Hernias – Presentation and Management

It is known as breuk in Dutch, rompure in French, keal in Greek and popularly as rupture in English. Hernia have always been around and plagued the human race throughout history. In fact one can find how hernias were reduced in the ancient writings of Hammurabi of Babylon and the Egyptian papyrus

Hernia is a protrusion of an organ through the abdominal wall and it can be either a congenital problem as in a child or it maybe an acquired problem as in an adult.

The abdominal wall is a sheet of muscle that acts like a corset and keeps the organ contained within it. However, certain areas are structurally weaker than others and therefore more prone to develop hernias. Although the term hernia can be used for bulges in other areas, it most often is used to describe hernias of the abdominal wall.

The contents of a Hernia are usually portions of intestine or abdominal fatty tissue, which are often enclosed in the thin membrane called the peritoneum that lines the inside of the abdominal cavity. This enclosing membrane is called the 'sac' of the Hernia. The 'neck' to the sac is a narrow area located in the defect of the abdominal wall and has the potential to develop complications.

Hernias most commonly occur in the groin and are called inguinal hernias. Depending on the place of occurrence Hernias can be categorized as:

Inguinal hernia

Femoral hernia

Umbilical hernia

Incisional hernia

Obturator hernia

Spigelian hernia

Epigastric hernia

Hernias by themselves are usually asymtomatic, but nearly all have a potential risk of becoming strangulated at the opening in the abdominal wall and having their blood supply cut off, it then becomes a medical and surgical emergency. To prevent this emergency all hernias should be repaired surgically unless severe pre-existing medical conditions make surgery unsafe.