HERNIA

AND OTHER DIGESTIVE CONGENITAL DISEASE

HERNIA
abnormal protrusion of a structure through a
defect in the tissues that normally contain that
structure
chronic sequelaestable symptoms, and
progressive enlargement with or without
symptoms, or due to acute complication
Source: The Netter Collection. Icon Learning Systems.
Source: The Netter Collection. Icon Learning Systems.
Source: The Netter Collection. Icon Learning Systems.
INGUINAL CANAL
The inguinal canal is the passageway by which the spermatic
cord leaves the abdomen to reach the testis in the male, and
by which the round ligament of the uterus travels to the
labium majoris in the female.
Cremasteric muscle and fascia surround the spermatic cord,
containing the vas deferens, testicular veins (pampiniform
plexus), testicular lymphatic vessels, autonomic nerves, and
the genital branch of the genitofemoral nerve
DIRECT INGUINAL
HERNIA
Medial hernia
Hesselbachs triangle!!
Acquired in origin weakening of abdominal wall
Etiologic factors:
high intra-abdominal pressure
Loss of structural integrity
INDIRECT INGUINAL
HERNIA
Lateral hernia
From deep and superficial inguinal ring through the scrotum
Congenital in origin patency of processus vaginalis (PPV)
Embriology & Pathogenesis??

Source: Aschraft of Pediatric Surgery 5th ed.

FEMORAL HERNIA
Through femoral canal;
The anterior border the inguinal ligament,
the posterior border the iliopectineal ligament
medial border the lacunar ligament
Occur primarily in females
More likely to incarcerate than inguinal hernias
CLINICAL PRESENTATION &
DIAGNOSIS
History and physical examination
Persistent or intermittent bulge in the groin
Irreducible mass with persistent pain associated with
incarceration
Strangulation??
Bowel obstruction?
PHYSICAL
EXAMINATION
Vital sign, cardiopulmonary function
Inguinal Examination
Inspection : bulge? reducible? Sign of inflamation? Direct
hernias are often observed medially and superiorly,
in contrast to indirect hernias, which are seen to
extend laterally and inferiorly.
Palpation : soft/fixed? mobile masses that can be either partially
or fully reduced? Tender?
Valsava maneuver finger test
Pediatric patient silk glove sign
Transilumination test
Auscultation : bowel sound on the bulge?

Abdominal Examination sign of bowel obstruction?

DIFFERENTIAL
DIAGNOSIS
Inguinal hernia
Femoral hernia
Lipoma
Lymphadenitis
Lymphadenopathy Abscess Hematoma
Varicocele
Hydrocele
Testicular mass
Testicular torsion
Epididymitis
Ectopic testicle
Femoral aneurysm or pseudoaneurysm
Cyst
Seroma
SURGICAL PRINCIPLES
Elective? Urgent? Emergency?
OTHER ABDOMINAL
HERNIA
Epigastric Hernia
Umbilical Hernia
Littre Hernia
Obturator Hernia
Richter Hernia
Lumbar Hernia (Petit or Grynfeltt)
Spigelian Hernia
Incisional Hernia
Internal Hernia