Hernias

• Hernia = An abnormal protrusion of an organ or tissue outside of the walls of the cavity that normally contain it
• The inguinal ligament is formed by the external oblique muscle
• The inguinal ligament goes from the ASIS to the pubic tubercle
• Hernia above inguinal ligament= inguinal hernia
• Hernia below inguinal ligament= femoral hernia

  Femoral hernia rare in males
• The inguinal ligament is at the level of L1

  Appendectomy can damage the ilio-inguinal nerve = weakened abdominal wall = increased risk of inguinal hernia
• The inguinal canal is a muscular canal above the medial section of the inguinal ligament

  Allows passage of structures between the abdominopelvic cavity and the scrotum/labia
• The inguinal canal has a deep ring and superficial ring

  ·       Deep ring is in the deep layer of abdominal tissue and becomes more superficial as it becomes the superficial ring
• Direct hernia:

  • Arise in the inguinal triangle - Hesselbach's triangle
  • Medial to the inferior epigastric artery
  • Due to a defect in the posterior wall of the canal
• Borders of inguinal triangle/Hesselbach's trangle:

  • Rectus abdominus
  • Inferior epigastric artery
  • inguinal ligament
• An indirect inguinal hernia is a hernia lateral to the inferior epigastric artery

  Have a tendency to enter the deep ring and travel down the inguinal canal

  More prone to complications such as strangulation
• The deep ring of the inguinal canal can be found by palpating the mid inguinal point

  The mid inguinal point is half way between the ASIS and pubic synthesis (not tubercle)
• Contents of the femoral triangle = femoral nerve, femoral artery and femoral vein
• Femoral artery and vein are wrapped in femoral sheet which forms a femoral canal

  Femoral canal is a blind ending canal with narrow neck so hernias get stuck easily
• Femoral hernia:

  • More common in females
  • Old age and obesity are biggest risk factor