Abdominal Wall Hernia

• Risk factors for Abdominal Wall Hernias are:

  • Increased Age
  • Obesity
  • Ascites
  • Surgical Wound
• Abdominal Wall Hernias present with:

  • Lump
  • Pain
  • Present Cough Impulse
• Epigastric Hernias occur in the Upper Abdominal Region, are often asymptomatic aside from a reducible lump.
• If Epigastric Hernias are symptomatic, they require surgical repair.
• The lump from Epigastric Hernias is located in the midline between the Umbilicus and Xiphisternum.
• Umbilical Hernias occur due to a defect at the Umbilical Cicatrix.

  Paraumbilical Hernias occur due to a defect adjacent to the Umbilicus.
• Umbilical and Paraumbilical Hernias contain pre-peritoneal fat and increase in size over time.
• Umbilical and Paraumbilical Hernias may present acutely with either strangulated or obstructed contents.
• A Spigelian Hernia occur at the level of the Arcuate Line at the Semi-Lunaris.

  They present with a small lump at the lower edge of the Rectus Abdominis Muscle.
• Spigelion Hernias should be repaired urgently, regardless of whether they are symptomatic or not.
• Obturator Hernias are Hernias of the Pelvic Floor, and occur through the Obturator Foraemen into the Obturator Canal.

  They are more common in women, and older patients.
• Obturator Hernias can present with a positive Howship-Romberg Sign due to compression of the Obturator Nerve.
• The Howship-Romberg Sign refers to Hip + Knee Pain which is exacerbated by thigh extension, medial rotation, and abduction.
• Obturator Hernias have a high risk of strangulation, and therefore should be repaired urgently.
• Richter's Hernia is a partial herniation of the Bowel through any Hernial Orifice, where only the anti-mesenteric border is involved.
• Richter's Hernia have a high risk of ischaemia, as there can be compromised blood supply.
• Patients with Richter's Hernia present with a tender and irreducible lump.

  Patients may present with symptoms of obstruction initially.
• Due to the risk of ischaemia, Richter's Hernias are a surgical emergency which should be managed urgently.
• Lumbar Hernias are rare, posterior Hernias.

  They can occur spontaneously, or may result from iatrogenic causes.
• A common Iatrogenic cause of Lumbar Hernias is open renal surgery.
• Lumbar Hernias present with a posterior lump which is often associate with back pain.