HERNIA

Dr Bwanga A.
 DEFINITION OF A HERNIA

• A hernia is a protrusion of a viscus or a part

of it out side its NORMAL BODY CAVITY OR
RESTRICTING SHEATH

 Protrusion may occur through –

 1.NATURAL PASSAGES i.e. femoral, inguinal, obturator canals and
oesophageal hiatus
 2. WEAKENED MUSCLES AND SHEATHS i.e. Direct inguinal hernia,
incisional hernia
 3. CONGENITAL DEVELOPMENTAL DEFECTS i.e. Congenital inguinal
hernia, defect in diaphragm(diaphragmatic hernias)
ANATOMY OF AN ABDOMINAL HERNIA
Muscle / sheath
Sac
(peritoneum)

Fundus

Body- contents
Neck- unyielding
Mouth -
narrowest part –
entrance
(strangulation)
 CLASSIFICATION OF HERNIAS
• Internal ---protrusion within the body cavities
i.e. diaphragmatic hernias etc.

• External -- protrusion out side the body cavity

i.e. Inguinal, femoral, umbilical hernias etc.
EXTERNAL HERNIAS
 CONTENT OF ABDOMINAL HERNIA
• Omentum – omentocoele
• Small intestine - entrocoele
• Urinary bladder – cystocoele
• Part of intestinal wall – Richter’s hernia
• Loops of intestines – Maydl’s hernia
• Appendix / Mickel’s diverticulum- Littre’s
hernia
 PRESENTING FEATURES OF ABDOMINAL HERNIA

• Reducible
• Irreducible
• Obstructed
• Strangulated
• Recurrent
 CLINICAL DIAGNOSTIC FEATURES OF EXTERNAL HERNIA
• Site
• Expansile cough impulse
• Swelling
• Reducibility
• Bowel sounds

 IRREDUCIBLE HERNIA IS IMPENDING TO STRANGULATION

>> URGEMT OPERATION

 AETIOLOGY OF ABDOMINAL HERNIAS
• Congenital – patent processus vaginalis - 3% of newborns
males have inguinal hernias
• Increased intra- abdominal pressure i.e. Chronic cough,
chronic constipation, chronic difficulty in passing urine,
ascites, intra-abdominal tumours , etc.
• Old age– weakening and atonia of muscles and ligaments –
direct hernias
• Obesity -- weakens tissues
• Strenuous work – weight lifters, etc.
• Abdominal wound infection - incisional hernias
DIRECT AND INDIRECT INGUINAL HERNIA

Hesselbach’s
triangle
DIRECT AND INDIRECT INGUINAL HERNIAS

Internal
ring

Hernia through
the posterior wall
into the inguinal
canal
DIRECT INGUINAL HERNIA

Direct
 FEMORAL HERNIA

Hernia below
inguinal ligament
and lateral to
pubic tubercle
Inguinal
ligament
 TYPES OF INGUINAL HERNIAS

• Bubonocoele – hernia does not extent beyond external

inguinal ring (within the inguinal canal)

• Funicular – hernia extents beyond external inguinal ring

• Complete or scrotal – hernia extends and is within the

scrotum
 INTERNAL (DEEP) RING OCCLUSION TEST TO
DIFFERENTIATE DIRECT FROM INDIRECT
INGUINAL HERNIA

• demonstration
 INGUINO-SCROTAL SWELLING
a hernia or a hydrocoele?
REACHING ABOVE THE SWELLING TEST
Reaching above the swelling test to
differentiate hernia from hydrocoele
Umbilical hernias
Para-umbilical hernia
INGUINAL HERNIA IN FEMALE

ANT. SUP. ILAC

SPINE

INGUINAL
LIGAMENT
ABOVE INGUINAL LIGAMENT
PUBIC TUBERCLE MEDIAL TO PUBIC TUBERCLE