Abdominal wall hernias

Definition :protrusion of intestine or other tissue through a weakness or gap

in the abdominal wall

Signs and symptoms

Hernias may be detected on routine physical examination, or patients with

hernias may present because of a complication associated with the hernia.

Characteristics of asymptomatic hernias are as follows:

 Swelling or fullness at the hernia site
 Aching sensation (radiates into the area of the hernia)
 No true pain or tenderness upon examination
 Enlarges with increasing intra-abdominal pressure and/or standing

Characteristics of incarcerated hernias are as follows:

 Painful enlargement of a previous hernia or defect
 Cannot be manipulated (either spontaneously or manually) through the
fascial defect
 Nausea, vomiting, and symptoms of bowel obstruction (possible)

Characteristics of strangulated hernias are as follows:

 Patients have symptoms of an incarcerated hernia
 Systemic toxicity secondary to ischemic bowel is possible
 Strangulation is probable if pain and tenderness of an incarcerated hernia
persist after reduction
 Suspect an alternative diagnosis in patients who have a substantial
amount of pain without evidence of incarceration or strangulation

Laboratory studies include the following:

 Stain or culture of nodal tissue
 Complete blood count (CBC)
 Electrolytes, blood urea nitrogen (BUN), and creatinine
 Urinalysis
 Lactate
Imaging studies are not required in the normal workup of a hernia.
However, they may be useful in certain scenarios, as follows:
 Ultrasonography can be used in differentiating masses in the groin or
abdominal wall or in differentiating testicular sources of swelling
 If an incarcerated or strangulated hernia is suspected, upright chest films
or flat and upright abdominal films may be obtained
Computed tomography (CT) or ultrasonography may be necessary if a good
examination cannot be obtained, because of the patient’s body habitus, or in
order to diagnose a spigelian or obturator hernia

Management

Nonoperative therapeutic measures include the following:

① Trusses

② Binders or corsets

③ Hernia reduction

④ Topical therapy

⑤ Compression dressings

Surgical options depend on type and location of hernia