Hernia (External)

– Protrusion of an internal organ (usually bowel) through an abnormal opening or weakness in the muscle wall.

Causes and Incidence

Causes include congenital malformation; traumatic injury; or muscle weakening caused by factors such as pregnancy, obesity, ascites, abdominal tumors, long-term heavy lifting, surgery, or aging. Herniation may be precipitated by excessive coughing or straining during defecation. Hernias occur in all age groups and are more common in men than women. About 75% of hernias occur in the groin area.

Disease Process

External hernias may be classified as inguinal, femoral, umbilical, or incisional. Inguinal hernias involve an abdominal wall weakness where the spermatic cord in men or the round ligament in women emerges. The herniation protrudes either through the inguinal ring (indirect) or through the posterior inguinal wall (direct). With a femoral hernia, the bowel protrudes through the femoral ring into the femoral canal. Umbilical hernias occur when bowel protrudes through the inguinal ring. Incisional hernias involve protrusion through an abdominal incision that may have healed improperly.

Symptoms

The most common sign is a bulge in the inguinal, femoral, or umbilical area or at the incision site. The bulge may become larger with a shift in position or coughing. Sharp, steady pain in the affected area may also be present. Signs of hernia strangulation include increasing severity of pain and fever, tachycardia, abdominal rigidity, and absence of bowel sounds.

Potential Complications

Incarceration or strangulation may lead to intestinal obstruction and necrosis of bowel tissue.

Diagnostic Tests

The diagnosis is made by the clinical presentation. X-ray studies may be used to confirm a suspected bowel obstruction.

Treatments

Surgery
Herniorrhaphy to repair the hernia or hernioplasty to reinforce weakened muscle with wire, fascia, or mesh; bowel resection and temporary colostomy if bowel obstruction and necrosis occur.

Drugs
None.

General
Manual reduction of hernia; binder or truss to prevent other herniations if individual is not a candidate for surgery.