Abdominal hernia
An abdominal hernia is when the abdominal contents protrude through a weakness or defect in the abdominal wall. It can be congenital or acquired and comes in various types based on location and underlying causes, such as ventral, inguinal, and femoral hernias. Diagnosis is often made through physical examination, although imaging studies may be necessary. Surgical repair is the main management approach, with decisions based on symptoms, patient preference, and risks of complications. Surgical options include open and laparoscopic procedures, with or without mesh placement.
Definition
A hernia occurs when abdominal contents protrude through a weakness or defect in the abdominal wall. Hernias can be congenital or acquired.
Epidemiology
Hernias affect approximately 5 million Americans.
The majority of hernias are groin hernias (inguinal/femoral).
One-third of all repaired ventral hernias are incisional, while the remaining two-thirds are primary ventral hernias.
Etiology
Some hernias are congenital:
Inguinal (resulting from failure of the closure of the processus vaginalis)
Umbilical (present at birth in all infants, but most close within the first two years of life)
Acquired hernias result from loss of mechanical integrity of the abdominal wall:
Primary: Genetic factors contribute to weakness of the abdominal wall.
Incisional: Damage to abdominal wall muscles and fascia during surgery.
Pathophysiology
A hernia is characterized by a hernia sac, an outpouching of the peritoneum covering the hernia contents.
Reduction hernia:
The hernia contents can freely return to the abdominal cavity and can be pushed back in during examination.
Incarceration:
The hernia contents cannot return to their original cavity, resulting in severe pain and a nonreducible bulge. Intestinal obstruction symptoms may develop if intestines are incarcerated.
Strangulation:
The hernia contents are incarcerated, compromising blood supply and causing ischemia and tissue death.
Anatomic Classification
Abdominal wall hernias can be classified anatomically into various types:
Anterior hernias:
- Epigastric
- Umbilical
- Spigelian
- Incisional
- Parastomal
Groin hernias:
- Inguinal
- Femoral
Pelvic hernias:
- Obturator
- Sciatic
- Perineal
Posterior hernias:
- Superior triangle (Grynfeltt hernia)
- Inferior triangle (Petit hernia)
