Test Yourself: Hernia Quiz

Hernioplasty, also known as tension-free repair, involves the placement of a synthetic mesh to strengthen the hernia repair area and reduce the risk of recurrence. This method is preferred especially in cases where the surrounding tissue is weak and unlikely to support a simple suture repair (herniorrhaphy) alone. Hernioplasty can be performed using traditional open surgery or through minimally invasive laparoscopic techniques.

A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm. The diaphragm normally has an opening, the hiatus, through which the esophagus passes before connecting to the stomach. In a hiatal hernia, the stomach pushes up through this opening and into the chest. Unlike other types of hernias, which typically involve the abdominal wall, a hiatal hernia specifically involves the diaphragm and the gastrointestinal tract.

Common symptoms of an inguinal hernia include a visible bulge, pain or discomfort, particularly when engaging in activities such as lifting, bending, or coughing. Nausea and vomiting can also occur, especially if the hernia is strangulated. However, a high fever is not a typical symptom of an inguinal hernia and may indicate another illness or infection.

Factors that increase the risk of developing a hernia include chronic cough, which consistently increases intra-abdominal pressure, pregnancy, which also increases intra-abdominal pressure and stretches tissues, and a high body mass index, which can weaken the abdominal wall. Conversely, frequent aerobic exercise generally strengthens the abdominal and pelvic muscles and is not a risk factor for hernia development; rather, it can potentially help prevent hernias by maintaining a healthy weight and strengthening core muscles.

"Reduction en masse" is a complication that can occur when an incarcerated hernia is reduced, but the entrapped bowel or other contents are not properly repositioned. Instead, part of the bowel can be trapped within the hernia sac or at the hernia's neck, leading to compromised blood flow and potential infarction or necrosis of the bowel. This condition can lead to severe complications such as sepsis and localized tenderness due to bowel perforation or ischemia, which aligns with the patient's symptoms of sepsis and LLQ tenderness after hernia reduction. This situation requires immediate medical attention, potentially including surgery to correct the underlying issue and manage any resulting complications.

Incarcerated groin hernia is the most likely etiology of a small bowel obstruction in a 45-year-old morbidly obese female with no previous abdominal operation. This is because obesity increases the risk of developing hernias, and the presence of a groin hernia can lead to the obstruction of the small bowel. Adhesions are also a common cause of small bowel obstruction, but since the patient has no previous abdominal operation, it is less likely to be the cause in this case. Internal paraduodenal hernia and Meckel's diverticulum are less common causes of small bowel obstruction compared to incarcerated groin hernia.

Femoral hernias are more prone to strangulation than other types due to their anatomical location in the femoral canal, just below the inguinal ligament. The narrowness of the femoral canal increases the risk of the intestinal segment or fat within the hernia sac becoming constricted, which can cut off blood supply to the herniated tissue. Strangulation is a serious complication that requires immediate surgical intervention to prevent tissue death.

The genitofemoral nerve is the most commonly injured nerve in a laparoscopic preperitoneal inguinal hernia repair. This nerve runs along the inguinal canal and supplies sensation to the groin and upper thigh. During the surgery, the nerve can be accidentally damaged or compressed, leading to symptoms such as pain, numbness, or weakness in the affected area.

A spigelian hernia is characterized by its interparietal location. This means that the hernia occurs between the layers of the abdominal wall, specifically through the spigelian fascia. Unlike other types of hernias, spigelian hernias do not have a peritoneal sac, which makes them more difficult to diagnose. However, they can be identified through careful examination and imaging techniques.

Gastroschisis is a condition that occurs during fetal development where there is a rupture in the abdominal wall, specifically near the umbilical cord. This rupture leads to the intestines and sometimes other organs protruding outside the body, without the protection of a peritoneal sac. It is not a genetic defect but rather a result of the intrauterine umbilical cord rupture. While gastroschisis can be associated with other congenital anomalies, it is primarily characterized by the abdominal wall defect caused by the umbilical cord rupture.