Introduction
This topic covers hernias of the anterior abdominal wall: their definition and structure, classification, clinical features, complications, diagnosis and the principles of surgical treatment. Inguinal hernias are the most common and carry most of the exam weight, but femoral, umbilical, epigastric and incisional hernias must also be described.
Definition and classification
A hernia is an abnormal protrusion of an organ or tissue through a defect or weak point in the wall that normally contains it. In the anterior abdominal wall the protruding content is usually a loop of small bowel or omentum, sometimes only preperitoneal fat. A hernia has three parts: the hernial sac (an outpouching of peritoneum, which may be absent in some cases), the hernial orifice or neck through which the sac passes, and the contents. The coverings are the skin and subcutaneous tissue.
Clinical features
Most hernias present as a swelling that enlarges on standing, straining, coughing or lifting and disappears on lying down. Symptoms are often mild.
- Lump in the groin, umbilicus, epigastrium or scar, with a cough impulse
- Dull ache or dragging discomfort, worse at the end of the day or with heavy lifting
- Scrotal swelling in an indirect inguinal hernia
- Usually reducible: the contents return spontaneously or with gentle pressure, often with a gurgling sound