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Abdominal Wall Hernias

Groin hernias - Inguinal hernia: -- Direct (medial to inferior epigastric vessel) -- Indirect (lateral to inferior epigastric vessel), more common in males - Femoral hernia: medial to the femoral vein, posterior to the inguinal ligament, more common in females Ventral hernias (anterior (midline [strangulation, incarceration]) and lateral abd. wall) - Umbilical: most common, more in females - Paraumbilical: large defects through the linea alba, diatasis of the rectus abdominis - Epigastric - Hypogastric hernias occurs in the linea alba above and below umbilicus. Lumbar hernias Incisional hernia, Parastomal hernia Intraparietal (interstitial) hernia in the fascial planes between the abdominal wall muscles that does not protrude into subcutaneous tissue (inguinal region) - Richter hernia involves antimesenteric wall of the bowel that does not compromise entire wall circumference (frequently with femoral hernias) - Littre hernia is inguinal hernia containig Meckels diverticulum Pelvic hernias (elderly women, weakness of the pelvic floor) Sciatic hernia rare Obturator hernia rare Perianal hernia Complications: SBO: small bowel obstruction due to hernia strangulation, incarceration (abd.pain, vomiting, distention, tender wall mass, abd.distention, dehydration, peritoneal signs) CT findings: 1. dilated bowel proximal to hernia 2. normal caliber, reduced caliber or collapsed bowel distal to the obstruction Incarceration: irreducible hernia occurs through a small defect and hernia has a narrow neck. If it contains bowel, strangulation and ischemia may happened anytime. Strangulation: causes closed loop obstruction and ischemia. Wall thickening, hypo or hyper attenuation, mesenteric vessel engorgement, mesenteric haziness and ascites