INCISIONAL HERNIA

1) An abdominal incisional hernia is a hernia through an acquired

scar in the abdominal wall, caused by a previous surgical
operation or injury.
2) Scar tissue is inelastic and stretches progressively if subjected
to constant stress.
History
1) Patients usually remember the operation or wound that
caused the scar, but may not recall any complications in the
original wound such as a haematoma or infection, which
weakened it and made it more susceptible to the development
of a hernia.
2) There may be a history of factors likely to weaken the
abdominal musculature, such as chronic cough, obesity or
steroid therapy.
3) Age: Incisional hernias occur at all ages but are more
common in the elderly.
4) Symptoms: The commonest symptoms are a lump and pain.
Intestinal obstruction can occur, causing distension, colic,
vomiting, constipation and severe pain in the lump.
Examination
1) The common findings are a lump with an expansile cough
impulse, beneath an old scar.
2) The defect in the abdominal wall may be palpable.
3) Incisional hernia are not infrequently irreducible, the defect
being plugged with adherent omentum.
4) If the lump does not reduce and does not have a cough
impulse, it may not be a hernia, but rather a deposit of
tumour, a chronic abscess or haematoma, or a foreign-body
granuloma. All these lesions, except recurrent tumour, appear
shortly after the initial surgery.
5) Incisional herniae usually appear in the first year after
surgery but may develop many years later.
6) The local tissues may be thin and weak because of local
damage or general cachexia.