24/11/2025
A hernia is a protrusion of an organ or tissue through a defect in the cavity wall, commonly affecting the abdominal wall.
**Types of Hernia (Based on Location)**
1. **Inguinal Hernia**
- Most common type
- Indirect: Lateral to inferior epigastric vessels; congenital
- Direct: Medial to inferior epigastric vessels; usually acquired
- More common in men
2. **Femoral Hernia**
- Passes below inguinal ligament into femoral canal
- More common in women
- Higher risk of strangulation
3. **Umbilical Hernia**
- Protrusion at the umbilicus
- Common in infants and adults with increased intra-abdominal pressure
4. **Incisional Hernia**
- Occurs at previous surgical incision sites
- Risk factors: wound infection, poor healing, obesity
5. **Hiatal Hernia**
- Protrusion of stomach through esophageal hiatus
- Types: Sliding (most common), Paraesophageal
- May cause GERD symptoms
6. **Others**
- Epigastric, Spigelian, Obturator hernias (rare)
**Pathophysiology**
- Weakness in abdominal wall → increased intra-abdominal pressure allows tissue to protrude
- Types: reducible, irreducible/incarcerated, strangulated
**Risk Factors**
- Male gender (inguinal)
- Age > 50 years
- Obesity
- Chronic cough, constipation, heavy lifting
- Pregnancy
- Previous abdominal surgery
**Clinical Features**
- Swelling or bulge at hernia site
- Pain or discomfort, especially with exertion
- Signs of strangulation: severe pain, tenderness, nausea, vomiting
**Diagnosis**
- Clinical examination: Most hernias diagnosed by inspection and palpation
- Imaging: Ultrasound for abdominal wall hernias, CT scan for complex cases
**Management**
1. **Conservative**
- Observation for asymptomatic or small reducible hernias
- Supportive trusses or belts
2. **Surgical**
- Herniorrhaphy: Sutured repair
- Hernioplasty: Mesh repair
- Emergency surgery for incarcerated or strangulated hernia
3. **Lifestyle**
- Weight reduction, avoid heavy lifting, treat chronic cough or constipation
**Key Points**
- Hernias are structural defects with potential complications.
- Strangulation is a surgical emergency.
- Inguinal hernias are most common; femoral hernias have higher complication risks.
