This document discusses different types of hernias including common hernias like inguinal, umbilical, femoral, and incisional hernias as well as rare hernias. It covers the anatomy, causes, signs and symptoms, and treatment options for various hernias. The most common hernia is the inguinal hernia. Treatment is generally surgical though some hernias can be managed conservatively with a truss. Strangulated hernias require emergency surgery.
10. Irreducible Hernia
• Due to
– Adhesions
– Narrowing of neck
– Incarceration
– Massive hernia inside scrotum
11. Obstructed Hernia
• Irreducibility + Intestinal obstruction
• Features
– No cough impulse
– Irreducible
– Painless
– Non tender
– Features of intestinal obstruction
12. Strangulated Hernia
• Blood supply of its contents impaired
• Intestinal obstruction ±
• Pathology
– Intestinal obstruction
– Dilation of hernial contents
– Impairment of venous return
– Stasis --------- Arterial impairment
13. • Appearance
– Congested and bright red
– Ecchymosis
– Extravasation of blood into lumen/ sac
– loss of tone
– Translocation of gut bacteria – peritonitis/ sepsis
– Gangrene
21. Inguinal canal
•
•
•
•
Triangular slit 3.75 cm long
Above the inner half of inguinal ligament
Deep to superficial inguinal ring
Developed due to the descent of testis in
embryonic life
22. Deep Inguinal Ring
•
•
•
•
Opening in the fascia transversalis
1.25 cm above mid inguinal point
Medially – inferior epigastric artery
Spermatic cord in males; round ligament in
females
23. Superficial Inguinal Ring
• Aponeurosis of external oblique – crurae
• Above and lateral to pubic crest
• Spermatic cord/ round ligament and illioinguinal nerves
24. • Anteriorly – skin, fascia, EO
aponeurosis, lateral third – IO aponeurosis
• Posteriorly – transversalis fascia, medial ½ conjoint tendon
• Above – transversus abdominins and internal
oblique fibres
• Below – inguinal ligamnet
25. Contents
• Illioinguinal nerves
• Spermatic cord
– Vas defrens
– Testicular artery, art to vas defrens, cremasteric
– Pampiniform plexus of veins
– Lymph vessels
– Testicular plexus of sympathetic nerves, genital
branch of genitofemoral
26. Hassenbach’s Triangle
•
•
•
•
•
•
Site of direct hernia
Medially – lateral border rectus abdominis
Laterally – inferior epigastric vessel
Inferiorly – inguinal ligament
Floor – fascia transversalis
Umbilical fold – obliterated umbilical artery
27. Mechanisms for preventing hernia
•
•
•
•
•
Obliquity of inguinal canal
Shutter mechanism of fibres of IO, TA
Sphincter action of TA, IO at deep inguinal ring
Ball valve action of cremasteric
Fibres of internal oblique over deep inguinal
ring
• Conjoint tendon
28.
29. INDIRECT INGUINAL HERNIA
•
•
•
•
More common
Young individuals
More common on the right side
On basis of extent
– Bubonocele
– Funicular hernia
– Complete hernia
30. • Coverings
– Peritoneum
– Extraperitoneal fat
– Internal spermatic fascia
– Cremasteric fascia
– External spermatic fascia
– Superficial fascia
– skin
31. DIRECT INGUINAL HERNIA
•
•
•
•
Directly through the hasselbach’s triangle
Acquired (ex- Oglive hernia)
More common in elderly, malgaigne bulgings
Rarely gets strangulated
37. Conservative management :
No Treatment
• Indications
– Severe ill health
– Short life expectency
– Refuse operation
38. Conservative management : Truss
• Indications
– Refuse operation
– Old patients with severe co morbidities
– Children ( c/I – undescended testis)
• Contraindications
–
–
–
–
–
Irreducible hernia
Undescended testis
Chronic bronchitits, strenous labour
Associated with large hydrocele
Not intelligent enough to position properly
39. • Dangers
– Pressure atropht of muscles of inguinal region
– Ostruction or strangulation
– Used with partially reduced hernia – may cause
trauma
– Improper cleanliness – unhealthy skin
– Adhesions between sac and canal
– Chance of strangulation remains
40. Operative treatment
• Herniotomy
– Neck of sac transfixed, ligated and excised
– Infants and children; young men with good
musculature
• Herniorrhaphy
– Herniotomy + repair of postrior wall
– Indirect hernias
– Adults with good muscle tone
43. Treatment of Strangulated Hernia
• Emergency surgery
• Resuscitation
• Reduction of hernia
– Foot end elevation
– Ice pack
– NG, IV fluids
– Analgesia, antibiotic
44. • Assess viability
– Green/ black color
– Flaccid , lustureless appearance
– No peristalssis
– Blood stained, foul smelling fluid in sac
• Bowel viable - HERNIORRHAPHY
45. • Bowel nonviable
– Linear patch of gangrene – invagination
– Loop of bowel – resection and anastomosis if gen
condition permits
– Bowel large intestine – exteriorisation
46. RECURRENT INGUINAL HERNIA
• Types of hernia
– Sliding
– Large/ long standing
– Large direct hernia
• Types of patients – chronic cough
• Inadequate preoperative preparation
47. RECURRENT INGUINAL HERNIA
• Operative faults
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–
–
–
–
Failure to ligate sac
Tension in repair
Use of absorbable sutures
Bleeding – infection
Fault in selection of operation
• Postoperative care
– Wound infection
– Lifting heaavy weights
– Persistence of predisposing factors
• Appearance of new hernia
51. Coverings of the sac of femoral hernia
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•
•
•
•
•
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Skin
Superficial fascia
Cribriform fascia
Anterior layer of femoral sheath
Fatty contents of femoral canal
Femoral septum
Peritoneum
53. • Symptoms
– Swelling
– Pain
– Systemic symptoms
•
•
•
•
Zeimenns technique
Invagination technique
Ring occlusion test
Position of swelling
54. Treatment
• No conservative management
• Surgery – herniorrhaphy
– High operation(McEvedy’s)
– Lottheissen’s
– Lockwood
55. UMBILICAL HERNIA
• Three major types
– Exomphalos
– Umbilical hernia in infants and children
– Paraumbilical hernia in adults
56. Exomphalos
• Minor
– Small sac
– Summit attached to the umbilical cord
– Treatment
• twisting of umbilical cord and strapping
57. Exomphalos
• Major
• Umbilical cord attached to inferior
aspect of swelling
• Contains intestines, liver
• Surgical emergency
• Immediate decompression and
reduction
58. Umbilical hernia in children and infants
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•
•
•
Weak umbilical scar following neonatal sepsis
Usually asymptomatic
90% cured within 12 – 18 months
> 18 months – surgery
59. Paraumbilical hernia of adults
• Supraumbilical or infraumbilical
• Adhesions - seldom reducible
• Predisposing factors –
– Women
– Obesity
– Repeated pregnancy
• Treatment – Mayo’s operation
60. EPIGASTRIC HERNIA
(Fatty Hernia of Linea Alba)
•
•
•
•
Through fibres of linea alba
Blood vessels pierce linea alba
Initially extraperitoneal fat only
M.c. – young muscular men with strenous
activity
• Usually irreducible, no cough impulse
• If symptomatic - surgery
63. Types of incisional hernia
• Type 1
– Upper abdomen/ midline lower abdomen
– Wide gap in musculature
– Low risk of strangulation
• Type 2
– Lateral part of abdomen
– Small defect
– Strangulation risk high
64. Treatment
• Prevention of incisional hernia
– Weight reduction
– Correct nutritional defects
– Treat chronic cough
– Careful closure of abdomen
– Prevent post op wound infection
67. Incisional lumbar hernia
• Renal surgery with post op infection
• Paralysis of lumbar muscles(phantom hernia)
• Treatment
– Primary hernia – herniorrhaphy
– Incisional hernia
68. OBTURATOR HERNIA
• Rare; old women
• Through obturator
foramen
• Thigh flexed, abducted and
externally rotated
• Referred pain to knee joint
• Strangulation - surgery
71. CONCLUSION
• Protrusion of a part or whole of viscus through
an abnormal opening in the wall of the cavity
that contains it
• Inguinal hernia most frequent
• Usual mode of treatment is surgical