Abdominal Wall Defects and Protrusion

Types of Abdominal Wall Hernias

Several types exist, categorized by location. Inguinal hernias are common in the groin area, affecting either the direct or indirect inguinal canal. Femoral hernias occur below the inguinal ligament, in the femoral canal. Umbilical hernias protrude through the umbilicus (belly button), while incisional hernias develop at the site of a previous surgical incision. Hiatal hernias involve the stomach protruding through the diaphragm into the chest cavity.

Clinical Presentation

Presentation varies depending on hernia type and size. Symptoms can range from asymptomatic to significant discomfort. A bulge or lump may be visible or palpable, often increasing in size with straining or coughing. Pain, especially with larger hernias or strangulation, is a common complaint. Nausea and vomiting may occur if bowel obstruction is present.

Physical Examination

A physical examination is crucial for diagnosis. The physician will palpate the affected area to assess the size, location, and reducibility (ability to push the contents back into the abdominal cavity) of the bulge. Auscultation (listening with a stethoscope) may reveal bowel sounds within the hernia sac, indicating bowel involvement.

Imaging Techniques

Imaging studies such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to confirm the diagnosis, determine the hernia's contents, and assess for complications such as strangulation or incarceration (irreducible hernia).

Complications

Potential complications include incarceration, where the hernia contents become trapped and cannot be reduced, and strangulation, which involves compromised blood supply to the incarcerated contents, leading to tissue death. Both conditions require immediate surgical intervention.

Treatment Options

Treatment options range from watchful waiting (for asymptomatic, small hernias) to surgical repair. Surgical repair techniques vary depending on the type and complexity of the hernia, and may involve open or laparoscopic approaches, using mesh reinforcement to prevent recurrence.