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A hernia is the abnormal protrusion of the whole or part of a viscus, from its normal position, through an opening in the wall of its containing cavity.

 

Predisposing factors

  • Increase in intra-abdominal pressure, e.g. chronic cough, straining

  • Abdominal wall weakness, e.g. previous surgery, malnutrition

 

Presentation

A hernia usually presents as a lump at the appropriate anatomical site. In the history, enquire about the location, size, how it affects the patient etc.

  • Lump often increases in size on coughing and straining.

  • May be associated with pain or discomfort.

  • Often decreases in size or disappears when relaxed or supine.

  • On examination it may have positive cough impulse, and may be reducible.

 

A hernia may become irreducible (incarcerated) and bowel within it may become obstructed or strangulated (ischemic).

 

Patients with an obstructed hernia may present acutely with:

  • Colicky abdominal pain

  • Vomiting

  • Constipation

  • Or abdominal distension.

 

The hernia will be tense and irreducible. If it becomes strangulated, the pain will become constant, and the patient may develop a pyrexia, tachycardia and leukocytosis.

 

Investigation

  • Diagnosis is usually clinical.

  • Herniography may be useful in the investigation of chronic groin/pelvic pain.

  • Ultrasound, CT or MRI may be useful if a clinically occult hernia (e.g. spigelian or obturator hernia) is suspected.

 

Click on the links below to read more about the management of specific types of herniae:

Inguinal

Femoral

Incisional

Other


Further reading:


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