Hernia: Difference between revisions

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{{Infobox_Disease
__NOTOC__
| Name          = Hernia
| Image          = Hernia de Morgani.JPG
| Caption        = Frontal [[chest X-ray]] showing a [[hernia of Morgagni]]
| DiseasesDB    =
| ICD10          = K40-K46
| ICD9          = {{ICD9|550}}-{{ICD9|553}}
| ICDO          =
| OMIM          =
| MedlinePlus    = 000960
| MeshID        =
}}
{{Hernias}}
'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
 
{{CMG}} '''Associate Editor-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]


{{Hernia}}


{{CMG}}; {{AE}} {{EG}}, {{Anmol}}


==Overview==
==Overview==
A hernia is “the protrusion of an organ, organic part, or other bodily structure through the wall that usually contains it.<ref>{{cite book | title = Webster's new college dictionary | publisher = Houghton Mifflin Harcourt |page=531 | location = Boston | year = 2008 | isbn = 9780618396016 }}</ref> Hernias may be [[Congenital disorder|congenital]] or [[acquired]]. Based on the protruded body structure and the location of the protrusion, the hernia may be classified into [[Inguinal hernia|inguinal]], [[Femoral hernia|femoral]], [[Umbilical hernia|umbilical]], [[Diaphragmatic hernia|diaphragmatic]], [[Incisional hernia|incisional]], and other hernias. Different kinds of hernias, such as [[central nervous system|central nervous system (CNS)]], [[diaphragmatic hernia|diaphragmatic]], [[lumbar]], [[abdominal]], and [[pelvic]] hernias have to be differentiated on the basis of clinical manifestations.


==Classification==


A '''hernia''' is a [[wiktionary:protrusion|protrusion]] of a [[Biological tissue|tissue]], structure, or part of an organ through the muscular tissue or the [[biological membrane|membrane]] by which it is normally contained. The hernia has 3 parts: the ''orifice'' through which it herniates, the ''hernial sac'', and its ''contents''. The contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. a Hernia has a potential risk of having its blood supply cut off (becoming strangulated), and the contents may become necrotic due to the lack of O2 supply.
=== Major classification of hernias in human body. ===
 
{{familytree/start}}
A hernia may be likened to a failure in the sidewall of a pneumatic tire. The tire's inner tube behaves like the organ and the side wall like the body cavity wall providing the restraint. A weakness in the sidewall allows a bulge to develop, which can become a split, allowing the inner tube to protrude, and leading to the eventual failure of the tire.
{{familytree | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | |A01='''[[Hernia]]'''}}
 
{{familytree | | | |,|-|-|-|v|-|-|-|v|-|-|-|-|-|-|-|+|-|-|-|v|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | |}}
==Types and classifications ==
{{familytree | | | B01 | | B06 | | B02 | | | | | | B03 | | B04 | | | | | | | | B05 | | | | | | | | | |B01='''''[[CNS]]'''''|B02='''''[[diaphragmatic hernia|Diaphragmatic]]'''''|B03='''''[[Lumbar]]'''''|B04='''''[[Abdominal]]'''''|B05='''''[[Pelvic]]'''''|B06='''''[[Hiatal hernia|Hiatal]]'''''}}
Hernias can be classified according to their anatomical location:
{{familytree | | | |!| | | |!| | | |!| | | | | | | |!| | | |!| | | | | | | | | |!| | | | | | | | | | |}}
 
{{familytree | |,|-|^|-|.| |!| |,|-|^|-|.| | | |,|-|^|-|.| |!| |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | |}}
Examples include:
{{familytree | C01 | | C11 |!| C02 | | C03 | | C04 | | C05 |!| C06 | | C07 | | C08 | | C09 | | C10 | |C01=[[Brain hernia]]|C02=[[Morgagni hernia]]|C03=[[Bochdalek hernia]]|C04=[[Petit's hernia]]|C05=[[Grynfeltt's hernia]]|C06=[[Inguinal hernia]]|C07=[[Obturator hernia]]|C08=[[Perineal hernia]]|C09=[[Femoral hernia]]|C10=[[Sciatic hernia]]|C11=[[Lumbar disc herniation|Lumbar disc hernia]]}}
* '''Abdominal hernias'''.
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | |}}
* '''Diaphragmatic hernias and [[hiatal hernia]]s (for example, paraesophageal hernia of the stomach).'''
{{familytree | | | | |,|-|-|^|-|.| | | |,|-|-|-|v|-|-|-|v|-|^|-|v|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | |}}
* '''Pelvic hernias, for example, obturator hernia.'''
{{familytree | | | | D09 | | | D10 | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | | D08 | |D01=[[Umbilical hernia]]|D02=[[Epigastric hernia]]|D03=[[Spigelian hernia]]|D04=[[Incisional hernia]]|D05=[[Amyand's hernia]]|D06=[[Alexis Littre|Littre's hernia]]|D07=[[August Gottlieb Richter|Richter's hernia]]|D08=[[Parastomal hernia]]|D09=[[Sliding hernias of the stomach|Sliding hernia]]|D10=Paraesophageal hernia}}
* '''Hernias of the nucleus pulposus of the intervertebral discs.'''
{{familytree/end}}
* '''Intracranial hernias.'''
 
Each of the above hernias may be characterised by several aspects:
*'''Congenital or acquired''': congenital hernias occur prenatally or in the first year(s) of life, and are caused by a congenital defect, whereas acquired hernias develop later on in life. However, this may be on the basis of a locus minoris resistentiae (Lat. place of least resistance) that is congenital, but only becomes symptomatic later on in life, when degeneration and increased stress (for example, increased abdominal pressure from coughing in [[COPD]]) provoke the hernia.
*'''Complete or incomplete''': for example, the stomach may partially herniate into the chest, or completely.
* '''Internal or external''': external ones herniate to the outside world, whereas internal hernias protrude from their normal compartment to another (for example, mesenteric hernias).
*'''Intraparietal hernia''': hernia that does not reach all the way to the [[subcutis]], but only to the musculoaponeurotic layer. An example is a [[Spigelian hernia]]. Intraparietal hernias may produces less obvious bulging, and may be less easily detected on clinical examination.
*'''Bilateral''': in this case, simultaneous repair may be considered, sometimes even with a giant prosthetic reinforcement.
*'''Irreducible''' (also known as incarcerated): the hernial contents cannot be returned to their normal site with simple manipulation.
 
If irreducible, hernias can develop several complications (hence, they can be '''complicated or uncomplicated'''):
*'''Strangulation''': pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later [[necrosis]] and [[gangrene]], which may become fatal.
*'''Obstruction''': for example, when a part of the bowel herniates, bowel contents can no longer pass the obstruction. This results in cramps, and later on vomiting, [[ileus]], absence of [[flatus]] and absence of defecation. These signs mandate urgent surgery.
*Another complication arises when the herniated organ itself, or surrounding organs start '''dysfunctioning''' (for example, sliding hernia of the stomach causing heartburn, lumbar disc hernia causing [[sciatic nerve]] pain, etc.)
 
==Treatment==
It is generally advisable to repair hernias in a timely fashion, in order to prevent complications such as organ dysfunction, [[gangrene]], and [[multiple organ dysfunction syndrome]]. Most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called [[herniorrhaphy]]). If complications have occurred, the surgeon will check the viability of the herniated organ, and resect it if necessary. Modern muscle reinforcement techniques involve synthetic materials (a mesh prosthesis) that avoid over-stretching of already weakened tissue (as in older, but still useful methods). The mesh is placed over the defect, and sometimes staples are used to keep the mesh in place. Increasingly, some repairs are performed through [[laparoscopy|laparoscopes]]<!--The operation is performed through an instrument called a laparoscope, so "laparoscopes" is correct-->.  
 
Many patients are managed through surgical daycare centers, and are able to return to work within a week or two, while heavy activities are prohibited for a longer period. Surgical complications have been estimated to be up to 10%, but most of them can be easily addressed. They include surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence.
 
Generally, the use of external devices to maintain reduction of the hernia without repairing the underlying defect (such as hernia trusses, trunks, belts, etc.), is not advised. Exceptions are uncomplicated [[incisional hernia]]s that arise shortly after the operation (should only be operated after a few months), or inoperable patients.
 
It is essential that the hernia not be further irritated by carrying out strenuous labour.


==Individual hernias==
==Differential Diagnosis==
A [[Athletic pubalgia|sportman's hernia]] is a [[syndrome]] characterized by chronic [[groin]] [[Pain and nociception|pain]] in athletes and a dilated [[Superficial inguinal ring|superficial ring]] of the inguinal canal, although a true hernia is not present.
* Different kinds of hernias, such as [[central nervous system|central nervous system (CNS)]], [[diaphragmatic hernia|diaphragmatic]], [[lumbar]], [[abdominal]], and [[pelvic]] hernias have to be differentiated upon various history, symptoms, and physical examination findings.
<small>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="3" |Location
! rowspan="3" |Diseases
! colspan="6" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="3" rowspan="2" |Laboratory Findings
! rowspan="3" |Definition
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" |Neurological
! colspan="4" |GI
! colspan="2" |Neurological
! colspan="2" |GI
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Confusion
!Paresthesia
!Dysphagia
!Heartburn
!Nausea
!Bowel habits
!Loss of Consciousness
!Straight leg raise (SLR)
!Mass protrusion
!Tenderness/Rebound tenderness
!Leukocytosis
!CRP
!ESR
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain hernia]]<ref name="pmid7627921">{{cite journal |vauthors=Fisher CM |title=Brain herniation: a revision of classical concepts |journal=Can J Neurol Sci |volume=22 |issue=2 |pages=83–91 |year=1995 |pmid=7627921 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Brain tissue]] herniation through [[foramen magnum]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spinal disc herniation|Lumbar disc hernia]]<ref name="pmid20689695">{{cite journal| author=Schoenfeld AJ, Weiner BK| title=Treatment of lumbar disc herniation: Evidence-based practice. | journal=Int J Gen Med | year= 2010 | volume= 3 | issue=  | pages= 209-14 | pmid=20689695 | doi= | pmc=2915533 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20689695  }} </ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Nucleus pulposus]] herniation through [[Annulus fibrosus disci intervertebralis|annulus fibrosus]]
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| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hiatal hernia|Hiatal]]<ref name="pmid21927653">{{cite journal| author=Hyun JJ, Bak YT| title=Clinical significance of hiatal hernia. | journal=Gut Liver | year= 2011 | volume= 5 | issue= 3 | pages= 267-77 | pmid=21927653 | doi=10.5009/gnl.2011.5.3.267 | pmc=3166665 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21927653  }} </ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sliding hernias of the stomach|Sliding hernia]]
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| style="background: #F5F5F5; padding: 5px;" |[[Stomach]] herniation through [[diaphragm]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Paraesophageal hernia
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| style="background: #F5F5F5; padding: 5px;" |[[Esophagus]] herniation through [[diaphragm]]
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| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Diaphragmatic hernia|Diaphragmatic]]<ref name="urlCongenital Diaphragmatic Hernia Overview - GeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1359/ |title=Congenital Diaphragmatic Hernia Overview - GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Morgagni hernia]]
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| style="background: #F5F5F5; padding: 5px;" |[[Congenital]] herniation of [[stomach]] through left side of [[diaphragm]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bochdalek hernia]]
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| style="background: #F5F5F5; padding: 5px; " |[[Congenital]] herniation of [[stomach]] through right anterior side of [[diaphragm]]
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| rowspan="7" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Abdominal]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Umbilical hernia]]<ref name="pmid14626398">{{cite journal| author=Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ| title=Laparoscopic versus open umbilical hernia repair. | journal=JSLS | year= 2003 | volume= 7 | issue= 4 | pages= 323-8 | pmid=14626398 | doi= | pmc=3021337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14626398  }}</ref>
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| style="background: #F5F5F5; padding: 5px; " |[[Bowels]] herniation through [[umbilicus]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epigastric hernia]]<ref name="pmid14533911">{{cite journal |vauthors=Muschaweck U |title=Umbilical and epigastric hernia repair |journal=Surg. Clin. North Am. |volume=83 |issue=5 |pages=1207–21 |year=2003 |pmid=14533911 |doi=10.1016/S0039-6109(03)00119-1 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; " |[[Bowels]] herniation through [[Epigastric region|epigastric abdominal wall]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spigelian hernia]]<ref name="pmid19547696">{{cite journal| author=Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M et al.| title=[Not Available]. | journal=J Minim Access Surg | year= 2008 | volume= 4 | issue= 4 | pages= 95-8 | pmid=19547696 | doi= | pmc=2699222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19547696  }}</ref>
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| style="background: #F5F5F5; padding: 5px; " |[[Bowels]] herniation through lateral [[abdominal wall]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Amyand's hernia]]<ref name="pmid22879848">{{cite journal| author=Singal R, Gupta S| title="Amyand's Hernia" - Pathophysiology, Role of Investigations and Treatment. | journal=Maedica (Buchar) | year= 2011 | volume= 6 | issue= 4 | pages= 321-7 | pmid=22879848 | doi= | pmc=3391951 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22879848  }}</ref>
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| style="background: #F5F5F5; padding: 5px; " |[[Vermiform appendix|Appendix vermiformis]] herniation through  [[abdominal wall]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Alexis Littre|Littre's hernia]]<ref name="pmid16553126">{{cite journal |vauthors=Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P |title=Littre hernia: surgical anatomy, embryology, and technique of repair |journal=Am Surg |volume=72 |issue=3 |pages=238–43 |year=2006 |pmid=16553126 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; " |[[Meckel's diverticulum]] herniation through [[abdominal wall]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[August Gottlieb Richter|Richter's hernia]]<ref name="pmid16536253">{{cite journal |vauthors=Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P |title=Richter hernia: surgical anatomy and technique of repair |journal=Am Surg |volume=72 |issue=2 |pages=180–4 |year=2006 |pmid=16536253 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Bowels]] herniation and [[strangulation]] through [[abdominal wall]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parastomal hernia]]<ref name="pmid25435825">{{cite journal| author=Gillern S, Bleier JI| title=Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials. | journal=Clin Colon Rectal Surg | year= 2014 | volume= 27 | issue= 4 | pages= 162-71 | pmid=25435825 | doi=10.1055/s-0034-1394090 | pmc=4226750 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25435825  }}</ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Bowels]] herniation through [[stoma]] in the [[abdominal wall]]
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| rowspan="5" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia]]<ref name="pmid18244999">{{cite journal| author=Jenkins JT, O'Dwyer PJ| title=Inguinal hernias. | journal=BMJ | year= 2008 | volume= 336 | issue= 7638 | pages= 269-72 | pmid=18244999 | doi=10.1136/bmj.39450.428275.AD | pmc=2223000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18244999  }}</ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Bowels]] herniation through [[inguinal ring]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Obturator hernia]]<ref name="pmid12371643">{{cite journal |vauthors=Nakayama T, Kobayashi S, Shiraishi K, Nishiumi T, Mori S, Isobe K, Furuta Y |title=Diagnosis and treatment of obturator hernia |journal=Keio J Med |volume=51 |issue=3 |pages=129–32 |year=2002 |pmid=12371643 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Viscera]] herniation through [[obturator canal]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Perineal hernia]]<ref name="pmid28673377">{{cite journal |vauthors=Levic K, Rosen KV, Bulut O, Bisgaard T |title=Low incidence of perineal hernia repair after abdominoperineal resection for rectal cancer |journal=Dan Med J |volume=64 |issue=7 |pages= |year=2017 |pmid=28673377 |doi= |url=}}</ref>
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoral hernia]]<ref name="pmid13595543">{{cite journal| author=LUDINGTON LG| title=Femoral hernia and its management, with particular reference to its occurrence following inguinal herniorrhaphy. | journal=Ann Surg | year= 1958 | volume= 148 | issue= 5 | pages= 823-6 | pmid=13595543 | doi= | pmc=1450902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13595543  }}</ref>
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sciatic hernia]]<ref name="pmid20197431">{{cite journal| author=Kandpal H, Madhusudhan KS| title=Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve. | journal=Br J Radiol | year= 2010 | volume= 83 | issue= 987 | pages= e65-6 | pmid=20197431 | doi=10.1259/bjr/47866965 | pmc=3473559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20197431  }}</ref>
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</small>


===Inguinal hernia===
==CNS Hernia==
:''Main article: [[inguinal hernia]].''
{| align="right"
|[[image:512px-Brain herniation types.svg.png|thumb|260px|Different types of brain herniation - By User:Delldot, via Wikimedia Commons<ref>[<"http://www.gnu.org/copyleft/fdl.html">GFDL, <"http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0 or <"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0], <"https://commons.wikimedia.org/wiki/File%3ABrain_herniation_types.svg"></ref>]]
[[image:Blausen 0484 HerniatedLumbarDisc.png|thumb|260px|Lumbar disc herniation - By BruceBlaus, via Wikimedia Commons<ref>Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. (Own work) [<"http://creativecommons.org/licenses/by/3.0">CC BY 3.0], <"https://commons.wikimedia.org/wiki/File%3ABlausen_0484_HerniatedLumbarDisc.png"></ref>]]
|}
===Brain hernia===
*[[Brain hernia]] is most commonly due to increase in [[Intracranial pressure|intracranial pressure (ICP)]].
*The cardinal features of [[brain herniation]] is acute [[loss of consciousness]], ipsilateral [[pupillary dilation]], and contralateral [[hemiparesis]].<ref name="pmid26438459">{{cite journal| author=Stevens RD, Shoykhet M, Cadena R| title=Emergency Neurological Life Support: Intracranial Hypertension and Herniation. | journal=Neurocrit Care | year= 2015 | volume= 23 Suppl 2 | issue=  | pages= S76-82 | pmid=26438459 | doi=10.1007/s12028-015-0168-z | pmc=4791176 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26438459  }}</ref>
* There are 4 types of brain hernation:
**'''Type 1:''' Subfalcine herniation
**'''Type 2:''' Transalar herniation (ascending and descending)
**'''Type 3:''' Transtentorial herniation (uncal herniation)
**'''Type 4:''' Extracranial herniation


[[Image:Inguinalhernia.gif|left|frame|Diagram of an [[indirect inguinal hernia|indirect]], [[scrotum|scrotal]] [[inguinal hernia]] ( [[Anatomical position|median]] view from the left).]]
For more information about brain hernia '''[[Brain hernia|click here]]'''
By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. For a thorough understanding of inguinal hernias, much insight is needed in the anatomy of the [[inguinal canal]]. Inguinal hernias are further divided into the more common [[indirect inguinal hernia]] (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the [[direct inguinal hernia]] type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal. Inguinal hernias are more common in men than women while femoral hernias are more common in women.
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===Femoral hernia===
:''Main article: [[femoral hernia]].''


Femoral hernias occur just below the [[inguinal ligament]], when abdominal contents pass into the weak area at the posterior wall of the [[femoral canal]]. They can be hard to distinguish from the inguinal type (especially when ascending cephalad): however, they generally appear more rounded, and, in contrast to inguinal hernias, there is a strong female preponderance in femoral hernias. The incidence of strangulation in femoral hernias is high. Repair techniques are similar for femoral and [[inguinal hernia]].
=== Lumbar disc hernia ===
* [[Lumbar disc herniation|Lumbar disc hernia]] is related to old age, lack of [[physical activity]], and all the factors that may result in [[dehydration]] of [[intervertebral discs]].
* The cardinal features of [[lumbar disc herniation]] is [[radiculopathy]], decreased [[Deep tendon reflex|deep tendon reflexes]], and [[Atrophy|muscular atrophy]].
* The mainstay of treatment in [[Lumbar disc herniation|lumbar disc hernia]] is complete bed rest.
* [[Neurosurgical]] interventions may be indicated in patients with refractory symptoms unresponsive to medical therapy.<ref name="urlHerniated Disc - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024495/ |title=Herniated Disc - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref>
For more information about lumbar disc hernia '''[[Spinal disc herniation|click here]]'''
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== Diaphragmatic Hernia ==


=== Bochdalek hernia ===
* [[Bochdalek|Bochdalek hernia]] is the most common type (80-90%) of [[congenital diaphragmatic hernia]].
* [[Bochdalek hernia]] is herniation of [[stomach]] through posterior left side of the [[diaphragm]].
* If the [[Bochdalek hernia]] occurs [[in utero]], the [[neonate]] present with complications including [[pulmonary]] [[hypoplasia]] and even death.<ref name="pmid3718216">{{cite journal |vauthors=Newman BM, Afshani E, Karp MP, Jewett TC, Cooney DR |title=Presentation of congenital diaphragmatic hernia past the neonatal period |journal=Arch Surg |volume=121 |issue=7 |pages=813–6 |year=1986 |pmid=3718216 |doi= |url=}}</ref>
For more information about Bochdalek hernia '''[[Bochdalek hernia|click here]]'''


===Umbilical hernia===
=== Morgagni hernia ===
:''Main article: [[umbilical hernia]].''
* [[Morgagni hernia]] is less common (10-20%) than [[Congenital diaphragmatic hernia|Bochdalek congenital diaphragmatic hernia]].
* [[Morgagni hernia]] is most commonly retrosternal and on the right side of the [[diaphragm]].
* [[Morgagni hernia]] occurs in approximately 50 per 100,000 [[pregnancies]].<ref name="pmid12751867">{{cite journal |vauthors=Robnett-Filly B, Goldstein RB, Sampior D, Hom M |title=Morgagni hernia: a rare form of congenital diaphragmatic hernia |journal=J Ultrasound Med |volume=22 |issue=5 |pages=537–9 |year=2003 |pmid=12751867 |doi= |url=}}</ref>
For more information about Morgagni hernia '''[[Morgagni hernia|click here]]'''


Umbilical hernias are especially common in infants of African descent, and occur more in boys. They involve protrusion of intraabdominal contents through a weakness at the site of passage of the [[umbilical cord]] through the [[abdominal wall]]. These hernias often resolve spontaneously.
== Hiatal Hernia ==
Umbilical hernias in adults are largely acquired, and are more frequent in [[obese]] or [[pregnant]] women. Abnormal decussation of fibers at the [[linea alba]] may contribute.


===Incisional hernia===
=== Sliding hernia ===
:''Main article: [[incisional hernia]].''
{| align="right"
|[[image:256px-Hiatus hernia.svg.png|thumb|400px|Different types of hiatal herniation - By Mysid, via Wikimedia Commons<ref>[<"http://creativecommons.org/publicdomain/zero/1.0/deed.en">CC0], <"https://commons.wikimedia.org/wiki/File%3AHiatus_hernia.svg"></ref>]]
|}


An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in median [[laparotomy]] incisions in the [[linea alba]], they are termed [[ventral hernia]]s. These can be the most frustrating and difficult to treat, as the repair utilizes already attenuated tissue.
==== Type I ====
* [[Hiatus hernia|Sliding hernia]] accounts for more than 95% of all cases of [[hiatal hernia]].
* [[Sliding hernias of the stomach|Sliding hernia]] is herniation of distal [[esophagus]] and also [[Cardia|gastric cardia]] into the [[Thoracic cavity|thoracic space]].
* Displacement of less than 2 cm is considered as [[Physiological|physiologic]] displacement, mostly occurred during [[swallow]] process.


===Diaphragmatic hernia===
=== Paraesophageal hernias ===
:''Main article: [[diaphragmatic hernia]]
[[Image:Hiatalhernia.gif|left|frame|Diagram of a [[hiatus hernia]] ([[Anatomical position|coronal section]], viewed from the front).]]
Higher in the abdomen, an (internal) "diaphragmatic hernia" results when part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm.


A [[hiatus hernia]] is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach ([[Diaphragm (anatomy)|esophageal hiatus]]) serves as a functional "defect", allowing part of the [[stomach]] to (periodically) "herniate" into the chest. Hiatus hernias may be either "''sliding''," in which the [[Esophagus|gastroesophageal junction]] itself slides through the defect into the [[chest]], or non-sliding (also known as ''para-esophageal''), in which case the junction remains fixed while another portion of the stomach moves up through the defect. Non-sliding or para-esophageal hernias can be dangerous as they may allow the stomach to rotate and obstruct. Repair is usually advised.
==== Type II ====
[[Image:Hernia de Morgani.JPG|thumb|left|Frontal [[chest X-ray]] showing a [[hernia of Morgagni]].]]
* Type II of paraesophageal hernias is the classic herniation of a part of [[Fundus (stomach)|gastric fundus]], but not [[gastroesophageal junction]], into the [[thoracic cavity]].
A [[congenital diaphragmatic hernia]] is a distinct problem, occurring in up to 1 in 2000 births, and requiring [[pediatric surgery]]. Intestinal organs may herniate through several parts of the [[diaphragm (anatomy)|diaphragm]], posterolateral (in [[Vincenc Bochdalek|Bochdalek's]] triangle, resulting in ''Bochdalek's hernia''), or anteromedial-retrosternal (in the cleft of [[Dominique Jean Larrey|Larrey]]/[[Giovanni Battista Morgagni|Morgagni's]] [[foramen]], resulting in ''Morgagni-Larrey hernia'', or [[Morgagni's hernia]]).
* Without [[surgical]] repair and fixation of the herniated portion, it leads to incarceration and may lead to complications.


===Other types of hernia===
==== Type III ====
Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and [[eponyms]]. The above article deals mostly with "visceral hernias", where the herniating tissue arises within the abdominal cavity. Other hernia types and unusual types of visceral hernias are listed below, in alphabetical order:
* Type III of paraesophageal hernias is the combination of both type I and type II.
* In type III, [[Fundus (stomach)|gastric fundus]] is herniated through the [[diaphragm]] along with [[gastroesophageal junction]].


* '''[[Brain herniation|Brain hernia]]''': herniation of part of the [[brain]] because of excessive [[intracranial pressure]]. This may be a life-threatening condition, especially if the [[brain stem]] (responsible for some important [[vital signs]]) is involved.
==== Type IV ====
* '''Cooper's hernia''': A femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing immediately beneath the skin.
* The most severe form of the [[hiatal hernia]] is type IV, which consists of herniation of other [[abdominal]] organs along with [[stomach]] and distal [[esophagus]] into [[thoracic cavity]].
*[[epigastric hernia]]: hernia through the [[linea alba]] above the [[umbilicus]].
* Severe [[respiratory distress]] and [[dyspepsia]] may occur secondary to type IV paraesophageal hernia.<ref name="pmid21927653">{{cite journal| author=Hyun JJ, Bak YT| title=Clinical significance of hiatal hernia. | journal=Gut Liver | year= 2011 | volume= 5 | issue= 3 | pages= 267-77 | pmid=21927653 | doi=10.5009/gnl.2011.5.3.267 | pmc=3166665 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21927653  }}</ref>
*'''Littre's hernia''': hernia involving a [[Meckel's diverticulum]]. It is named after French anatomist [[Alexis Littre]] (1658-1726).
For more information about hiatal hernia '''[[Hiatal hernia|click here]]'''
*[[Lumbar hernia]]: hernia in the lumbar region (not to be confused with a lumbar disc hernia), contains following entities:
1. [[Petit's hernia]] - hernia through Petit's triangle (inferior lumbar triangle). It is named after French surgeon  [[Jean Louis Petit]] (1674-1750).


2. [[Grynfeltt's hernia]] - hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle). It is named after physician Joseph Grynfeltt (1840-1913).
== Lumbar Hernia ==
*'''obturator hernia''': hernia through [[obturator canal]].
{| align="right"
*'''pantaloon hernia''': a combined direct and indirect hernia, when the hernial sac protrudes on either side of the [[inferior epigastric vessels]].
|[[image:LumbarTriangle.jpg|thumb|600px|Lumbar triangles - Zyryab at English Wikipedia, via Wikimedia Commons<ref><"https://en.wikipedia.org/wiki/User:Zyryab" class="extiw" title="wikipedia:User:Zyryab">Zyryab at <"https://en.wikipedia.org/wiki/" class="extiw" title="wikipedia:">English Wikipedia [<"http://www.gnu.org/copyleft/fdl.html">GFDL, <"http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0 or <"http://creativecommons.org/licenses/by/2.5">CC BY 2.5], <"https://commons.wikimedia.org/wiki/File%3ALumbarTriangle.jpg">via Wikimedia Commons</ref>]]
*[[perineal hernia]]: A perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually, is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.
|}
*'''properitoneal hernia''': rare hernia located directly above the peritoneum, for example, when part of an inguinal hernia projects from the [[deep inguinal ring]] to the preperitoneal space.
=== Petit's hernia ===
*'''Richter's hernia''': strangulated hernia involving only one sidewall of the bowel, which can result in bowel perforation through ischaemia without causing [[bowel obstruction]] or any of its warning signs. It is named after German surgeon [[August Gottlieb Richter]] (1742-1812).
* Inferior [[lumbar]] region has a triangle formed by the [[iliac crest]], the margins of the [[latissimus dorsi muscle]], and [[Abdominal external oblique muscle|external abdominal oblique muscles]].
*'''sliding hernia''': occurs when an organ drags along part of the peritoneum, or, in other words, the organ is part of the hernia sac. The [[Colon (anatomy)|colon]] and the [[urinary bladder]] are often involved. The term also frequently refers to [[sliding hernias of the stomach]].
* [[Petit's hernia]] is defined as herniation of [[retroperitoneal]] fat through [[internal oblique muscle]] [[aponeurosis]] within the inferior lumbar triangle.
* '''sciatic hernia''': this hernia in the [[greater sciatic foramen]] most commonly presents as an uncomfortable mass in the gluteal area. Bowel obstruction may also occur. This type of hernia is only a rare cause of [[sciatic]] neuralgia.
* [[Petit's hernia]] commonly occurs on the left side and in males.
* [[Spigelian hernia]], also known as [[spontaneous lateral ventral hernia]].
* [[Strangulation]] rarely occurs in [[Petit's hernia]], because of wide herniation neck.
*Velpeau hernia: a hernia in the groin in front of the femoral blood vessels.
* [[spinal disc herniation]], or "herniated nucleus pulposus": a condition where the central weak part of the [[intervertebral disc]] ([[nucleus pulposus]], which helps absorb shocks to our [[Vertebral column|spine]]), herniates through the fibrous band ([[annulus fibrosus disci intervertebralis|annulus fibrosus]]) by which it is normally bound. This usually occurs low in the back at the [[lumbar]] or lumbo-[[sacrum|sacral]] level and can cause back pain which usually radiates well into the thigh or leg. When the sciatic nerve is involved, the symptom complex is called [[sciatica]]. Herniation can occur in the [[cervical]] vertebrae too. A [[nucleoplasty]] is an operation to repair the herniation.
* [[Traumatic abdominal wall hernia]]:  herniation of viscera occurring after a force is applied to the abdomen in a patient without preexisting abdominal hernia, resulting in disruption of muscles and fascia while maintaining skin continuity.


== Complications ==
=== Grynfeltt's hernia ===
Complications may arise post-operation, including [http://www.blackwell-synergy.com/links/doi/10.1111/j.1469-0691.2004.01014.x/full/ rejection of the mesh] that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localised swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed.
* Superior [[lumbar]] region has a triangle formed formed medially by the [[quadratus lumborum muscle]], laterally by the internal abdominal oblique muscle, and superiorly by the 12th rib.
* [[Grynfeltt's hernia]] is defined as herniation of retroperitoneal fat through transversalis muscle [[aponeurosis]] within the superior lumbar triangle.
* The mainstay of treatment for lumbar hernias is surgery fixation.<ref name="pmid28944339">{{cite journal| author=Başak F, Hasbahçeci M, Canbak T, Acar A, Şişik A, Baş G et al.| title=Lumbar (Petit's) hernia: A rare entity. | journal=Turk J Surg | year= 2017 | volume= 33 | issue= 3 | pages= 220-221 | pmid=28944339 | doi=10.5152/UCD.2015.2986 | pmc=5602318 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28944339  }}</ref>


An untreated hernia may complicate by:
<br>
* [[Inflammation]]
* [[Reduction (orthopedic surgery)|Irreducibilty]]
* [[Bowel obstruction|Obstruction]]
* [[Strangulating|Strangulation]]
* [[Hydrocele]] of the hernial sac


==References==
== Abdominal Hernia ==
* ''Surgical recall'', 2nd edition, by Lorne. H. Blackbourne, published by Lippincott Williams & Wilkins
{| align="right"
* ''Sabiston textbook of surgery'', 17th edition, Townsend et.al.(e.d.), Elsevier-Saunders
|[[image:Ernia Ombelicale.jpg|thumb|300px|Umbilical hernia - By Rocco_Cusari, via Wikimedia Commons<ref>[<"https://creativecommons.org/licenses/by-sa/2.5">CC BY-SA 2.5], <"https://commons.wikimedia.org/wiki/File%3AErnia_Ombelicale.jpg"></ref>]]
[[image:Hernia epigástrica.png|thumb|300px|Epigastric hernia - By PacoPeramo (Own work), via Wikimedia Commons<ref>[<"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0], <"https://commons.wikimedia.org/wiki/File%3AHernia_epig%C3%A1strica.png"></ref>]]
[[image:Hernia spiegheli 01.JPG|thumb|300px|Spigelian hernia - By AfroBrazilian (Own work), via Wikimedia Commons<ref>[<"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0 or <"http://www.gnu.org/copyleft/fdl.html">GFDL], <"https://commons.wikimedia.org/wiki/File%3AHernia_spiegheli_01.JPG"></ref>]]
[[image:De Garengeot-Hernie mit Appendizitis - CT axial und coronar - 001.jpg|thumb|300px|Amyand's hernia: presence of appendix vermiformis (red arrows) in inguinal hernia - By Hellerhoff (Own work), via Wikimedia Commons<ref>[<"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0], <"https://commons.wikimedia.org/wiki/File%3ADe_Garengeot-Hernie_mit_Appendizitis_-_CT_axial_und_coronar_-_001.jpg"></ref>]]
|}
=== Umbilical hernia ===
* [[Umbilical hernia]] consists of 6% of all [[abdominal]] hernias in adults.
* The mainstay of treatment for [[umbilical hernia]] is surgery, including [[Mesh|Mesh repair]], Mayo repair, and [[Laparoscopic surgery|laparoscopic repair]].
* [[Strangulation]] and incarceration are very rare in [[umbilical hernia]].<ref name="pmid15972174">{{cite journal |vauthors=Polat C, Dervisoglu A, Senyurek G, Bilgin M, Erzurumlu K, Ozkan K |title=Umbilical hernia repair with the prolene hernia system |journal=Am. J. Surg. |volume=190 |issue=1 |pages=61–4 |year=2005 |pmid=15972174 |doi=10.1016/j.amjsurg.2004.09.021 |url=}}</ref>
For more information about umbilical hernia '''[[Umbilical hernia|click here]]'''
<br>
<br>


==External links==
=== Epigastric hernia ===
*[http://www.hernia.org/ Hernia Resources]
* [[Epigastric hernia]] is accounted for 0.5-5% of hernias.
*[http://www.herniablog.com/ The Hernia Blog]
* [[Epigastric hernia]] is a kind of [[abdominal wall]] herniation which is caused by weakness or defect in upper [[abdominal muscles]] or [[tendons]].
*[http://www.herniasymptoms.org/ Hernia Symptoms]
* The herniated contents are mostly [[vascular]] structures and properitoneal fat, rarely [[Abdominal|abdominal viscera]].<ref name="pmid25667986">{{cite journal| author=Grella R, Razzano S, Lamberti R, Trojaniello B, D'Andrea F, Nicoletti GF| title=Combined epigastric hernia repair and mini-abdominoplasty. Case report. | journal=Int J Surg Case Rep | year= 2015 | volume= 8C | issue=  | pages= 111-3 | pmid=25667986 | doi=10.1016/j.ijscr.2014.10.033 | pmc=4353989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25667986  }}</ref>
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*[http://www.wikisurgery.com/index.php?title=Hernia-femoral-adult-Operationscript Hernia femoral adult: Operation Script on Wikisurgery].
=== Spigelian hernia ===
* [[Spigelian hernia]] is caused by a defect in [[anterior abdominal wall]]. It is also named “[[spontaneous lateral ventral hernia]]” or “hernia of semilunar line”.
* The mainstay of treatment for [[Spigelian hernia]] is surgery, can be done [[Laparoscopic surgery|laparoscopically]] or total exteraperitoneal repair method.
* Incarceration and secondary [[bowel obstruction]] are the probable [[complications]] of [[Spigelian hernia]].<ref name="pmid19547696">{{cite journal| author=Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M et al.| title=[Not Available]. | journal=J Minim Access Surg | year= 2008 | volume= 4 | issue= 4 | pages= 95-8 | pmid=19547696 | doi= | pmc=2699222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19547696  }}</ref>
<br>


*[http://www.wikisurgery.com/index.php?title=Hernia-femoral-adult-daycase-Patientinformation Hernia femoral adult day case: Information for patients on Wikisurgery].
=== Incisional hernia ===
* [[Incisional hernia]] occurs in 20% of patients [[Postoperative complication|postoperatively]].
* The common risk factors for patients with [[Post operative complications|postoperative]] [[incisional hernia]] include [[obesity]], [[diabetes]], emergency surgery, [[Wound dehiscence|postoperative wound dehiscence]], [[smoking]], and post-operative wound infection.
* The mainstay of treatment for [[incisional hernia]] is open [[abdominal]] fixation [[surgery]].<ref name="pmid16719992">{{cite journal| author=Kingsnorth A| title=The management of incisional hernia. | journal=Ann R Coll Surg Engl | year= 2006 | volume= 88 | issue= 3 | pages= 252-60 | pmid=16719992 | doi=10.1308/003588406X106324 | pmc=1963672 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16719992  }}</ref>
<br>


*[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-adult-Operationscript Hernia inguinal adult day case: Operation Script  on Wikisurgery].
=== Amyand's hernia ===
* [[Amyand's hernia]] is a kind of [[inguinal hernia]] which contains [[Vermiform appendix|appendix vermiformis]].
* The incidence of [[Amyand's hernia]] is approximately 0.19% to 1.7% of all reported hernias.
* The [[strangulation]] and infarction are common complications of [[Amyand's hernia]].<ref name="pmid24473371">{{cite journal| author=Ivanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR| title=Amyand's hernia: a review. | journal=Med Sci Monit | year= 2014 | volume= 20 | issue=  | pages= 140-6 | pmid=24473371 | doi=10.12659/MSM.889873 | pmc=3915004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24473371 }}</ref>
<br>


*[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-TAPP-Operationscript Hernia inguinal TAPP: Operation Script on Wikisurgery].
=== Littre's hernia ===
* Littre's hernia is incarcerated [[Meckel's diverticulum]] in [[Femoral hernia|femoral]], [[Inguinal hernia|inguinal]], or [[umbilical hernia]].
* Littre's hernia is a very rare condition, reported only in 50 cases till date.
* [[Bowel obstruction]] and local inflammation are the possible [[complications]].<ref name="pmid28597002">{{cite journal| author=Malling B, Karlsen AA, Hern J| title=Littre Hernia: A Rare Case of an Incarcerated Meckel's Diverticulum. | journal=Ultrasound Int Open | year= 2017 | volume= 3 | issue= 2 | pages= E91-E92 | pmid=28597002 | doi=10.1055/s-0043-102179 | pmc=5462611 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28597002  }}</ref>
<br>


*[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-adult-daycase-Patientinformation  Hernia inguinal adult day case: Information for patients on Wikisurgery].
=== Richter's hernia ===
* Richter's hernia is first described in 1598.
* Richter's hernia is the incarceration of a part of [[bowel]] in [[Femoral hernia|femoral]], [[Inguinal hernia|inguinal]], or [[umbilical hernia]].
* Since the high rates of [[Strangulation|strangulations]] and [[bowels]] infarctions, the [[mortality rate]] is very high and emergency surgical intervention is mandatory.<ref name="pmid8542091">{{cite journal |vauthors=Kadirov S, Sayfan J, Friedman S, Orda R |title=Richter's hernia--a surgical pitfall |journal=J. Am. Coll. Surg. |volume=182 |issue=1 |pages=60–2 |year=1996 |pmid=8542091 |doi= |url=}}</ref>
<br>


*[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-child-herniotomy-Operationscript Hernia inguinal child: Operation Script on Wikisurgery].
=== Parastomal hernia ===
* [[Parastomal hernia]] is a common complication of [[colostomy]] or [[ileostomy]], actually a type of [[incisional hernia]] related to them.
* [[Parastomal hernia]] is classified into 4 subtpes:
** '''[[Interstitial]]:''' The hernial sac lies within the layers of the [[abdominal wall]].
** '''[[Subcutaneous]]:''' The hernial sac lies in the [[subcutaneous]] plane.
** '''Intrastomal:''' The hernial sac penetrates into a spout [[ileostomy]].
** '''Peristomal ([[prolapse]]):''' The hernial sac lies within a prolapsing stoma.<ref name="pmid12854101">{{cite journal |vauthors=Carne PW, Robertson GM, Frizelle FA |title=Parastomal hernia |journal=Br J Surg |volume=90 |issue=7 |pages=784–93 |year=2003 |pmid=12854101 |doi=10.1002/bjs.4220 |url=}}</ref>
<br>


*[http://www.wikisurgery.com/index.php?title=Hernia-inguinal-child-herniotomy-Patientinformation Hernia inguinal child: Information for patients on Wikisurgery].
== Pelvic Hernia ==


*[http://www.wikisurgery.com/index.php?title=Hernia-umbilical-adult-Patientinformation Hernia umbilical adult: Information for patients on Wikisurgery].
=== Inguinal hernia ===
* [[Inguinal hernia]] accounts for 75% of all hernias. [[Inguinal hernia]] repair is one of the most common [[surgeries]] in US (28 per 100,000 individuals).
* [[Inguinal hernia]] is a bulging [[lump]] in [[Groin area|groin region]], presents commonly without [[pain]] or [[Inflammation|local inflammation]].
* [[Inguinal hernias]] classification is as follows:
** '''[[Direct inguinal hernia|Direct hernia]]:''' The hernia sac herniates directly through the posterior wall of the [[inguinal canal]].
** '''[[Indirect inguinal hernia|Indirect hernia]]:''' The hernia sac herniates through the [[internal inguinal ring]] alongside the [[spermatic cord]].<ref name="pmid18244999">{{cite journal| author=Jenkins JT, O'Dwyer PJ| title=Inguinal hernias. | journal=BMJ | year= 2008 | volume= 336 | issue= 7638 | pages= 269-72 | pmid=18244999 | doi=10.1136/bmj.39450.428275.AD | pmc=2223000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18244999  }}</ref>
For more information about inguinal hernia '''[[Inguinal hernia|click here]]'''


*[http://www.wikisurgery.com/index.php?title=Hernia-umbilical-child-Operationscript Hernia umbilical child: Operation Script on Wikisurgery].
=== Obturator hernia ===
* Less than 1% of all hernias are [[obturator hernia]], and majority of times occurs in elderly women with [[chronic disease]].
* [[Obturator hernia]] is herniation of [[small intestine]] through [[obturator canal]], therefore mechanical [[small intestine]] obstruction is the most common complication.
* The most common symptoms of [[obturator hernia]] are [[groin]] and proximal [[thigh]] pain.<ref name="pmid3413651">{{cite journal |vauthors=Bjork KJ, Mucha P, Cahill DR |title=Obturator hernia |journal=Surg Gynecol Obstet |volume=167 |issue=3 |pages=217–22 |year=1988 |pmid=3413651 |doi= |url=}}</ref>


*[http://www.wikisurgery.com/index.php?title=Hernia-umbilical-child-Patientinformation Hernia umbilical child: Information for patients on Wikisurgery].
=== Perineal hernia ===
* [[Perineal hernia]] is herniation of [[intraperitoneal]] or [[Extraperitoneal fat|extraperitoneal]] contents through a [[congenital]] or acquired defect of the [[pelvic diaphragm]].
* [[Perineal hernia]] may be anterior or posterior to the [[Perineal membrane|superficial perineal muscles]].
* Majority of the times [[Perineal hernia|perineal hernias]] are [[congenital]] condition, while acquired [[Perineal hernia|perineal hernias]] are [[incisional hernia]] secondary to major [[pelvic]] surgeries (e.g., [[abdominoperineal resection]] of the anorectum and [[pelvic exenteration]]).<ref name="pmid20506875">{{cite journal |vauthors=Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P |title=Perineal hernia: surgical anatomy, embryology, and technique of repair |journal=Am Surg |volume=76 |issue=5 |pages=474–9 |year=2010 |pmid=20506875 |doi= |url=}}</ref>


{{Gastroenterology}}
=== Femoral hernia ===
* [[Femoral hernia]] is the condition in which [[bowels]] herniate through [[femoral triangle]] medial to [[Femoral vein|femoral vessels]].
* The classification of [[Femoral hernia|femoral hernias]] into prevascular and retrovascular hernias is based on their position related to [[Femoral vein|femoral vessels]].
* [[Strangulation]] and incarceration of [[Femoral hernia|femoral hernias]] are common.<ref name="pmid18724783">{{cite journal| author=Paquet M, Penney J, Boerboom D| title=Lateral femoral hernias in a line of FVB/NHsd mice: a new confounding lesion linked to genetic background? | journal=Comp Med | year= 2008 | volume= 58 | issue= 4 | pages= 395-8 | pmid=18724783 | doi= | pmc=2706040 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18724783  }}</ref>
For more information about femoral hernia '''[[Femoral hernia|click here]]'''


[[Category:Surgery]]
=== Sciatic hernia ===
[[Category:Hernias]]
* [[Sciatic hernia]] is a rare herniation of [[bowels]] through the [[Greater sciatic foramen|greater]] or [[lesser sciatic foramen]].
 
* The [[symptoms]] and [[Physical examination|physical examinations]] are very similar to [[obturator hernia]].
[[ca:Hèrnia]]
* [[Swelling]] of [[gluteal region]], severe [[pelvic pain]] and local [[paresthesia]] are the common symptoms of [[sciatic hernia]].
[[de:Hernie]]
* The mainstay of treatment is [[surgery]] and includes transabdominal and transgluteal approaches.<ref name="pmid21935810">{{cite journal |vauthors=Rather SA, Dar TI, Malik AA, Parray FQ, Ahmad M, Asrar S |title=Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report |journal=Ulus Travma Acil Cerrahi Derg |volume=17 |issue=3 |pages=277–9 |year=2011 |pmid=21935810 |doi= |url=}}</ref>
[[es:Hernia]]
[[fr:Hernie]]
[[ko:탈장]]
[[it:Ernia]]
[[he:בקע]]
[[nl:Hernia]]
[[ja:ヘルニア]]
[[no:Brokk]]
[[nn:brokk]]
[[pl:Przepuklina]]
[[pt:Hérnia]]
[[ru:Грыжа]]
[[sr:Брух]]
[[fi:Tyrä]]
[[sv:Bråck]]
[[tr:Fıtık]]


=References=
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[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Emergency medicine]]

Latest revision as of 22:08, 29 July 2020


Hernia Landing page

Patient Information

Classification

Inguinal hernia
Femoral hernia
Umbilical hernia
Diaphragmatic hernia
Incisional hernia
Others

Differential Diagnosis

CNS Hernia

Brain Hernia
Lumbar Disc Hernia

Diaphragmatic Hernia

Bochdalek Hernia
Morgagni Hernia

Hiatal Hernia

Sliding Hernia
Paraesophageal Hernias

Lumbar Hernia

Petit's Hernia
Grynfeltt's Hernia

Abdominal Hernia

Umbilical Hernia
Epigastric Hernia
Spigelian Hernia
Incisional Hernia
Amyand's Hernia
Richter's Hernia
Parastomal Hernia

Pelvic Hernia

Inguinal Hernia
Obturator Hernia
Perineal Hernia
Incisional Hernia
Femoral Hernia
Sciatic Hernia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2], Anmol Pitliya, M.B.B.S. M.D.[3]

Overview

A hernia is “the protrusion of an organ, organic part, or other bodily structure through the wall that usually contains it.[1] Hernias may be congenital or acquired. Based on the protruded body structure and the location of the protrusion, the hernia may be classified into inguinal, femoral, umbilical, diaphragmatic, incisional, and other hernias. Different kinds of hernias, such as central nervous system (CNS), diaphragmatic, lumbar, abdominal, and pelvic hernias have to be differentiated on the basis of clinical manifestations.

Classification

Major classification of hernias in human body.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hernia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CNS
 
Hiatal
 
Diaphragmatic
 
 
 
 
 
Lumbar
 
Abdominal
 
 
 
 
 
 
 
Pelvic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Brain hernia
 
Lumbar disc hernia
 
 
Morgagni hernia
 
Bochdalek hernia
 
Petit's hernia
 
Grynfeltt's hernia
 
 
Inguinal hernia
 
Obturator hernia
 
Perineal hernia
 
Femoral hernia
 
Sciatic hernia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sliding hernia
 
 
Paraesophageal hernia
 
Umbilical hernia
 
Epigastric hernia
 
Spigelian hernia
 
Incisional hernia
 
Amyand's hernia
 
Littre's hernia
 
Richter's hernia
 
Parastomal hernia
 

Differential Diagnosis

Location Diseases History and Symptoms Physical Examination Laboratory Findings Definition
Neurological GI Neurological GI
Confusion Paresthesia Dysphagia Heartburn Nausea Bowel habits Loss of Consciousness Straight leg raise (SLR) Mass protrusion Tenderness/Rebound tenderness Leukocytosis CRP ESR
CNS Brain hernia[2] + + + - + - + - - - - - - Brain tissue herniation through foramen magnum
Lumbar disc hernia[3] - + - - - - - + - - - - - Nucleus pulposus herniation through annulus fibrosus
Hiatal[4] Sliding hernia - - + + + - - - - - - + - Stomach herniation through diaphragm
Paraesophageal hernia - - + + + - - - - - - - - Esophagus herniation through diaphragm
Diaphragmatic[5] Morgagni hernia - - + - + - - - - - - - - Congenital herniation of stomach through left side of diaphragm
Bochdalek hernia - - + - + - - - - - - - - Congenital herniation of stomach through right anterior side of diaphragm
Abdominal Umbilical hernia[6] - - - - + + - - + + + + - Bowels herniation through umbilicus
Epigastric hernia[7] - - - + + + - - + + + + - Bowels herniation through epigastric abdominal wall
Spigelian hernia[8] - - - - + + - - + + + + - Bowels herniation through lateral abdominal wall
Amyand's hernia[9] - - - - + + - - + + + + - Appendix vermiformis herniation through abdominal wall
Littre's hernia[10] - - - - + + - - + + + + - Meckel's diverticulum herniation through abdominal wall
Richter's hernia[11] - - - - + + - - + + + + + Bowels herniation and strangulation through abdominal wall
Parastomal hernia[12] - - - - + + - - + + + + + Bowels herniation through stoma in the abdominal wall
Pelvic Inguinal hernia[13] - - - - - + - - + + - - - Bowels herniation through inguinal ring
Obturator hernia[14] - + - - - + - - - + - - - Viscera herniation through obturator canal
Perineal hernia[15] - - - - - + - - + + + - - Viscera herniation through pelvic floor
Femoral hernia[16] - + - - - + - - + + - - - Bowels herniation through femoral ring
Sciatic hernia[17] - + - - - + - + - + + - + Viscera herniation through sciatic canal

CNS Hernia

Different types of brain herniation - By User:Delldot, via Wikimedia Commons[18]
Lumbar disc herniation - By BruceBlaus, via Wikimedia Commons[19]

Brain hernia

For more information about brain hernia click here







Lumbar disc hernia

For more information about lumbar disc hernia click here






Diaphragmatic Hernia

Bochdalek hernia

For more information about Bochdalek hernia click here

Morgagni hernia

For more information about Morgagni hernia click here

Hiatal Hernia

Sliding hernia

Different types of hiatal herniation - By Mysid, via Wikimedia Commons[24]

Type I

Paraesophageal hernias

Type II

Type III

Type IV

For more information about hiatal hernia click here

Lumbar Hernia

Lumbar triangles - Zyryab at English Wikipedia, via Wikimedia Commons[25]

Petit's hernia

Grynfeltt's hernia

  • Superior lumbar region has a triangle formed formed medially by the quadratus lumborum muscle, laterally by the internal abdominal oblique muscle, and superiorly by the 12th rib.
  • Grynfeltt's hernia is defined as herniation of retroperitoneal fat through transversalis muscle aponeurosis within the superior lumbar triangle.
  • The mainstay of treatment for lumbar hernias is surgery fixation.[26]


Abdominal Hernia

Umbilical hernia - By Rocco_Cusari, via Wikimedia Commons[27]
Epigastric hernia - By PacoPeramo (Own work), via Wikimedia Commons[28]
Spigelian hernia - By AfroBrazilian (Own work), via Wikimedia Commons[29]
Amyand's hernia: presence of appendix vermiformis (red arrows) in inguinal hernia - By Hellerhoff (Own work), via Wikimedia Commons[30]

Umbilical hernia

For more information about umbilical hernia click here

Epigastric hernia


Spigelian hernia


Incisional hernia


Amyand's hernia


Littre's hernia


Richter's hernia


Parastomal hernia


Pelvic Hernia

Inguinal hernia

For more information about inguinal hernia click here

Obturator hernia

Perineal hernia

Femoral hernia

For more information about femoral hernia click here

Sciatic hernia

References

Template:WH Template:WS

  1. ↑ Webster's new college dictionary. Boston: Houghton Mifflin Harcourt. 2008. p. 531. ISBN 9780618396016.
  2. ↑ Fisher CM (1995). "Brain herniation: a revision of classical concepts". Can J Neurol Sci. 22 (2): 83–91. PMID 7627921.
  3. ↑ Schoenfeld AJ, Weiner BK (2010). "Treatment of lumbar disc herniation: Evidence-based practice". Int J Gen Med. 3: 209–14. PMC 2915533. PMID 20689695.
  4. ↑ 4.0 4.1 Hyun JJ, Bak YT (2011). "Clinical significance of hiatal hernia". Gut Liver. 5 (3): 267–77. doi:10.5009/gnl.2011.5.3.267. PMC 3166665. PMID 21927653.
  5. ↑ "Congenital Diaphragmatic Hernia Overview - GeneReviews® - NCBI Bookshelf".
  6. ↑ Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ (2003). "Laparoscopic versus open umbilical hernia repair". JSLS. 7 (4): 323–8. PMC 3021337. PMID 14626398.
  7. ↑ Muschaweck U (2003). "Umbilical and epigastric hernia repair". Surg. Clin. North Am. 83 (5): 1207–21. doi:10.1016/S0039-6109(03)00119-1. PMID 14533911.
  8. ↑ 8.0 8.1 Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M; et al. (2008). "[Not Available]". J Minim Access Surg. 4 (4): 95–8. PMC 2699222. PMID 19547696.
  9. ↑ Singal R, Gupta S (2011). ""Amyand's Hernia" - Pathophysiology, Role of Investigations and Treatment". Maedica (Buchar). 6 (4): 321–7. PMC 3391951. PMID 22879848.
  10. ↑ Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006). "Littre hernia: surgical anatomy, embryology, and technique of repair". Am Surg. 72 (3): 238–43. PMID 16553126.
  11. ↑ Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006). "Richter hernia: surgical anatomy and technique of repair". Am Surg. 72 (2): 180–4. PMID 16536253.
  12. ↑ Gillern S, Bleier JI (2014). "Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials". Clin Colon Rectal Surg. 27 (4): 162–71. doi:10.1055/s-0034-1394090. PMC 4226750. PMID 25435825.
  13. ↑ 13.0 13.1 Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  14. ↑ Nakayama T, Kobayashi S, Shiraishi K, Nishiumi T, Mori S, Isobe K, Furuta Y (2002). "Diagnosis and treatment of obturator hernia". Keio J Med. 51 (3): 129–32. PMID 12371643.
  15. ↑ Levic K, Rosen KV, Bulut O, Bisgaard T (2017). "Low incidence of perineal hernia repair after abdominoperineal resection for rectal cancer". Dan Med J. 64 (7). PMID 28673377.
  16. ↑ LUDINGTON LG (1958). "Femoral hernia and its management, with particular reference to its occurrence following inguinal herniorrhaphy". Ann Surg. 148 (5): 823–6. PMC 1450902. PMID 13595543.
  17. ↑ Kandpal H, Madhusudhan KS (2010). "Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve". Br J Radiol. 83 (987): e65–6. doi:10.1259/bjr/47866965. PMC 3473559. PMID 20197431.
  18. ↑ [<"http://www.gnu.org/copyleft/fdl.html">GFDL, <"http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0 or <"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0], <"https://commons.wikimedia.org/wiki/File%3ABrain_herniation_types.svg">
  19. ↑ Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. (Own work) [<"http://creativecommons.org/licenses/by/3.0">CC BY 3.0], <"https://commons.wikimedia.org/wiki/File%3ABlausen_0484_HerniatedLumbarDisc.png">
  20. ↑ Stevens RD, Shoykhet M, Cadena R (2015). "Emergency Neurological Life Support: Intracranial Hypertension and Herniation". Neurocrit Care. 23 Suppl 2: S76–82. doi:10.1007/s12028-015-0168-z. PMC 4791176. PMID 26438459.
  21. ↑ "Herniated Disc - National Library of Medicine - PubMed Health".
  22. ↑ Newman BM, Afshani E, Karp MP, Jewett TC, Cooney DR (1986). "Presentation of congenital diaphragmatic hernia past the neonatal period". Arch Surg. 121 (7): 813–6. PMID 3718216.
  23. ↑ Robnett-Filly B, Goldstein RB, Sampior D, Hom M (2003). "Morgagni hernia: a rare form of congenital diaphragmatic hernia". J Ultrasound Med. 22 (5): 537–9. PMID 12751867.
  24. ↑ [<"http://creativecommons.org/publicdomain/zero/1.0/deed.en">CC0], <"https://commons.wikimedia.org/wiki/File%3AHiatus_hernia.svg">
  25. ↑ <"https://en.wikipedia.org/wiki/User:Zyryab" class="extiw" title="wikipedia:User:Zyryab">Zyryab at <"https://en.wikipedia.org/wiki/" class="extiw" title="wikipedia:">English Wikipedia [<"http://www.gnu.org/copyleft/fdl.html">GFDL, <"http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0 or <"http://creativecommons.org/licenses/by/2.5">CC BY 2.5], <"https://commons.wikimedia.org/wiki/File%3ALumbarTriangle.jpg">via Wikimedia Commons
  26. ↑ Başak F, Hasbahçeci M, Canbak T, Acar A, Şişik A, Baş G; et al. (2017). "Lumbar (Petit's) hernia: A rare entity". Turk J Surg. 33 (3): 220–221. doi:10.5152/UCD.2015.2986. PMC 5602318. PMID 28944339.
  27. ↑ [<"https://creativecommons.org/licenses/by-sa/2.5">CC BY-SA 2.5], <"https://commons.wikimedia.org/wiki/File%3AErnia_Ombelicale.jpg">
  28. ↑ [<"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0], <"https://commons.wikimedia.org/wiki/File%3AHernia_epig%C3%A1strica.png">
  29. ↑ [<"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0 or <"http://www.gnu.org/copyleft/fdl.html">GFDL], <"https://commons.wikimedia.org/wiki/File%3AHernia_spiegheli_01.JPG">
  30. ↑ [<"https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0], <"https://commons.wikimedia.org/wiki/File%3ADe_Garengeot-Hernie_mit_Appendizitis_-_CT_axial_und_coronar_-_001.jpg">
  31. ↑ Polat C, Dervisoglu A, Senyurek G, Bilgin M, Erzurumlu K, Ozkan K (2005). "Umbilical hernia repair with the prolene hernia system". Am. J. Surg. 190 (1): 61–4. doi:10.1016/j.amjsurg.2004.09.021. PMID 15972174.
  32. ↑ Grella R, Razzano S, Lamberti R, Trojaniello B, D'Andrea F, Nicoletti GF (2015). "Combined epigastric hernia repair and mini-abdominoplasty. Case report". Int J Surg Case Rep. 8C: 111–3. doi:10.1016/j.ijscr.2014.10.033. PMC 4353989. PMID 25667986.
  33. ↑ Kingsnorth A (2006). "The management of incisional hernia". Ann R Coll Surg Engl. 88 (3): 252–60. doi:10.1308/003588406X106324. PMC 1963672. PMID 16719992.
  34. ↑ Ivanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR (2014). "Amyand's hernia: a review". Med Sci Monit. 20: 140–6. doi:10.12659/MSM.889873. PMC 3915004. PMID 24473371.
  35. ↑ Malling B, Karlsen AA, Hern J (2017). "Littre Hernia: A Rare Case of an Incarcerated Meckel's Diverticulum". Ultrasound Int Open. 3 (2): E91–E92. doi:10.1055/s-0043-102179. PMC 5462611. PMID 28597002.
  36. ↑ Kadirov S, Sayfan J, Friedman S, Orda R (1996). "Richter's hernia--a surgical pitfall". J. Am. Coll. Surg. 182 (1): 60–2. PMID 8542091.
  37. ↑ Carne PW, Robertson GM, Frizelle FA (2003). "Parastomal hernia". Br J Surg. 90 (7): 784–93. doi:10.1002/bjs.4220. PMID 12854101.
  38. ↑ Bjork KJ, Mucha P, Cahill DR (1988). "Obturator hernia". Surg Gynecol Obstet. 167 (3): 217–22. PMID 3413651.
  39. ↑ Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P (2010). "Perineal hernia: surgical anatomy, embryology, and technique of repair". Am Surg. 76 (5): 474–9. PMID 20506875.
  40. ↑ Paquet M, Penney J, Boerboom D (2008). "Lateral femoral hernias in a line of FVB/NHsd mice: a new confounding lesion linked to genetic background?". Comp Med. 58 (4): 395–8. PMC 2706040. PMID 18724783.
  41. ↑ Rather SA, Dar TI, Malik AA, Parray FQ, Ahmad M, Asrar S (2011). "Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report". Ulus Travma Acil Cerrahi Derg. 17 (3): 277–9. PMID 21935810.
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