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1 Hernias
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1.3.1 Structure
Derived from the Greek word hernos (bud, sprout, protrusion), the term herniaDerived from the Greek word
hrnos (bud, sprout, protrusion). Hernia with congenital or acquired gap in the abdominal wall or diaphragm
(hernial orifice) through which the peritoneum (hernial sac), possibly together with parts of the intestines, protrudes.
means an opening, for example in the abdominal wallThe anterior tissue structures (skin, subcutaneous adipose
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Hernial orificeGap in the abdominal wall or in the diaphragm through which the peritoneum, possibly
together with parts of the intestines, protrudes.: Disease-induced gap, for example in the abdominal wall.
Depending on its location, it runs through different tissue layers (muscles, tendons, scar tissue, etc.). The location
of the hernial opening determines how the hernia will be designated, for example, one uses the term inguinal
herniaThe most common type of hernia with hernial orifice above the inguinal ligament in the region of the lateral or
medial inguinal fossa (Latin term: [no-glossary]fossa inguinalis lateralis[/no-glossary]/medialis). See also lateral
inguinal hernia and medial inguinal hernia., umbilical hernia (close to the navel), incisional herniaHernia occurring
after an abdominal operation in the region of the surgical scar. (in the region of a surgical scar), diaphragmatic
herniaHernia in the region of the diaphragm. See also hiatal hernia., etc.
Hernial sacEvagination of the peritoneum that protrudes through a hernial orifice. It may contain
hernia contents.: Projection of the peritoneum protruding through the hernial opening. On the outside the hernial
sac is covered by subcutaneous adipose tissue and skin. These layers are called the hernia coveringStructure
enclosing the hernial sac with subcutaneous adipose tissue and skin. .
Hernia contents: The hernial sac is either empty or as in the majority of cases filled with the hernia
contents. The hernia contents can be made of different components, for example of intestinal loops and/or parts of
the greater omentumLatin term: omentum majus. An adipose and connective tissue layer lined with the peritoneum
and covering the small intestine. The greater omentum is responsible for immune defence in the abdominal
cavity. (this is an apron-like peritoneal structure made of fat and connective tissue which is normally spread across
the intestinal loops). The hernia sac generally contains a fluid called hernia waterFluid contained within the hernial
sac, promoting sliding of the hernia contents., promoting sliding of the hernia contents.
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1.3.2 Causes
A herniaDerived from the Greek word hrnos (bud, sprout, protrusion). Hernia with congenital or acquired gap in
the abdominal wall or diaphragm (hernial orifice) through which the peritoneum (hernial sac), possibly together with
parts of the intestines, protrudes. can have different causes. Essentially, a distinction is made between congenital
and acquired herniaHernia with hernial orifice and hernial sac situated at a location on the abdominal wall where
there is acquired weakness. The reduction in the strength of the abdominal wall may be due to: impaired collagen
synthesis, raised internal abdominal pressure, overweight, pregnancy.s.
1.3.3 Complications
HerniaDerived from the Greek word hrnos (bud, sprout, protrusion). Hernia with congenital or acquired gap in
the abdominal wall or diaphragm (hernial orifice) through which the peritoneum (hernial sac), possibly together with
parts of the intestines, protrudes.s can lead to a number of physical and aesthetic defects. Strangulation of the
hernial sacEvagination of the peritoneum that protrudes through a hernial orifice. It may contain hernia contents. in
the hernial opening gives rise to a dangerous situation. This is called incarcerationConstriction of tissue, for
example of hernia contents such as greater omentum or intestinal loops in the presence of hernias. Due to swelling
following blood congestion and oedema there is a risk of death (necrosis) of the constricted organs. and results in
local blood congestionLocal accumulation of blood. and leakage of fluid into the tissues (oedemaWater
accumulation in tissue; accompanied by swelling of the tissue.). Tissue swelling leads to virtual strangulation and
impaired blood flow of the organ structure enclosed within the hernial sac. If, because of its size, it is no longer
possible to push back the hernial sac into the body, there is a risk of death (necrosisTissue death due to
irreversible failure of cell functions (cell death).) of its contents, for example strangulated intestinal loops, if surgery
is not promptly carried out. This situation causes the patient severe pain and constitutes an acute emergency
warranting immediate hospitalisation or emergency treatment.
Strangulation of a hernia poses a threat of tissue death and calls for immediate surgery.
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Hiatal herniaDiaphragmatic hernia Diaphragmatic herniaHernia in the region of the diaphragm. See also hiatal hernia. at the s
protruding through the
the oesophagusGullet. enters the abdomen
oesophageal hiatus.
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1.4.8.2 Spieghel herniaA rare hernia which, in the region of the lateral abdominal wall, penetrates what is known as
Spieghels line (muscle-tendon border of the transverse abdominal muscle at the lateral margin of the rectus
abdominis muscle).
This is a hernia which occurs in the region of the lateral abdominal wallThe anterior tissue structures (skin,
subcutaneous adipose tissue as well as muscle layers) enclosing the abdominal cavity.. It penetrates what is
known as Spieghels line (muscle-tendon border of the transverse abdominal muscle at the lateral margin of the
anterior rectus abdominis muscleLatin term: musculus rectus abdominis. The rectus muscle runs in two straight
lines from the chest to the pelvis. It is subdivided by several intermediate tendons.).
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