Hernia
A hernia is the protrusion of tissue through a weakness or defect in the muscle wall that normally contains it. The most common site is the groin, but hernias can also occur in the abdominal wall, at prior surgical sites, and at the diaphragm. A hernia may be reducible or irreducible, and complications can include incarceration and strangulation.
Common Hernia Types
- Inguinal hernia (through the inguinal canal, more common in males) [1].
- Femoral hernia (through the femoral canal, more common in females) [1].
- Umbilical hernia (through or near the umbilicus) [1].
- Ventral/incisional hernia (through the abdominal wall at a prior incision or surgical scar) [1].
- Hiatal hernia (upward displacement of part of the stomach through the esophageal hiatus into the thorax) [1].
Typical Clinical Presentation
- A visible or palpable bulge that may enlarge with standing, coughing, or straining [1].
- Discomfort or pain at the bulge site, which may improve with lying down (common but not universal) [1].
- Symptoms related to location, such as reflux symptoms for hiatal hernia [1].
Hernia Complications
- Incarceration is entrapment of herniated tissue that cannot be reduced back into the abdomen [1].
- Strangulation is compromised blood supply to the herniated tissue, which can lead to ischemia and necrosis [1].
- Symptoms suggesting complications may include severe or worsening pain, redness or tenderness over the bulge, bowel obstruction symptoms, and systemic toxicity [1].
Evaluation Principles
- Diagnosis is often clinical based on history and physical examination for groin, umbilical, and ventral/incisional hernias [1].
- Imaging may be used when the diagnosis is uncertain or to define anatomy, such as ultrasound or computed tomography [1].