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Hernias
Alexander J. Towbin, MD
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Hernia: Protrusion of contents from normally encasing body cavity through normal or abnormal opening
          • Inguinal hernia: Protrusion of abdominal contents through defect in inguinal region
            • Indirect inguinal hernia: Protrusion of abdominal contents into open deep inguinal ring, through patent processus vaginalis, exiting superficial inguinal ring
              • Canal of Nuck: Term for patent processus vaginalis in females; extends into labia majoris
            • Direct inguinal hernia: Abdominal contents pass through wall of inguinal canal (due to weak abdominal musculature), exiting superficial inguinal ring
          • Umbilical hernia: Protrusion of abdominal contents through open umbilical ring
          • Femoral hernia: Protrusion of abdominal contents through femoral ring
          • Spigelian hernia: Protrusion of abdominal contents through defect between rectus muscles & semilunar line
          • Incisional hernia: Protrusion of abdominal contents through defect caused by surgical incision
          • Ventral hernia: Protrusion of abdominal contents through defect along anterior abdominal wall
          • Littre hernia: Hernia contains Meckel diverticulum
          • Amyand hernia: Inguinal hernia containing appendix
          • Richter hernia: Hernia contains only 1 wall of bowel
          • Internal hernia: Hernia through fossa or foramen within abdominal cavity
            • Defect associated with internal hernia can be congenital or acquired
          • Traumatic: Hernia through traumatic abdominal wall defect
        • Incarcerated hernia: Hernia in which contents cannot be reduced without special maneuvers, sedation, anesthesia, or surgery
        • Strangulated hernia: Hernia in which contents become ischemic due to vascular compression by hernia channel
      • Associations

        • Indirect inguinal hernia: Prematurity
        • Umbilical hernia: Prematurity, Down syndrome, Beckwith-Wiedemann syndrome
        • Acquired internal hernia: Abdominal surgery requiring Roux-en-Y reconstruction
        • Recent repair of large congenital hernia: Omphalocele, gastroschisis, diaphragmatic hernia
          • ↑ intraabdominal pressure status post reduction of abdominal contents + defect repair can lead to recurrent or new hernias

      IMAGING

      • General Features

        • Radiographic Findings

          • Fluoroscopic Findings

            • CT Findings

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            Selected References

                            1. Cigsar EB et al: Amyand's hernia: 11 years of experience. J Pediatr Surg. 51(8):1327-9, 2016
                            2. Guler I et al: Amyand's Hernia: ultrasonography findings. J Emerg Med. 50(1):e15-7, 2016
                            3. Duggan EM et al: Inguinal hernia repair in premature infants: more questions than answers. Arch Dis Child Fetal Neonatal Ed. 100(4):F286-8, 2015
                            4. Shi Y et al: Congenital left paraduodenal hernia causing chronic abdominal pain and abdominal catastrophe. Pediatrics. 135(4):e1067-71, 2015
                            5. Kelly KB et al: Pediatric abdominal wall defects. Surg Clin North Am. 93(5):1255-67, 2013
                            6. Orth RC et al: Acute testicular ischemia caused by incarcerated inguinal hernia. Pediatr Radiol. 42(2):196-200, 2012
                            7. Rathore A et al: Traumatic abdominal wall hernias: an emerging trend in handlebar injuries. J Pediatr Surg. 47(7):1410-3, 2012
                            8. Clarke S: Pediatric inguinal hernia and hydrocele: an evidence-based review in the era of minimal access surgery. J Laparoendosc Adv Surg Tech A. 20(3):305-9, 2010
                            9. Brandt ML: Pediatric hernias. Surg Clin North Am. 88(1):27-43, vii-viii, 2008
                            10. Shahzad F et al: Pediatric femoral hernias: a case report and review of the literature. W V Med J. 104(2):10-1, 2008
                            11. Skandalakis PN et al: Littre hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 72(3):238-43, 2006
                            12. Skandalakis PN et al: Richter hernia: surgical anatomy and technique of repair. Am Surg. 72(2):180-4, 2006
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                TERMINOLOGY

                                • Definitions

                                  • Hernia: Protrusion of contents from normally encasing body cavity through normal or abnormal opening
                                    • Inguinal hernia: Protrusion of abdominal contents through defect in inguinal region
                                      • Indirect inguinal hernia: Protrusion of abdominal contents into open deep inguinal ring, through patent processus vaginalis, exiting superficial inguinal ring
                                        • Canal of Nuck: Term for patent processus vaginalis in females; extends into labia majoris
                                      • Direct inguinal hernia: Abdominal contents pass through wall of inguinal canal (due to weak abdominal musculature), exiting superficial inguinal ring
                                    • Umbilical hernia: Protrusion of abdominal contents through open umbilical ring
                                    • Femoral hernia: Protrusion of abdominal contents through femoral ring
                                    • Spigelian hernia: Protrusion of abdominal contents through defect between rectus muscles & semilunar line
                                    • Incisional hernia: Protrusion of abdominal contents through defect caused by surgical incision
                                    • Ventral hernia: Protrusion of abdominal contents through defect along anterior abdominal wall
                                    • Littre hernia: Hernia contains Meckel diverticulum
                                    • Amyand hernia: Inguinal hernia containing appendix
                                    • Richter hernia: Hernia contains only 1 wall of bowel
                                    • Internal hernia: Hernia through fossa or foramen within abdominal cavity
                                      • Defect associated with internal hernia can be congenital or acquired
                                    • Traumatic: Hernia through traumatic abdominal wall defect
                                  • Incarcerated hernia: Hernia in which contents cannot be reduced without special maneuvers, sedation, anesthesia, or surgery
                                  • Strangulated hernia: Hernia in which contents become ischemic due to vascular compression by hernia channel
                                • Associations

                                  • Indirect inguinal hernia: Prematurity
                                  • Umbilical hernia: Prematurity, Down syndrome, Beckwith-Wiedemann syndrome
                                  • Acquired internal hernia: Abdominal surgery requiring Roux-en-Y reconstruction
                                  • Recent repair of large congenital hernia: Omphalocele, gastroschisis, diaphragmatic hernia
                                    • ↑ intraabdominal pressure status post reduction of abdominal contents + defect repair can lead to recurrent or new hernias

                                IMAGING

                                • General Features

                                  • Radiographic Findings

                                    • Fluoroscopic Findings

                                      • CT Findings

                                        • Ultrasonographic Findings

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Demographics

                                                  • Natural History & Prognosis

                                                    • Treatment

                                                      Selected References

                                                      1. Cigsar EB et al: Amyand's hernia: 11 years of experience. J Pediatr Surg. 51(8):1327-9, 2016
                                                      2. Guler I et al: Amyand's Hernia: ultrasonography findings. J Emerg Med. 50(1):e15-7, 2016
                                                      3. Duggan EM et al: Inguinal hernia repair in premature infants: more questions than answers. Arch Dis Child Fetal Neonatal Ed. 100(4):F286-8, 2015
                                                      4. Shi Y et al: Congenital left paraduodenal hernia causing chronic abdominal pain and abdominal catastrophe. Pediatrics. 135(4):e1067-71, 2015
                                                      5. Kelly KB et al: Pediatric abdominal wall defects. Surg Clin North Am. 93(5):1255-67, 2013
                                                      6. Orth RC et al: Acute testicular ischemia caused by incarcerated inguinal hernia. Pediatr Radiol. 42(2):196-200, 2012
                                                      7. Rathore A et al: Traumatic abdominal wall hernias: an emerging trend in handlebar injuries. J Pediatr Surg. 47(7):1410-3, 2012
                                                      8. Clarke S: Pediatric inguinal hernia and hydrocele: an evidence-based review in the era of minimal access surgery. J Laparoendosc Adv Surg Tech A. 20(3):305-9, 2010
                                                      9. Brandt ML: Pediatric hernias. Surg Clin North Am. 88(1):27-43, vii-viii, 2008
                                                      10. Shahzad F et al: Pediatric femoral hernias: a case report and review of the literature. W V Med J. 104(2):10-1, 2008
                                                      11. Skandalakis PN et al: Littre hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 72(3):238-43, 2006
                                                      12. Skandalakis PN et al: Richter hernia: surgical anatomy and technique of repair. Am Surg. 72(2):180-4, 2006