DOCSLIB.ORG

Inguinal Hernia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Inguinal Hernia Inguinal Hernia National Digestive Diseases Information Clearinghouse What is inguinal hernia? What are the types and An inguinal hernia is a condition in which causes of inguinal hernia? intra-abdominal fat or part of the small The two types of inguinal hernia have differ­ intestine, also called the small bowel, bulges U.S. Department ent causes. of Health and through a weak area in the lower abdominal Human Services muscles. An inguinal hernia occurs in the Indirect inguinal hernia. Indirect inguinal groin—the area between the abdomen and hernias are congenital hernias and are much NATIONAL thigh. This type of hernia is called inguinal more common in males than females because INSTITUTES OF HEALTH because fat or part of the intestine slides of the way males develop in the womb. In through a weak area at the inguinal ring, the a male fetus, the spermatic cord and both opening to the inguinal canal. An inguinal testicles—starting from an intra-abdominal hernia appears as a bulge on one or both location—normally descend through the sides of the groin. An inguinal hernia can inguinal canal into the scrotum, the sac that occur any time from infancy to adulthood holds the testicles. Sometimes the entrance and is much more common in males than of the inguinal canal at the inguinal ring does females. Inguinal hernias tend to become not close as it should just after birth, leav­ larger with time. ing a weakness in the abdominal wall. Fat or part of the small intestine slides through the weakness into the inguinal canal, caus­ ing a hernia. In females, an indirect inguinal Small intestine hernia is caused by the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall. Internal Indirect hernias are the most common type inguinal ring of inguinal hernia. Premature infants are External especially at risk for indirect inguinal hernias inguinal ring because there is less time for the inguinal Pubic canal to close. Penis bone Spermatic Direct inguinal hernia. Direct inguinal her­ cord nias are caused by connective tissue degener­ ation of the abdominal muscles, which causes Testes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small An inguinal hernia showing the small intestine descending through the inguinal canal. intestine sliding through the weak muscles What are “incarcerated” into the groin. A direct hernia develops gradually because of continuous stress on and “strangulated” inguinal the muscles. One or more of the following hernias? factors can cause pressure on the abdominal An incarcerated inguinal hernia is a hernia muscles and may worsen the hernia: that becomes stuck in the groin or scro­ tum and cannot be massaged back into the • sudden twists, pulls, or muscle strains abdomen. An incarcerated hernia is caused • lifting heavy objects by swelling and can lead to a strangulated • straining on the toilet because of hernia, in which the blood supply to the constipation incarcerated small intestine is jeopardized. A strangulated hernia is a serious condition • weight gain and requires immediate medical attention. • chronic coughing Symptoms of a strangulated hernia include Indirect and direct inguinal hernias usually • extreme tenderness and redness in the slide back and forth spontaneously through area of the bulge the inguinal canal and can often be moved • sudden pain that worsens in a short back into the abdomen with gentle massage. period of time What are the symptoms of • fever inguinal hernia? • rapid heart rate Symptoms of inguinal hernia include Left untreated, nausea, vomiting, and severe infection can occur. If surgery is not per­ • a small bulge in one or both sides of formed right away, the condition can become the groin that may increase in size and life threatening, and the affected intestine disappear when lying down; in males, may die. Then that portion of the intestine it can present as a swollen or enlarged must be removed. scrotum • discomfort or sharp pain—especially How is inguinal hernia when straining, lifting, or exercising— diagnosed? that improves when resting To diagnose inguinal hernia, the doctor takes • a feeling of weakness or pressure in the a thorough medical history and conducts a groin physical examination. The person may be • a burning, gurgling, or aching feeling at asked to stand and cough so the doctor can the bulge feel the hernia as it moves into the groin or scrotum. The doctor checks to see if the hernia can be gently massaged back into its proper position in the abdomen. 2 Inguinal Hernia How is inguinal hernia best option if the hernia is very large or the treated? person has had pelvic surgery. In adults, inguinal hernias that enlarge, Most adults experience discomfort after sur­ cause symptoms, or become incarcerated are gery and require pain medication. Vigorous treated surgically. In infants and children, activity and heavy lifting are restricted for inguinal hernias are always operated on to several weeks. The doctor will discuss when prevent incarceration from occurring. Sur­ a person may safely return to work. Infants gery is usually done on an outpatient basis. and children also experience some discom­ Recovery time varies depending on the size fort but usually resume normal activities of the hernia, the technique used, and the after several days. age and health of the patient. The two main types of surgery for hernias are as follows: What are the complications • “Open” hernia repair. In open hernia of surgery for inguinal repair, also called herniorrhaphy, a hernia? person is given local anesthesia in the Surgery to repair an inguinal hernia is quite abdomen or spine to numb the area, safe and complications are uncommon. general anesthesia to sedate or help the Knowing possible risks allows patients to person sleep, or a combination of the report postoperative symptoms to their doc­ two. Then the surgeon makes an inci­ tor as soon as they occur. sion in the groin, moves the hernia back into the abdomen, and reinforces the • Risk of general anesthesia. Before muscle wall with stitches. Usually the surgery, the anesthesiologist—a doctor area of muscle weakness is reinforced who administers anesthesia—reviews with a synthetic mesh or screen to pro­ the risks of anesthesia with the patient vide additional support—an operation and asks about medical history and called hernioplasty. allergies to medications. Complications • Laparoscopy. Laparoscopic surgery is most likely occur in older people and performed using general anesthesia. those with other medical conditions. The surgeon makes several small inci­ Common complications include nausea, sions in the lower abdomen and inserts vomiting, urinary retention, sore throat, a laparoscope—a thin tube with a tiny and headache. More serious problems video camera attached to one end. The include heart attack, stroke, pneumonia, camera sends a magnified image from and blood clots in the legs. inside the body to a monitor, giving the Getting out of bed after surgery and surgeon a close-up view of the hernia moving as soon as the doctor allows will and surrounding tissue. While viewing help reduce the risk of complications the monitor, the surgeon uses instru­ such as pneumonia and blood clots. ments to carefully repair the hernia using synthetic mesh. • Hernia recurrence. A hernia can recur up to several years after repair. Recur­ People who undergo laparoscopic surgery rence is the most common complica­ generally experience a somewhat shorter tion of inguinal hernia repair, causing recovery time. However, the doctor may patients to undergo a second operation. determine laparoscopic surgery is not the Hernia recurrence occurs less often when a hernioplasty is performed. 3 Inguinal Hernia • Bleeding. Bleeding inside the incision is Points to Remember another complication of inguinal hernia • An inguinal hernia is a condition in repair. It can cause severe swelling and which intra-abdominal fat or part of bluish discoloration of the skin around the small intestine, also called the small the incision. Surgery may be necessary bowel, bulges through a weak area in to open the incision and stop the bleed­ the lower abdominal muscles. An ingui­ ing. Bleeding is unusual and occurs in nal hernia occurs in the groin—the area less than 2 percent of patients.1 between the abdomen and thigh. • Wound infection. The risk of wound • An inguinal hernia can occur any time infection is small—less than 2 percent— from infancy to adulthood and is much and is more likely to occur in older more common in males than females. adults and people who undergo more complex hernia repair.2 The person • Direct and indirect hernias are the two may experience a fever, discharge types of inguinal hernia, and they have from the incision, and redness, swelling, different causes. or tenderness around the incision. Post­ • Symptoms of an inguinal hernia usually operative infection requires antibiotics appear gradually and include a bulge in and, occasionally, another procedure the groin, discomfort or sharp pain, a requiring local anesthesia to make a feeling of weakness or pressure in the small opening in the incision and drain groin, and a burning, gurgling, or aching the infection. feeling at the bulge. • Painful scar. Sometimes people expe­ • An incarcerated inguinal hernia is a her­ rience sharp, tingling pain in a spe­ nia that becomes stuck in the groin or cific area near the incision after it has scrotum and cannot be massaged back healed. The pain usually resolves with into the abdomen. time. Medicine may be injected in the area if the pain continues. • A strangulated hernia, in which the blood supply to the incarcerated small • Injury to internal organs. Although intestine is jeopardized, is a serious con­ extremely rare, injury to the intestine, dition and requires immediate medical bladder, kidneys, nerves and blood ves­ attention.
Load more

Recommended publications
  • Umbilical Hernia with Cholelithiasis and Hiatal Hernia
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Springer - Publisher Connector Yamanaka et al. Surgical Case Reports (2015) 1:65 DOI 10.1186/s40792-015-0067-8 CASE REPORT Open Access Umbilical hernia with cholelithiasis and hiatal hernia: a clinical entity similar to Saint’striad Takahiro Yamanaka*, Tatsuya Miyazaki, Yuji Kumakura, Hiroaki Honjo, Keigo Hara, Takehiko Yokobori, Makoto Sakai, Makoto Sohda and Hiroyuki Kuwano Abstract We experienced two cases involving the simultaneous presence of cholelithiasis, hiatal hernia, and umbilical hernia. Both patients were female and overweight (body mass index of 25.0–29.9 kg/m2) and had a history of pregnancy and surgical treatment of cholelithiasis. Additionally, both patients had two of the three conditions of Saint’s triad. Based on analysis of the pathogenesis of these two cases, we consider that these four diseases (Saint’s triad and umbilical hernia) are associated with one another. Obesity is a common risk factor for both umbilical hernia and Saint’s triad. Female sex, older age, and a history of pregnancy are common risk factors for umbilical hernia and two of the three conditions of Saint’s triad. Thus, umbilical hernia may readily develop with Saint’s triad. Knowledge of this coincidence is important in the clinical setting. The concomitant occurrence of Saint’s triad and umbilical hernia may be another clinical “tetralogy.” Keywords: Saint’s triad; Cholelithiasis; Hiatal hernia; Umbilical hernia Background of our knowledge, no previous reports have described the Saint’s triad is characterized by the concomitant occur- coexistence of umbilical hernia with any of the three con- rence of cholelithiasis, hiatal hernia, and colonic diverticu- ditions of Saint’s triad.
    [Show full text]
  • Diverticular Abscess Presenting As a Strangulated Inguinal Hernia: Case Report and Review of the Literature
    Ulster Med J 2007; 76 (2) 107-108 Presidential Address 107 Case Report Diverticular Abscess Presenting as a Strangulated Inguinal Hernia: Case Report and review of the literature. S Imran H Andrabi, Ashish Pitale*, Ahmed AS El-Hakeem Accepted 22 December 2006 ABSTRACT noted nausea, anorexia and increasing abdominal pain. She had no previous history of any surgery or trauma and was on Potentially life threatening diseases can mimic a groin hernia. warfarin for atrial fibrillation. We present an unusual case of diverticulitis with perforation and a resulting abscess presenting as a strangulated inguinal hernia. The features demonstrated were not due to strangulation of the contents of the hernia but rather pus tracking into the hernia sac from the peritoneal cavity. The patient underwent sigmoid resection and drainage of retroperitoneal and pericolonic abscesses. Radiological and laboratory studies augment in reaching a diagnosis. The differential diagnosis of inguinal swellings is discussed. Key Words: Diverticulitis, diverticular perforation, diverticular abscess, inguinal hernia INTRODUCTION The association of complicated inguinal hernia and diverticulitis is rare1. Diverticulitis can present as left iliac fossa pain, rectal bleeding, fistulas, perforation, bowel obstruction and abscesses. Our patient presented with a diverticular perforation resulting in an abscess tracking into the inguinal canal and clinically masquerading as a Fig 2. CT scan showing inflammatory changes with strangulated inguinal hernia. The management warranted an stranding of the subcutaneous fat in the left groin and a exploratory laparotomy and drainage of pus. large bowel diverticulum CASE REPORT On admission, she had a tachycardia (pulse 102 beats/min) and a temperature of 37.5OC.
    [Show full text]
  • Abdominal Pain - Gastroesophageal Reflux Disease
    ACS/ASE Medical Student Core Curriculum Abdominal Pain - Gastroesophageal Reflux Disease ABDOMINAL PAIN - GASTROESOPHAGEAL REFLUX DISEASE Epidemiology and Pathophysiology Gastroesophageal reflux disease (GERD) is one of the most commonly encountered benign foregut disorders. Approximately 20-40% of adults in the United States experience chronic GERD symptoms, and these rates are rising rapidly. GERD is the most common gastrointestinal-related disorder that is managed in outpatient primary care clinics. GERD is defined as a condition which develops when stomach contents reflux into the esophagus causing bothersome symptoms and/or complications. Mechanical failure of the antireflux mechanism is considered the cause of GERD. Mechanical failure can be secondary to functional defects of the lower esophageal sphincter or anatomic defects that result from a hiatal or paraesophageal hernia. These defects can include widening of the diaphragmatic hiatus, disturbance of the angle of His, loss of the gastroesophageal flap valve, displacement of lower esophageal sphincter into the chest, and/or failure of the phrenoesophageal membrane. Symptoms, however, can be accentuated by a variety of factors including dietary habits, eating behaviors, obesity, pregnancy, medications, delayed gastric emptying, altered esophageal mucosal resistance, and/or impaired esophageal clearance. Signs and Symptoms Typical GERD symptoms include heartburn, regurgitation, dysphagia, excessive eructation, and epigastric pain. Patients can also present with extra-esophageal symptoms including cough, hoarse voice, sore throat, and/or globus. GERD can present with a wide spectrum of disease severity ranging from mild, intermittent symptoms to severe, daily symptoms with associated esophageal and/or airway damage. For example, severe GERD can contribute to shortness of breath, worsening asthma, and/or recurrent aspiration pneumonia.
    [Show full text]
  • Female Inguinal Hernia – Conservatively Treated As Labial Swelling for a Long Time-A Case Report Shabnam Na, Alam Hb, Talukder Mrhc, Humayra Zud, Ahmed Ahmte
    Case Report Female Inguinal Hernia – Conservatively Treated as Labial Swelling for a Long Time-A Case Report Shabnam Na, Alam Hb, Talukder MRHc, Humayra ZUd, Ahmed AHMTe Abstract Inguinal hernia in females is quite uncommon compared to males. However, in female it may pose both a diagnostic as well as surgical challenge to the attending surgeon. Awareness of anatomy of the region and all the possible contents is essential to prevent untoward complications. Here we are presenting a case of indirect inguinal hernia in a 25 years old women and how she was diagnosed and ultimately managed. Key words: Inguinal hernia, females (BIRDEM Med J 2018; 8(1): 81-82 ) Introduction Case Report Inguinal hernia in female is relatively uncommon as A 25-year-old female, non obese, mother of one child, compared to males. The incidence of inguinal hernia in delivered vaginal (NVD) presented with a swelling in females is 1.9%1 . Obesity, pregnancy and operative the left groin for 7 years. Initially she presented to procedures have been shown to be risk factors that different gynecologists with labial swelling. They treated commonly contribute to the formation of inguinal her conservatively. As she was not improving, she finally hernia2. Surgical management in women is similar to presented to surgeon. She gave history of left groin swelling extending down to labia majora which initially that in men. However a wide variety of presentations appeared during straining but later on it persisted all may add to the confusion in diagnosing inguinal hernia the time. In lying position, the swelling disappeared.
    [Show full text]
  • Clinical Acute Abdominal Pain in Children
    Clinical Acute Abdominal Pain in Children Urgent message: This article will guide you through the differential diagnosis, management and disposition of pediatric patients present- ing with acute abdominal pain. KAYLEENE E. PAGÁN CORREA, MD, FAAP Introduction y tummy hurts.” That is a simple statement that shows a common complaint from children who seek “M 1 care in an urgent care or emergency department. But the diagnosis in such patients can be challenging for a clinician because of the diverse etiologies. Acute abdominal pain is commonly caused by self-limiting con- ditions but also may herald serious medical or surgical emergencies, such as appendicitis. Making a timely diag- nosis is important to reduce the rate of complications but it can be challenging, particularly in infants and young children. Excellent history-taking skills accompanied by a careful, thorough physical exam are key to making the diagnosis or at least making a reasonable conclusion about a patient’s care.2 This article discusses the differential diagnosis for acute abdominal pain in children and offers guidance for initial evaluation and management of pediatric patients presenting with this complaint. © Getty Images Contrary to visceral pain, somatoparietal pain is well Pathophysiology localized, intense (sharp), and associated with one side Abdominal pain localization is confounded by the or the other because the nerves associated are numerous, nature of the pain receptors involved and may be clas- myelinated and transmit to a specific dorsal root ganglia. sified as visceral, somatoparietal, or referred pain. Vis- Somatoparietal pain receptors are principally located in ceral pain is not well localized because the afferent the parietal peritoneum, muscle and skin and usually nerves have fewer endings in the gut, are not myeli- respond to stretching, tearing or inflammation.
    [Show full text]
  • SAS Journal of Surgery Rare Complication of a Hernia in The
    SAS Journal of Surgery Abbreviated Key Title: SAS J Surg ISSN 2454-5104 Journal homepage: https://www.saspublishers.com/sasjs/ Rare Complication of a Hernia in the Linea Alba: Generalized Peritonitis Due to Perforation by a Chicken Bone Incarcerated in the Hernia Anas Belhaj*, Mohamed Fdil, Mourad Badri, Mohammed Lazrek, Younes Hamdouni Ahmed, Zerhouni, Tarik Souiki, Imane Toughraï, Karim Ibn Majdoub Hassani, Khalid Mazaz Visceral and Endocrinological Surgery Service II, Chu Hassan II, Fes, Morocco DOI: 10.36347/sasjs.2020.v06i03.016 | Received: 05.03.2020 | Accepted: 13.03.2020 | Published: 23.03.2020 *Corresponding author: Anas Belhaj Abstract Case Report Small intestine perforation by a foreign body is a rare cause of secondary peritonitis. We report the case of peritonitis due to an exceptional mechanism; a small perforation by incarceration of a bony flap in the small bowel due to the existence of a hernia of the white line. Keywords: Peritonitis, white line hernia, fragment of bone, incarceration. Copyright @ 2020: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source are credited. NTRODUCTION I Patient was conscious, with a temperature at Acute peritonitis is the acute inflammation of 38.8 ° C, a pulse at 120 bpm, accelerated breathing rate the peritoneal serosa. It can either be generalized to the at 22 cycles / min, and coldness of the extremities. The large peritoneal cavity, or localized, following a abdominal examination found a slight distension with bacterial or chemical peritoneal attack.
    [Show full text]
  • Describe the Anatomy of the Inguinal Canal. How May Direct and Indirect Hernias Be Differentiated Anatomically
    Describe the anatomy of the inguinal canal. How may direct and indirect hernias be differentiated anatomically. How may they present clinically? Essentially, the function of the inguinal canal is for the passage of the spermatic cord from the scrotum to the abdominal cavity. It would be unreasonable to have a single opening through the abdominal wall, as contents of the abdomen would prolapse through it each time the intraabdominal pressure was raised. To prevent this, the route for passage must be sufficiently tight. This is achieved by passing through the inguinal canal, whose features allow the passage without prolapse under normal conditions. The inguinal canal is approximately 4 cm long and is directed obliquely inferomedially through the inferior part of the anterolateral abdominal wall. The canal lies parallel and 2-4 cm superior to the medial half of the inguinal ligament. This ligament extends from the anterior superior iliac spine to the pubic tubercle. It is the lower free edge of the external oblique aponeurosis. The main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females. They are functionally and developmentally distinct structures that happen to occur in the same location. The canal also transmits the blood and lymphatic vessels and the ilioinguinal nerve (L1 collateral) from the lumbar plexus forming within psoas major muscle. The inguinal canal has openings at either end – the deep and superficial inguinal rings. The deep (internal) inguinal ring is the entrance to the inguinal canal. It is the site of an outpouching of the transversalis fascia.
    [Show full text]
  • Incarcerated Gallbladder in Inguinal Hernia: a Case Report and Literature
    Tajti Jr. et al. BMC Gastroenterol (2020) 20:425 https://doi.org/10.1186/s12876-020-01569-5 CASE REPORT Open Access Incarcerated gallbladder in inguinal hernia: a case report and literature review János Tajti Jr., József Pieler, Szabolcs Ábrahám, Zsolt Simonka, Attila Paszt and György Lázár* Abstract Background: Treating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date. Case presentation: A 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confrmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confrmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory fndings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the signifcantly ptotic, large gallbladder. Cholecystectomy and Bassini’s repair of the inguinal hernia were performed safely.
    [Show full text]
  • A Rare Case of Pancreatitis from Pancreatic Herniation
    Case Report J Med Cases. 2018;9(5):154-156 A Rare Case of Pancreatitis From Pancreatic Herniation David Doa, c, Steven Mudrocha, Patrick Chena, Rajan Prakashb, Padmini Krishnamurthyb Abstract nia sac, resulting in mediastinal abscess which was drained sur- gically. He had a prolonged post-operative recovery following Acute pancreatitis is a commonly encountered condition, and proper the surgery. In addition, he had a remote history of exploratory workup requires evaluation for underlying causes such as gallstones, laparotomy for a retroperitoneal bleed. He did not have history alcohol, hypertriglyceridemia, trauma, and medications. We present a of alcohol abuse. His past medical history was significant for case of pancreatitis due to a rare etiology: pancreatic herniation in the hypertension and osteoarthritis. context of a type IV hiatal hernia which involves displacement of the On examination, his vitals showed a heart rate of 106 stomach with other abdominal organs into the thoracic cavity. beats/min, blood pressure of 137/85 mm Hg, temperature of 37.2 °C, and respiratory rate of 20/min. Physical exam dem- Keywords: Pancreatitis; Herniation; Hiatal hernia onstrated left-upper quadrant tenderness without guarding or rebound tenderness, with normoactive bowel sounds. Lipase was elevated at 2,687 U/L (reference range: 73 - 383 U/L). His lipase with the first episode of abdominal pain had been 1,051 U/L. Hematocrit was 41.2% (reference range: 42-52%), Introduction white cell count was 7.1 t/mm (reference range 4.8 - 10.8 t/ mm) and creatinine was 1.0 mg/dL (references range: 0.5 - 1.4 Acute pancreatitis is a commonly encountered condition with mg/dL).
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • What Is a Paraesophageal Hernia?
    JAMA PATIENT PAGE What Is a Paraesophageal Hernia? A paraesophageal hernia occurs when the lower part of the esophagus, the stomach, or other organs move up into the chest. The hiatus is an opening in the diaphragm (a muscle separating the chest from the abdomen) through which organs pass from the Paraesophageal or hiatal hernia The junction between the esophagus and the stomach (the gastroesophageal chest into the abdomen. The lower part of the esophagus and or GE junction) or other organs move from the abdomen into the chest. the stomach normally reside in the abdomen, just under the dia- phragm. The gastroesophageal (GE) junction is the area where Normal location of the esophagus, Type I hiatal hernia (sliding hernia) with the GE junction and stomach The GE junction slides through the the esophagus connects with the stomach and is usually located in the abdominal cavity diaphragmatic hiatus to an abnormal 1to2inchesbelowthediaphragm.Ahiatalorparaesophagealhernia position in the chest. occurs when the GE junction, the stomach, or other abdominal or- Esophagus gans such as the small intestine, colon, or spleen move up into the GE junction chest where they do not belong. There are several types of para- Hiatus esophagealhernias.TypeIisahiatalherniaorslidinghernia,inwhich the GE junction moves above the diaphragm, leaving the stomach in D I A P H R A the abdomen; this represents 95% of all paraesophageal hernias. G M Types II, III, and IV occur when part or all of the stomach and some- S T O M A C H times other organs move up into the chest. Common Symptoms of Paraesophageal Hernia More than half of the population has a hiatal or paraesophageal Less common types of paraesophageal hernias are classified based on the extent hernia.
    [Show full text]
  • Pediatric Hernia
    Pediatric Surgery Pediatric Hernia Pediatric Hernias: Definitions, Diagnosis and Treatment Hernia repair is among the most common type of general surgical procedure performed in children each year. The two most common types of congenital hernias in children are umbilical and inguinal hernias. The infor- mation below offers information on symptoms, diagnosis and treatment of these medical conditions. Umbilical Hernia Umbilical hernias are fairly common among newborns and infants younger than 6 months. Caused when the umbilical ring fails to close after birth, umbilical hernias present as an outward bulging in the abdominal area at the umbilicus. Umbilical hernias can vary in width from less than 1 cm to more than 5 cm and may seem to expand when the child cries or strains. Although the exact incidence of umbilical hernias in children is unknown, they are reported slightly more often in African Americans. Symptoms and Diagnosis • Present as a soft swelling at the navel that bulges when the baby or child sits up, cries or strains and usually disappears when the baby or child lies flat. • Usually painless. • Often detected on physical exam, without the need for additional testing. Treatment • Often closes by 1 or 2 years of age. • Surgery needed when hernia has not closed by 2 to 4 years of age. • Emergency surgery required if intestinal blood supply is cut off (strangulation). Inguinal Hernias There are two types of inguinal hernias — direct and indirect. Direct inguinal hernias are very rare in children and are caused by a weakness in the abdominal wall that allows intestines to protrude through.
    [Show full text]