HERNIA

The varieties of hernia can be differentiated as to time, location causation, contents and
reducibility. Unfortunately, there is no simpler way to discuss the subject.
A hernia (rupture) is an abnormal protrusion of aviscus and its sac through the walls of the
cavity that it normally occupies. Prolapse also refers the escape of a viscus through an anatomic
opening; however, the protruding part is not coveres by a sac.
CLASSIFICATIONS
1. As to time
A. Congenital, hernia that exists a birth
B. Acquired, one that develops after birth
2. As to location
A. External hernias protrude through the parietes, the underlying sac and its contens
being situated under the skin
B. Internal hernias lie within the abdomen (intersigmoid fossa, pericecal fossae,
foramen of Winslow, ect.).
C. Inguinal hernias involve the inguinal region.
D. Fermoral hernias traverse the femoral canal.
E. Miscellaneous locations such as ventral, obturator, lumbar, perinal, sciatic, vaginal,
pudendal and diaphragmatic.
F. Interstitial hernias are located between the layers of the abdominal wall
3. As to contents
A. Epiplocele contains omentum
B. Enterocele contains small intestine
C. Cystocele contains urinary bladder
D. Cecocele contains the cecum
E. Richter’s hernia contains only a part of the circumference of the bowel.
F. Little’s hernia as described by Alexis Littre: the hernial sac contains a Mickel’s
diverticulum
4. as to causation
A. traumatic
B. postpoliperative (incisional)
5. as to reducibility
A. reducible when the contens are returned the abdominal cavity, either spontaneously
or by manipulation (taxis)
 B. Irreducible when the contens cannot be returned the abdomen.
ETIOLOGY
Hernias occur commonly during infancy and betweeb the ages of 15 and 50.
Umbilical hernias of childhood are seen equally in the sexes but after middle life
are more frequent in females. Heredity of plays a part in that there is a history of
similar herniations in about 25 per cent of the cases.
Those specific hernias which are considered most important anda most common
will be discussed:
- Inguinal
- Sliding
- Femoral
- Ventral :
a. Median
b. Lateral
c. Incisional
- Internal

INGUINAL HERNIA
These hernias constitute about 85 per cent of all hernias. They are more common in
men then women because the descent of the testicle makes the inguinal canal larger and more
vulnerable. Hernias occur more frequently on the right side, probably because of the later
descent of the right testicle. Inguinal hernias may be of 2 types: indirect and direct. They should
be considered as entirely dofferent conditions and will be discussed as such.
1. Indirect inguinal hernia
This has been referred to as an oblique or lateral inguinal hernia.
Indirect inguinal hernia is an embryologic hernia, since it is related to ther descent of
gonad. Therefore, this type of hernia follows the course of the spermatic cord sd far as
the scrotum, or the round ligament into the labium majus. As the hernia leaves the
internal abdominal inguinal canal and emerges at the external (subcutaneous) inguinal
ring.
As the testicle descends it pushes together the 2 leaves of peritonium which extend
downward toward the scrotum. If descent of the testicle fails, the peritoneal
prolongation remains open. Therefore, in every case of undescended testicle there must
be an associated indirect inguinal hernia. The peritoneal layers which form the vaginal
process may not fuse firmly despite the normal descent of the testicle; a potential
embryologic weakness then exist, and a hernia may develop.
If such hernia is present at birth it is referred to as congenital; if it develops after birth
it cannot be called congenitalm however, it is nevertheless embryologic.
Age plays an important role in the diagnosis, because an indirect inguinal hernia appears
in younger individuals. These hernia are seen more frequently before middle life.
The hernia (slow to appear) does not immediately “pop out” when the patient stands.
The patient states that it usually reduces itself slowly or disappears while he is asleep.
This is explained by the fact that this type of hernia has to find its way gradually though
the small internal inguinal ring. The smallness of the ring also explaines the need
reduction (taxis).