THEME I: ANTERIOR ABDOMINAL WALL HERNIAS
1. What is the definition of “Hernia”?
➥ A Hernia is a protrusion of a viscus or other structure beyond the normal coverings of the cavity in which it is contained
Contents of hernia sac
- Omentum – omentocele- difficult to reduce the later part, initial part may reduce easily.
- Intestine – enterocele
- Two loops of intestine in a manner of W -Maydl's hernia
- Appendix – may become adherent and rarely acute appendicitis occur.
- Meckel's diverticulum– litter's hernia
- urinary bladder-cystocele or as sliding hernia when it forms part of the wall.
- Adnexia
- Fluid – from congested bowel or omentum
2. Which are the elements of Hernia?
- Sac
- Contents
- Neck
Indications for TAXIS-
time limit of 2-4hrs in children 2-3 hrs in adults from onset of strangulation. Only in high risk patients eg. elderly patients, patients w too many severe comorbidities.
TAXIS procedure- patient lying grab hernia sack w one hand and with other hand push back hernia content thru internal inguinal ring. Be careful cause too much pressure could lead to perforation.
3. Which are the complications of Hernia?
- Incarceration
- Intestinal obstructions
- Strangulation
4. What does the term “taxis” mean?
➥ Taxis is non-operative treatment of intestinal obstruction = manual reposition
5. What is the definition of “Strangulated Hernia”?
➥ An irreducible hernia with ischaemic or necrotic contents
6. What is the definition of “recurrent Hernia”?
➥ A Hernia recurring after previous hernia repair
7. Which are the types of abdominal wall Hernias?
- Groin (inguinal, femoral)
- Umbilical
- Epigastric
- Spigelian
- Incisional hernias
- The ilioinguinal nerve does not enter through the deep ring — it enters the canal midway, then exits through the superficial ring.
- Indirect inguinal hernias enter via the deep ring and may pass through the entire canal to the scrotum/labia.
- Direct hernias protrude through the posterior wall of the canal (medial to deep ring), and only exit via the superficial ring.
8. What is the anatomy of Inguinal canal?
The walls
1. Anterior wall - made of aponeurosis of the external oblique (and its reinforced by internal oblique muscle laterally)
2. Posterior wall - Transversalis fascia
3. Roof/ superior wall - arching fibres of Internal oblique and transverse abdominis muscle
4. Floor/ inferior wall - In rolled edge of the Inguinal ligament (It is thickened by lacunar ligament)
Rings
Internal inguinal ring
- Funiculus spermaticus (spermatic cord) – men
- Ligamentum teres uteri (round ligament of uterus ) – women