intestinal obstruction occurs. an uncomfortable or slowly enlarging mass in the gluteal臀肌or intragluteal area. Prosthetic mesh repair is usually preferred
• Inferior lumbar trigone (Petit’s)： Less common . bounded by the iliac crest髂嵴, latissimus dorsi muscle背阔肌, and external
oblique muscle.
• Repair is best done by placement of prosthetic mesh
Chronically increased intra-abdominal pressure: abdominal strain from heavy exercise or lifting, chronic cough, constipation with straining at stool, prostatism with straining on micturition. cirrhosis with ascitise, pregancy, chronic ambulatory peritoneal dalysis, chronic enlarged pelvic organ or tumors.
• • Spigelian hernia： occurs
through the spigelian fascia (semilunar line). Most spigelian hernias are small. often present with localized pain in the area without a bulge. simple suture repair of the transversus abdominis and internal oblique muscles
• Pelvic： Obturator，Sciatic，Perineal
• Posterior： Lumbar：Superior triangle Inferior triangle
• Diaphramatic
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• Superior lumbar trigone (Grynfeltt’s) : more common. is bounded by the 12th rib, paraspinal muscles, and internal oblique muscle.
• Groin：
Inguinal：Indirect， Direct，Combined Femoral Pre/peri-Vessel hernia
• Anterior Umbilical，Spigelian， Linea alba Artificial fistula-induced, Incisional
Hernia covering
Clinical classification
reducible hernia:contents can be pushed back into the abdomen by applying manual pressure.