Abdominal Wall Hernia

A part of the intestine may protrude through a weak area or an opening in the wall of the abdomen resulting in an abdominal wall hernia.

  • The bulge may be prominent but may not cause any discomfort or pain.
  • The doctor may diagnose the hernia by a physical examination and it is confirmed by a CT scan or an ultrasound scan of the abdomen.
  • Surgical repair of the hernia is the main treatment.

Abdominal wall hernias are a common occurrence; found more often in men than in women. In the United States alone, seven hundred thousand surgeries take place every year for the repair of hernias.

The thick wall of the abdomen is usually tough enough to keep the intestines from bulging out but some weak areas may have resulted from previous surgeries or injuries. Physical strain like lifting of heavy loads may aggravate an existing hernia, but such activities are not considered a reason for the development of hernias.

Abdominal wall hernias are named according to their location.

Inguinal Hernia: they are common hernias in men. The intestine protruding into the scrotum or the groin area through a weakness in the lower part of the abdominal wall results in inguinal hernia. Depending on their exact location they can be called either direct or indirect hernia.

Umbilical Hernia: these hernias are a common occurrence in babies. The intestine bulges out through the umbilicus or navel. Many newborn babies have this condition due to the incomplete closure of the blood vessel which was supplying to the umbilical cord. Eventually, the bulge will disappear as the opening closes. If the hernia persists in young children, it is checked periodically to see if the opening will close naturally. During pregnancy, a woman may notice umbilical hernia. A condition called ascites caused by fluid accumulation in the abdomen and obesity are reasons for the development of umbilical hernia in adults.

Femoral Hernia: This hernia is found more often in women. It occurs in the thigh, just below the line of the groin, at the place where femoral artery and vein are diverted into the leg.

Incisional Hernia:  Theses hernias occur in people with a history of abdominal surgery. The hernia usually develops through the weak abdominal opening, sometimes even a long time after the surgery.

Incarceration and Strangulation:  When a portion of the intestine gets stuck in the opening of the abdominal wall, it can cause obstruction in the intestine. It is called incarceration. When the blood supply to the intestine is obstructed it may cause strangulation, which often leads to gangrene in a few hours of time. It can become very serious if there is a rupture causing inflammation and infection in the abdomen. If peritonitis develops, it can lead to shock and eventually death.

Sports Hernia: It is not a typical hernia where the intestine protrudes through the abdominal wall. It got the name hernia because this sports injury usually occurs in the typical location of the inguinal hernia. A muscle tear, or a tear of the ligaments or tendons at the place where they join the pubic bone, is the usual cause of sports hernia.

Symptoms

A bulge or protrusion may be the only symptom of an abdominal wall hernia. Hernia may be felt at all times, or only when a person strains, as in lifting weights or coughing. The person may be able to push back the hernia without any difficulty such as pain or discomfort. But if the hernia is incarcerated, it cannot be pushed back easily. Still, there may not be any pain or discomfort from an incarcerated hernia. On the other hand, if the hernia is strangulated, pain may be felt which steadily increases. Other symptoms such as nausea and vomiting also may be present. It is not possible to push back a strangulated hernia and immediate medical intervention is necessary to avoid complications such as gangrene.

Diagnosis

A physical examination is the usual basis of diagnosis. However, other abnormal conditions such as an undescended testes or swollen lymph nodes in the groin area may be mistaken as a hernia.  A swollen vein in the scrotum called varicocele or an accumulation of sperms in the epididymus called spermatocele are other conditions resembling an inguinal hernia. Additional imaging tests such as a CT scan or an ultra sound scan may be done to confirm the diagnosis.

Treatment

No treatment is required for the umbilical hernias found in new born babies. Usually strangulations do not take place and the hernias resolve in a few years time. If the hernia is too large for comfort, surgical repair may be done after the child has become two years old.

Hernias other than the umbilical hernia in children are surgically repaired as soon as they are confirmed, to avoid complications later on. The surgery is often elective, scheduled for the convenience of the patient, except in the cases of strangulated or incarcerated hernias which require emergency surgery. During the surgery, the opening in the abdominal wall is tightly closed so that the intestines cannot bulge out.

Umbilical hernias usually need no treatment as they resolve by themselves. But for other type of hernias, temporary measures like holding them fast with bandages and tapes do not serve in healing the condition. As long as the openings remain, the chances of strangulation are very high. It is always recommended that the hernia is surgically repaired for lasting results.

INGUINAL HERNIA

A portion of the intestine bulging out through the wall of the abdomen, near the groin area is called inguinal Hernia.

The opening through which the inguinal hernia protrudes may have been there from the time of birth or it may have developed much later. Through this opening the intestine may extend into the scrotal sac or into the groin area.

The bulge due to inguinal hernia is usually painless irrespective of whether it occurs in the groin or in the scrotum. It may have a tendency to enlarge on exertion. Even standing up will increase the bulge due to gravity while lying down will reduce it. If the hernia gets trapped in the opening on the wall, it will result in incarceration which is a serious medical condition. If the blood supply to the intestine is compromised, it will cause the dangerous condition called strangulation which leads to the development of gangrene.

When diagnosed in women, the inguinal hernias are repaired as soon as possible. But in men the surgical repair is done only when symptoms of incarceration develop. Emergency surgery may be necessary in case the hernia becomes incarcerated or strangulated because of the risk of gangrene developing in a few hours time. However, if the hernia is not causing any discomfort or other symptoms surgery is elective. But since there is no other treatment available for abdominal wall hernias, sooner or later surgery may be required.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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