Write a Review
x
Feedback General Surgery

Other Hernias

Incisional Hernia

  • Hernias that develop at sites of previous abdominal incisions
  • Vertical incisions have a higher risk of hernia formation than horizontal incisions

Predisposing factors

  • Scar of emergency surgeries – e.g. peritonitis, acute abdomen
  • Poor nutritional status of patient
  • Presence of cough, tuberculosis, malignancy or immunosuppression
  • Increased intra-abdominal pressure – straining, ascites
  • Obesity

Type of defect

  • Small <2cm
  • Large >2cm
  • Very large
  • Massive/diffuse
  • Multiple defects – Swiss cheese pattern

Clinical features

  • Swelling
  • Pain
  • Impulse on coughing
  • Visible bowel peristalsis
  • Can eventually show features of irreducibility, obstruction and strangulation

Investigations

  • CXR
  • US abdomen

Treatment

  • Pre-operative management – weight loss, nutrition, management of diabetes, hypertension etc
  • Operative
    • Mesh repair – the mesh can be positioned in several places
      • Above the midline fascia (overlay), bridged across fascial defects (interlay), outer to peritoneum (sublay), under the peritoneum, directly over the content (underlay)
    • Laparoscopic mesh repair
    • Cattell’s operation – layer by layer closure

Spigelian Hernia

  • It is a type of lateral ventral hernia through the Spigelian fascia at any point along the semilunar line of Spigel
  • Semilunar line of Spigel is a line from the pubic tubercle to the tip of the 9th costal cartilage
    • It marks the lateral margin of the rectus sheath
  • Spigelian fascia is the area between the lateral border of the rectus muscle, composed of the aponeuroses of the external oblique, internal oblique and transverse abdominis muscle

Etiology

  • Congenital – associated with cryptorchidism
  • Acquired

Clinical features

  • Intermittent pain and lump
  • Symptoms of bowel obstruction
  • High risk of strangulation

Diagnosis

  • Ultrasound
  • CT

Treatment

  • Transverse incision herniotomy and closure of defect, followed by mesh

Petit’s and Grynfeltt Hernia

  • Hernia that protrudes through the lumbar triangle

There are two lumbar triangles

  • Inferior lumbar triangle of Petit
    • Borders – iliac crest, latissimus dorsi and external oblique muscle
    • A hernia in this triangle is Petit’s hernia
  • Superior lumbar triangle of Grynfeltt
    • Borders – quadratus lumborum, internal oblique and the 12th rib
    • A hernia in this triangle is Grynfeltt hernia

Etiology

  • Congenital – due to defects in the musculoskeletal system
  • Primary acquired – spontaneous, without an underlying factor e.g. surgery, infection, trauma
  • Secondary acquired – due to blunt, penetrating and crushing fractures

Clinical features

  • Posterolateral mass, back pain
  • Bowel obstruction
  • Urinary symtoms

Treatment

  • Surgical repair with mesh
Feedback