Abdominal hernia is a designation for protrusion of peritoneum, which is a membrane lining the inside of abdominal cavity. Hernias may be internal (inner) and external (outer). In this article we are interested in outer hernias that protrude as a sac out of the abdominal cavity through a weak spot in abdominal wall. This type of hernia is one of the most frequently operated conditions.
A hernia usually occurs at the spot, where abdominal wall is weakened. In some places such attenuations are naturally present like in middle line of the abdomen or in inguinal canals. The weakening of the abdominal wall can also be found in scars after abdominal surgery, where hernias occur relatively frequently.
Not only weakening of the abdominal is needed for a hernia formation. Other factors often contribute and the main increased intra-abdominal pressure is probably the most important of them all. It is logical – high pressure makes peritoneal protrusion more likely. The situations associated with increased intra-abdominal pressure include lifting of heavy objects, chronic cough, chronic constipation, etc. Lack of exercise and atrophic abdominal musculature also plays a certain role.
Hernial pouch covered by peritoneum is usually empty. It can, however, contain some of abdominal organs, most typically an intestinal loop. That is the source of potentially serious complications.
Schema - hernial sac with intestinal loop
A hernia is mostly perceived as a palpable painless sac-like subcutaneous structure. When it is located in midline of the abdomen, we call it abdominal hernia, when it is in the groin; we describe it as inguinal hernia. Sometimes the hernia sac can descend from inguinal area under the skin of upper thigh (femoral hernia). Inguinal hernia in men can also reach the scrotum and deform its shape. A hernia temporary enlarges when coughing (increase in intra-abdominal pressure). When we are able to push hernia back towards the abdominal cavity we refer as to reducible hernia and this is not possible, we call it non-reducible.
Hernia incarceration is probably the most dreaded complications. In such case the intestinal loop in hernia sac strangulates and looses blood supply. It is a classic example of is intestinal obstruction (more precisely strangulation mechanical ileus) with all its symptoms – abdominal pain and vomiting. The skin over the hernia sac is reddish and hernia becomes very painful when palpated. Without a surgical treatment, this condition could be easily fatal.
Scrotal hernia can threaten a man’s fertility. Testicle in scrotum need lower temperature to function properly and create sperm. The temperature in intraabdominal cavity is higher and scrotal hernia brings this temperature to close vicinity of testicles. In short term it disrupts viable sperm creation but when chronic it can irreversibly damage testicle tissue and cause sterility.
Suspected hernia falls within the competence of a surgeon, who physically examines the patient thoroughly and determines the type and extent of present hernia. The surgeon also evaluates further approach.
Hernias are treatable by surgery. Regardless of the type of hernia we can generally say that the surgery is performed in general anesthesia. The hernial sac is located and reduced back to abdominal cavity. Consequently, it is necessary to prevent a hernia recurrence. This may be done by sewing some anatomical structures to strengthen the abdominal wall or to place a special net to the area of hernia formation that prevents recurrent protrusion of peritoneum.