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DEFINITION OF HERNIA A hernia is a protrusion of an organ or structure through a defect in the mascular wall of the abdomen. Hernia are generally composed of the covering skin and subcuteneous tissues, a peritoneal sec, and the underlying viscera, such as loops of bowel or other internal organs. Hernia may be congenital,cause by structural closure defect, or acquired.
TYPES OF HERNIA • UMBILICAL HERNIA • INGUINAL HERNIA - Indirect inguinal hernia - Direct inguinal hernia • FEMORAL HERNIA • INCISIONAL HERNIA
Umbilical hernia • An umbilical hernia occurs when part of the intestine protrudes through an opening in the abdominal muscles. Umbilical hernias are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries, causing the baby's bellybutton protrude. This is a classic sign of an umbilical hernia. • Most umbilical hernias close on their own by age 1, though some take longer to heal. To prevent complications, umbilical hernias that don't disappear by age 4 or those that appear during adulthood may need surgical repair. • Umbilical hernia is a common and typically harmless condition
Cause • During pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just before birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life. • In adults, too much abdominal pressure can cause an umbilical hernia. Possible causes in adults include: • Obesity • Heavy lifting • A long history of coughing • Multiple pregnancies • Fluid in the abdominal cavity (ascites)
Symptoms • Soft swelling or bulge near the navel (umbilicus). • The bulge may range from less than 1/2 inch to about 2 inches (about 1 to 5 centimeters) in diameter. • Baby will crying because pain • The baby begins to vomit • The bulge becomes tender, swollen or discolored
Inguinal hernia • An inguinal hernia is a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower abdominal muscles. An inguinal hernia occurs in the groin—the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. • An inguinal hernia appears as a bulge on one or both sides of the groin. An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females. Inguinal hernias tend to become larger with time.
An inguinal hernia showing the small intestine descending through the inguinal canal.
Cause • The two types of inguinal hernia have different causes. Indirect inguinal herniaIndirect inguinal hernias are congenital hernias and are much more common in males than females because of the way males develop in the womb. In a male fetus, the spermatic cord and both testicles—starting from an intra-abdominal location—normally descend through the inguinal canal into the scrotum, the sac that holds the testicles • Sometimes the entrance of the inguinal canal at the inguinal ring does not close as it should just after birth, leaving a weakness in the abdominal wall. Fat or part of the small intestine slides through the weakness into the inguinal canal, causing a hernia. In females, an indirect inguinal hernia is caused by the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall. • Indirect hernias are the most common type of inguinal hernia. Premature infants are especially at risk for indirect inguinal hernias because there is less time for the inguinal canal to close.
Direct inguinal herniaDirect inguinal hernias are caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through the weak muscles into the groin. A direct hernia develops gradually because of continuous stress on the muscles. One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia: • sudden twists, pulls, or muscle strains • lifting heavy objects • straining on the toilet because of constipation • weight gain • chronic coughing Indirect and direct inguinal hernias usually slide back and forth spontaneously through the inguinal canal and can often be moved back into the abdomen with gentle massage.
Symptoms • Symptoms of inguinal hernia include • a small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum • discomfort or sharp pain—especially when straining, lifting, or exercising—that improves when resting • a feeling of weakness or pressure in the groin • a burning, gurgling, or aching feeling at the bulge
Femoral hernia • A femoral hernia is a bluge in the upper part of the thigh near the groin. • A hernia occurs when the contents of the abdomen (usually part of the small intestine) push through a weak point or tear the thin muscular wall of the abdomen, which holds the abdominal organs in place. Cause • Most of the time, there is no clear cause of a hernia. Some hernias may be present at birth (congenital), but are not noticed until later in life. • Some factors that contribute to the development of a hernia include: • Chronic constipation • Chronic cough • Heavy lifting • Obesity • Straining to urinate because of an enlarged prostate • Femoral hernias tend to occur more often in women than in men.
Symptoms • You may see a bulge in the upper thigh next to the groin. • Most femoral hernias cause no symptoms. There may be some groin discomfort that is worse when you stand, lift heavy objects, or strain. • Sometimes, the first symptoms are abdominal pain, nausea, and vomiting. This may mean that the intestine is blocked, which is an emergency.
Incisional/ventral hernia • A hernia is the protrusion of an organ through the wall that normally contains it. An incisional hernia occurs in the abdomen in the area of an old surgical scar. A part of an organ in the abdomen, such as the bowel or intestines, protrudes through the weakened area of the abdominal wall. Cause • incisional hernias are caused by thinning or stretching of scar tissue that forms after surgery. This weakened scar tissue then creates a weakness in the abdominal wall. • Excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing causes the scar tissue to thin or stretch. Because the abdominal wall is weak, the hernia occurs during abdominal strain.
Symptoms • An incisional hernia causes a bulge in the abdominal area. This type of hernia is often painless, but may be tender and can cause discomfort during any type of physical strain, such as lifting or coughing. The bulge may disappear when the patient is lying down, and be more visible when standing up. A hernia can often be pushed gently back into place. • This is called a reducible hernia. When a hernia cannot be pushed back into place, it means a piece of the organ has become trapped, or incarcerated. Symptoms include pain, nausea, vomiting, inability to have a bowel movement, and a bulge that remains even when lying down. • When a portion of an organ is incarcerated, its blood supply can be cut off, which means the organ’s tissue will die. This condition is called a strangulated hernia. Incisional hernias can increase in size with time.
MBBS - OCTOBER 1995-BHARATI VIDYAPEETH'S MEDICAL COLLEGE, PUNE, INDIA • FCPS (General Surgery) - SEPTEMBER 2000, MUMBAI, INDIA • (FELLOW OF COLLEGE OF PHYSICIANS AND SURGEONS) • DNB (General Surgery) - MAY 2001-KING EDWARD MEMORIAL HOSPITAL, PUNE, INDIA (DIPLOMATE OF NATIONAL BOARD, NEW DELHI) • MNAMS - MEMBER OF NATIONAL ACADEMY OF MEDICAL SCIENCES, NEW DELHI Contact Details: Laparoscopic Surgery Clinic, PariharChowk, Aundh, Pune, Maharashtra 411007Mobile : 91 +98 2200 94 90Email : email@example.com http://www.drsanjaykolte.in/