The classical surgical definition of a hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
Risk factors for abdominal wall hernias include:
Features
Types of abdominal wall hernias:
| Type of hernia | Details |
|---|---|
| Inguinal hernia | Inguinal hernias account for 75% of abdominal wall hernias. Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia. |
| Above and medial to pubic tubercle | |
| Strangulation is rare | |
| Femoral hernia | Below and lateral to the pubic tubercle |
| More common in women, particularly multiparous ones | |
| High risk of obstruction and strangulation | |
| Surgical repair is required | |
| Umbilical hernia | Symmetrical bulge under the umbilicus |
| Paraumbilical hernia | Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus |
| Epigastric hernia | Lump in the midline between umbilicus and the xiphisternum |
| Risk factors include extensive physical training or coughing (from lung diseases), obesity | |
| Incisional hernia | May occur in up to 10% of abdominal operations |
| Spigelian hernia | Also known as lateral ventral hernia |
| Rare and seen in older patients | |
| A hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally) | |
| Obturator hernia | A hernia which passes through the obturator foramen. More common in females and typical presents with bowel obstruction |
| Richter hernia | A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect |
| Richter's hernia can present with strangulation without symptoms of obstruction |
Abdominal wall hernias in children:
| Type of hernia | Details |
|---|---|
| Congenital inguinal hernia | Indirect hernias resulting from a patent processus vaginalis |
| Occur in around 1% of term babies. More common in premature babies and boys60% are right sided, 10% are bilaterally | |
| Should be surgically repaired soon after diagnosis as at risk of incarceration | |
| Infantile umbilical hernia | Symmetrical bulge under the umbilicus |
| More common in premature and Afro-Caribbean babies | |
| The vast majority resolve without intervention before the age of 4-5 years | |
| Complications are rare |