Management of herniae
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
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Increase in intra-abdominal pressure, e.g. chronic cough, straining
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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.
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Lump often increases in size on coughing and straining.
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May be associated with pain or discomfort.
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Often decreases in size or disappears when relaxed or supine.
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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:
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Colicky abdominal pain
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Vomiting
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Constipation
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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
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Diagnosis is usually clinical.
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Herniography may be useful in the investigation of chronic groin/pelvic pain.
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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:
Further reading:
- ← Management of altered bowel habit
- Management of breast disease →