Hernias PDF

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Some hernias discussed by clinical lecturers...

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SPIGELIAN HERNIA (Lateral ventral hernia) Sources:    

https://www.uptodate.com/contents/spigelian-hernias https://emedicine.medscape.com/article/189563-overview#a1 https://www.healthline.com/health/spigelian-hernia#causes https://www.amboss.com/us/knowledge/Abdominal_hernias

= Herniation of intra-abdominal contents through the semilunar line below the arcuate line of rectus sheath (typically below the umbilicus) 1. Epidemiology  Rare (0.1-2% of ventral hernias)  Peak around 50 to 60 years old 2. Aetiology  The semilunar line is the lateral border of the rectus abdominis. The arcuate line is the inferior border of the posterior rectus sheath. Spigelian hernia typically occur at the junction of the semilunar line and the arcuate line as there is no posterior rectus sheath below this point

3. Classification  Ventral hernias 4. Clinical features  Pain and an ill-defined mass in the lower abdomen  Pain increases with contraction of the abdominal musculature

5. Diagnostics  Ultrasound or CT scan, which can demonstrate the abdominal wall defect or the hernia sac and its contents 6. Differential diagnoses  Diastasis recti: a > 2 cm separation of the right and left rectus abdominis muscle with resultant protrusion of abdominal organs on straining  In new-borns: omphalocele, gastroschisis  Abdominal wall tumour (e.g., desmoid tumour)  Lipoma  Rectus sheath hematoma 7. Treatment  Repaired surgically because of the high risk of incarceration/obstruction  A transverse incision over the hernia to the sac allows dissection to the neck, and clean approximation of the internal oblique muscle and the transversus abdominis followed by closure of the external oblique aponeurosis completes the repair 8. Complications  Strangulation (symptoms include vomiting, nausea, severe abdominal pain)

HERNIA IN W (Madyl’s hernia) Sources:    

https://www.gpnotebook.co.uk/simplepage.cfm?ID=1738145802 https://radiopaedia.org/articles/maydl-hernia-1 https://www.slideshare.net/jibranmohsin/etymology-of-hernia https://www.ajol.info/index.php/aas/article/viewFile/139443/129141

= hernial sac contains 2 loops of bowel (afferent and efferent) with another loop of bowel being intra-abdominal 1. Epidemiology  Rare (0.5 to 1.92% of strangulated hernias)  More often seen in men  Predominantly on the right side (containing terminal ileum or caecum) 2. Aetiology  Loop of the bowel in the form of W lies in the hernial sac and the centre portion of the W loop may become strangulated, either alone or in combination with the bowel in the hernial sac

3. Classification 4. Clinical features  Intestinal obstruction  Tense, slightly tender, irreducible hernia above inguinal ligament 5. Diagnostics 6. Differential diagnoses 7. Treatment  the risk of a strangulated central intraabdominal loop being missed at surgery with inguinal approach. High index of suspicion, adequate surgical exposure is essential; therefore laparotomy is recommended 8. Complications  Strangulation and necrosis, which could result in peritonitis  Intervening intra-abdominal loop at risk of closed loop obstruction

SLIDING HIATAL HERNIA Sources: 

https://www.slideshare.net/UgochukwuAniedu/hiatal-hernia-59416819

= Herniation of both the stomach and the gastroesophageal junction into the thorax 1. Epidemiology  90% of oesophageal hernias 2. Aetiology

 3. Classification 4. Clinical features  Majority are asymptomatic  Larger hernias frequently associated with GORD due to decreased competence of the lower oesophageal sphincter (LES) 5. Diagnostics  CXR  Barium swallow  Endoscopy  Oesophageal manometry (to measure pressure of LES)  24-48 hr oesophageal pH monitoring to quantify reflux  Gastroscopy with biopsy TRO cancer and esophagitis

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 6. Differential diagnoses 7. Treatment  Lifestyle modification i. Stop smoking ii. Weight loss iii. Elevate head of bed iv. No meals...