WHAT IS HERNIA?

Hernia occurs when an organ or fatty tissue

squeezes through a weak spot in a surrounding
muscle or connective tissue called fascia.
 The most important types of hernias:

 Epigastric hernia
 Hernia in the midline of the upper abdomen
 Umbilical hernia
 Hernia in the navel region
 Incisional hernia
 Hernia in the vicinity of a scar left after a previous operation
 Inguinal hernia
 Hernia in the inguinal region
 Femoral hernia
 Special form of inguinal hernias descending to the thigh
 Parastomal hernia
 Hernia in the presence of an artificial intestinal outlet (stoma)
 Hiatal hernia
 Diaphragmatic hernia at the site where the oesophagus enters the abdomen
  
INGUINAL HERNIA IN ULTRASOUND

 The ultrasound examination of the inguinal

region was conducted using a 5-10 MHz linear
probe. The scan was performed with the patient
in the supine and erect positions, in a relaxed
state, as well as during coughing and during a
Valsalva maneuver. (100% ultrasound
sensitivity and 96.9% specificity).. Ultrasound is
capable of accurately diagnosing groin hernia
and this may justify its use in patients with
chronic groin pain due to a suspected occult
hernia.
 There are other signs and symptoms of
inguinal or groin type of hernia which may
include:
 Burning sensations.
 A heavy or fuller sensation in the groin region
is a symptom of inguinal or groin hernia.
 A sharp pain is also felt in the groin region in
this type of hernia
 Pain while coughing, bending or exercising.
 Swelling of the scrotum in men.
 FEMURAL HERNIA
 True-positive cases of femoral hernias have a
sonographic appearance of a hypoechoic sac
with speckled internal echoes. When
examining during the Valsalva maneuver, a
femoral hernia passes deep to the inguinal
ligament, expands the femoral canal,
displacing the normal canal fat, and effaces the
femoral vein.
 Femoral hernias typically present as a lump in the
groin area.
  
  
 This situation is considered as a medical emergency.
Some of the major symptoms of a femoral hernia are:
  
 Sudden groin pain
 Nausea
 Vomiting
 Major abdominal pain is a symptom of femoral
hernia.
 INCISIONAL HERNIA
 Sometimes a previous incision in the abdominal wall can lead to hernia. This
type of hernia is called Incisional hernia and this is one of the different types of
hernia. The incision which causes hernia would have been made to cure an
internal organ such as the appendix or a caesarian section. After the surgery
the doctor closes the layers of the stomach wall with stiches and this closure
sometimes comes apart, failing to heal the incision properly. It can also just
come apart with time.
 
 Some of the symptoms that show an incisional hernia are as follows:
 Bulging in the surgical area.
 Pain
 Fever
 Infection
 Swelling
 Aching
 Bowel obstruction, red streaks or redness is a major sign of incisional hernia.
 Foul-smelling drainage is another major symptom of incisional hernia.
 Visible protrusion is also seen in incisional hernia.
 Umbilical Hernia.

 Ultrasound features suggestive of bowel

strangulation within a hernia sac are:
thickening of the hernial sac. presence of
hyperechoic fat. ... dilated bowel within the sac
EPIGASTRIC HERNIA.

Shows a midline defect which is usually small

with or without herniation of
omental/properitoneal fat. Bowel or stomach
rarely herniates in an epigastric hernia unless there
is a large defect.
 Hiatal Hernia

 Ultrasound diagnosis of gastro esophageal

reflux and hiatal hernia in infants and young
children. Author information: ... Morphological
findings associated with significant reflux
were (1) a short intra-abdominal part of the
esophagus
 Small hiatal hernia does not have any signs or
symptoms whereas larger hiatal hernia can cause
signs and symptoms which are as follows:
  
 Belching is a sign of hiatal hernia,
 Feeling too full after regular meal,
 Heartburn,
 Difficulty in swallowing,
 Chest or stomach pain,
 Vomiting blood or passing black stools indicating
gastrointestinal bleeding is a major symptom of
hiatal hernia.
 Strangulated Hernia.

 The most difficult or dangerous complication of stomach

walls hernia are the strangulated hernia.
 Ultrasound features suggestive of bowel strangulation
within a hernia sac are:
 thickening of the hernial sac
 presence of hyperechoic fat
 fluid within the sac
 dilated bowel within the sac
 oedamatous thick bowel walls
 loss of peristalsis
  
  
 Ultrasound images of the para-umbilical hernia
showing loops of bowel within the hernia sac
with edematous bowel wall. 
 Small hyperechoic foci are compatible with
intraluminal gas rather than pneumatosis
intestinalis.
 
 Spigelian Hernia.
 Since spigelian hernias are difficult to diagnose due to
lack of unique symptoms and clinical features, it is
important to know the sonographic presentation.
Spigelian hernias are a rare type of lateral ventral hernia
that arises through a defect in the spigelian fascia within
the anterior abdominal wall.

 SYSTOMS
 Symptoms of a Spigelian hernia vary from person to
person and range from mild to severe. A common sign of
this hernia is a lump or bulge either below or to the side
of the belly button. The lump may feel soft to the touch.
Another symptom is constant or intermittent abdominal
pain.
 OBUTURATOR HERNIA

 Obturator hernia is defined as an abdominal wall hernia

protruded through the obturator canal, and usually consists
of a hernia sac containing small bowel. The entity is
relatively rare, but a significant cause of small bowel
obstruction, especially in thin, elderly females
  
 SYSTOM
 Obturator hernia is a diagnostic challenge because the signs
and symptoms are usually non-specific. The cardinal clinical
symptom is Acute Intestinal Obstruction. The clinical
course is usually manifested by acute small bowel
obstruction, pain on the medial aspect of thigh due to
compression of obturator nerve.
 VENTRAL HERNIA
 Ventral hernia is a situation in which a weak spot in the
stomach lets the tissue or an organ of the abdomen project
through a cavity muscle area. Ventral hernia is a type of
hernia that may or may not occur after an abdominal
operation
SYSTOM
 If you experience any of the following symptoms, make sure
to consult a doctor right away:
 mild discomfort in your abdominal area.
 pain in your abdomen.
 outward bulging of skin or tissues in your abdominal area.
 nausea.
 vomiting.
 Hernia Repair
 A hernia is when an internal part of your body,
such as an organ, pushes through a weakness
in the muscle or surrounding tissue wall.
Usually your muscles are strong and tight
enough to keep your intestines and organs in
place, but sometimes they aren’t, causing a
hernia.
 A hernia can occur anywhere in the abdomen region. Patients will normally
notice a lump, or discomfort, at the site of the hernia. The most common
types of hernia are:
 Inguinal hernia – when tissue (usually part of the intestines) pokes through
your lower abdomen.
 Femoral hernia – when tissue pokes through into your groin, or the top of
your inner thigh.
 Incisional hernia – when tissue pokes through a surgical wound or incision
that has not fully healed.
 Umbilical/Paraumbilical hernias – when tissue pokes through the part of the
abdomen directlty through or immediately around the navel (belly button)
 Epigastric Hernia- when tissue pokes through into the upper part of the
abdomen
 Spigelian herniaThis is a rare type of hernia that appears on the edge of one
of the rectus abdominis muscles (these muscles are described as the “six
pack” which are readily seen in athletic individuals) 4 or 5 cm below the
“belly button”.