protrusion of part or whole of organ/tissue through wall of cavity that normally contains it

Inguinal Canal anatomy

Hesselbach’s triangle

Many incisional hernias remain asymptomatic life-long; 6-15% of them will incarcerate and 2% will progress to strangulation.

Irreducible/incarcerated: cannot return contents to original cavity

obstruction: bowel lumen is obstructed

strangulation: compression → compromised supply → ischemia. Pain out of proportion.

Types

• Hiatus: through oesophageal hiatus. typically stomach. typically asymptomatic, sometimes epigastric pain, hiccups, vomiting, swallowing difficulties. can do scope. manage as GORD.
• Inguinal:
  • Direct: direct through wall (Hesslebachs triangle: Lateral border - inf epigastric vessels, inferior border - inguinal ligament, medial border - rectus abdominis). Older deconditioned males with lifting
  • indirect: MOST COMMON. Enters the inguinal canal via the deep inguinal ring. Young males, congenital (processus vaginalus fails to obliterate)
• Femoral: infero-lateral to the pubic tubercle (and medial to the femoral pulse). old ladies. symptomatic, strangulating, often emergency. Unlikely to be reducible.
• Incisional: herniation through incision.
• epigastric: through linea alba in upper abdomen.
• umbilical/paraumbilical: common. defect in abdominal wall. progresses over time, may eventually contain bowel and strangulate.
• spigelian: rare. Arcuate line of semilunaris. lower lateral rectus abdominis lump. High risk strangulation.