vaginal hernia


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hernia

 [her´ne-ah] the abnormal protrusion of part of an organ or tissue through the structures normally containing it. adj., adj her´nial. A weak spot or other abnormal opening in a body wall permits part of the organ to bulge through. A hernia may develop in various parts of the body, most commonly in the region of the abdomen (abdominal hernia), and may be either acquired or congenital. An old popular term for hernia is rupture, but this term is misleading because it suggests tearing and nothing is torn in a hernia. Although various supports and trusses can be tried in an effort to contain the hernia, the best treatment for this condition is herniorrhaphy, surgical repair of the weakness in the muscle wall through which the hernia protrudes.Bochdalek's hernia congenital posterolateral diaphragmatic hernia, with extrusion of bowel and other abdominal viscera into the thorax; due to failure of closure of the pleuroperitoneal hiatus.cerebral hernia (hernia ce´rebri) protrusion of brain substance through a defect in the skull.crural hernia femoral hernia.diaphragmatic hernia see diaphragmatic hernia.fat hernia hernial protrusion of peritoneal fat through the abdominal wall.femoral hernia protrusion of a loop of intestine into the femoral canal, a tubular passageway that carries nerves and blood vessels to the thigh; this type occurs more often in women than in men. Called also crural hernia and femorocele.hiatal hernia (hiatus hernia) protrusion of a structure, often a portion of the stomach, through the esophageal hiatus of the diaphragm; see diaphragmatic hernia.Holthouse's hernia an inguinal hernia that has turned outward into the groin.incarcerated hernia a hernia so occluded that it cannot be returned by manipulation; it may or may not become strangulated. Called also irreducible hernia.incisional hernia hernia after operation at the site of the surgical incision, owing to improper healing or to excessive strain on the healing tissue; such strain may be caused by excessive muscular effort, such as that involved in lifting or severe coughing, or by obesity, which creates additional pressure on the weakened area.inguinal hernia hernia occurring in the groin, or inguen, where the abdominal folds of flesh meet the thighs. It is often the result of increased pressure within the abdomen, whether due to lifting, coughing, straining, or accident. Inguinal hernia accounts for about 75 per cent of all hernias.
A sac formed from the peritoneum and containing a portion of the intestine or omentum, or both, pushes either directly outward through the weakest point in the abdominal wall (direct hernia) or downward at an angle into the inguinal canal (indirect hernia). Indirect inguinal hernia (the common form) occurs more often in males because it follows the tract that develops when the testes descend into the scrotum before birth, and the hernia itself may descend into the scrotum. In the female, the hernia follows the course of the round ligament of the uterus.
Inguinal hernia begins usually as a small breakthrough. It may be hardly noticeable, appearing as a soft lump under the skin, no larger than a marble, and there may be little pain. As time passes, the pressure of the contents of the abdomen against the weak abdominal wall may increase the size of the opening and, accordingly, the size of the lump formed by the hernia. In the early stages, an inguinal hernia is usually reducible—it can be pushed gently back into its normal place. Inguinal hernia usually requires herniorrhaphy.intra-abdominal hernia (intraperitoneal hernia) a congenital anomaly of intestinal positioning, occurring within the abdomen, in which a portion of bowel protrudes through a defect in the peritoneum or, as a result of abnormal rotation of the intestine during embryonic development, becomes trapped in a sac of peritoneum.irreducible hernia incarcerated hernia.mesocolic hernia an intra-abdominal hernia in which the small intestine rotates incompletely during development and becomes trapped within the mesentery of the colon.Morgagni's hernia congenital retrosternal diaphragmatic hernia, with extrusion of tissue into the thorax through the foramen of Morgagni.paraesophageal hernia hiatal hernia in which part or almost all of the stomach protrudes through the hiatus into the thorax to the left of the esophagus, with the gastroesophageal junction remaining in place.Paraesophageal hernia. From Dorland's, 2000.posterior vaginal hernia downward protrusion of the pouch of Douglas, with its intestinal contents, between the posterior vaginal wall and the rectum; called also enterocele. See illustration.Posterior vaginal hernia. From McKinney et al., 2000.reducible hernia one that can be returned by manipulation.Richter's hernia incarcerated or strangulated hernia in which only a portion of the circumference of the bowel wall is involved.rolling hernia paraesophageal hernia.scrotal hernia an inguinal hernia that has passed into the scrotum.sliding hernia hernia of the cecum (on the right) or the sigmoid colon (on the left) in which the wall of the viscus forms a portion of the hernial sac, the remainder of the sac being formed by the parietal peritoneum.sliding hiatal hernia the most common type of diaphragmatic hernia; a hiatal hernia in which the upper stomach and the cardioesophageal junction protrude upward into the posterior mediastinum. The protrusion, which may be fixed or intermittent, is partially covered by a peritoneal sac.Sliding hiatal hernia. From Dorland's, 2000.slip hernia (slipped hernia) sliding hernia.strangulated hernia one that is tightly constricted. As any hernia progresses and bulges out through the weak point in its containing wall, the opening in the wall tends to close behind it, forming a narrow neck. If the neck becomes pinched tight enough to cut off the blood supply, the hernia will quickly swell and become strangulated. This is a very dangerous condition that can appear suddenly and requires immediate surgical attention. Unless the blood supply is restored promptly, gangrene can set in and may cause death. If a hernia suddenly grows larger, becomes tense, and will not go back into place, and there is pain and nausea, it is strangulated. Occasionally, especially in the elderly, hernia strangulation may occur without pain or tenderness.umbilical hernia see umbilical hernia.vaginal hernia hernia into the vagina; called also colpocele.

hernia

(her'ne-a ) [L. hernia, rupture] COMMON LOCATIONS OF HERNIASThe protrusion of an anatomical structure through the wall that normally contains it. Synonym: rupture (2) See: illustration; herniotomyhernialhernioid, adjective

Etiology

Hernias may be caused by congenital defects in the formation of body structures, defects in collagen synthesis and repair, trauma, or surgery. Conditions that increase intra-abdominal pressures, e.g., pregnancy, obesity, weight lifting, straining (the Valsalva maneuver), and abdominal tumors, may also contribute to hernia formation.

Treatment

Surgical or mechanical reduction is the treatment of choice.

ABDOMINAL WALL HERNIA

abdominal hernia

A hernia through the abdominal wall. See: illustration

acquired hernia

A hernia that develops any time after birth in contrast to one that is present at birth (congenital hernia).

bladder hernia

The protrusion of the bladder or part of the bladder through a normal or abnormal orifice. Synonym: cystic hernia

Cloquet hernia

See: Cloquet, Jules G.

complete hernia

A hernia in which the sac and its contents have passed through the aperture.

concealed hernia

A hernia that is not easily palpated.

congenital hernia

A hernia existing from birth.

crural hernia

A hernia that protrudes behind the femoral sheath. Synonym: femoral hernia.

cystic hernia

Bladder hernia.

diaphragmatic hernia

Herniation of abdominal contents into the thoracic cavity through an opening in the diaphragm. The condition may be congenital, acquired (traumatic), or esophageal.

direct inguinal hernia

Inguinal hernia.

diverticular hernia

The protrusion of an intestinal congenital diverticulum.

encysted hernia

A scrotal protrusion that, enveloped in its own sac, passes into the tunica vaginalis.

epigastric hernia

A hernia through a defect in the linea alba above the umbilicus.

fascial hernia

Protrusion of muscular tissue through its fascial covering.

fatty hernia

The prolapse of fat from its normal, anatomical position, e.g., from behind the peritoneum into the inguinal canal.

femoral hernia

Crural hernia.

hiatal hernia

The protrusion of the stomach into the chest through the esophageal hiatus of the diaphragm. ;

incarcerated hernia

A hernia in which the presenting content cannot be returned to its site of origin, e.g., a hernia in which a segment of intestine cannot be returned to the abdominal cavity. It may produce pain or intestinal obstruction. If left untreated, an incarcerated hernia may cause strangulation of the bowel.

incisional hernia

A hernia through a surgical scar.

incomplete hernia

A hernia that has not gone completely through the aperture.

indirect inguinal hernia

Inguinal hernia.

inguinal hernia

The protrusion of a hernial sac containing intraperitoneal contents (e.g., intestine, omentum, or ovary) at the superficial inguinal ring. In an indirect inguinal hernia, the sac protrudes lateral to the inferior epigastric artery through the internal inguinal ring into the inguinal canal, often descending into the scrotum (in males) or labia (in females). In a direct inguinal hernia, the sac protrudes through the abdominal wall within Hesselbach's triangle, a region bounded by the rectus abdominis muscle, inguinal ligament, and inferior epigastric vessels. The sliding hernia is a kind of indirect inguinal hernia, in which a portion of the wall of the protruding cecum or sigmoid colon is part of the sac, the rest composed of parietal peritoneum. Femoral hernias occur where the femoral artery passes into the femoral canal. Indirect and direct inguinal hernias and femoral hernias are collectively referred to as groin hernias. Inguinal hernias account for about 80% of all hernias. Synonym: direct inguinal hernia; indirect inguinal hernia ; hernia inguinalis; lateral hernia; medial hernia; oblique hernia

Patient care

Preoperative: The surgical procedure and expected postoperative course are explained to the patient. The patient should understand that the surgery will repair the defect caused by the hernia but that surgical failures can occur. If the patient is undergoing elective surgery, recovery usually is rapid; if no complications occur, the patient probably will return home the same day as surgery and usually can resume normal activity within 4 to 6 weeks. Patients who undergo emergency surgery for a strangulated or incarcerated hernia may remain hospitalized longer commensurate with the degree of intestinal involvement. The patient is prepared for surgery.

Postoperative: Vital signs are monitored. The patient is instructed on the changing of position to avoid undue stress on the wound area. Stool softeners may be administered to prevent straining during defecation, and the patient is instructed in their use. Early ambulation is encouraged, but other physical activities are modified according to the surgeon's instructions. The patient should void prior to discharge and be able to tolerate oral fluids. The patient is taught to check the incision and dressing for drainage, inflammation, and swelling and to monitor his/her temperature for fever, any of which should be reported to the surgeon. Analgesics are administered as prescribed, and the patient is taught about their use and supplied with a prescription for home use. Male patients are advised that scrotal swelling can be reduced by supporting the scrotum on a rolled towel and applying an ice bag. The patient is warned to avoid lifting heavy objects or straining during bowel movements. Drinking plenty of fluids should help the patient prevent constipation and maintain hydration. The patient is advised to make and keep a postoperative surgical visit and to resume normal activity and return to work only as permitted by the surgeon.

hernia inguinalis

Inguinal hernia.

inguinocrural hernia

A hernia that is both femoral and inguinal.

internal hernia

A hernia that occurs within the abdominal cavity. It may be intraperitoneal or retroperitoneal.

interstitial hernia

A form of inguinal hernia in which the hernial sac lies between the layers of the abdominal muscles.

irreducible hernia

A hernia that cannot be returned to its original position out of its sac by manual methods. See: incarcerated hernia

labial hernia

The protrusion of a loop of bowel or other intraperitoneal organ into the labia majora.

lateral hernia

Inguinal hernia.

lumbar hernia

A hernia through the inferior lumbar triangle (Petit) or the superior lumbar triangle (Grynfelt). It occurs most often in association with surgery on the kidneys or ureters.

medial hernia

Inguinal hernia.

mesocolic hernia

A hernia between the layers of the mesocolon.

Nuckian hernia

A hernia into the canal of Nuck.

oblique hernia

Inguinal hernia.

obturator hernia

A hernia through the obturator foramen.

omental hernia

A hernia containing a portion of the omentum.

ovarian hernia

The presence of an ovary in a hernial sac.

parastomal hernia

A hernia in the abdominal wall adjacent to a constructed stoma, e.g., a colostomy or iliostomy.

perineal hernia

Perineocele.

phrenic hernia

A hernia projecting through the diaphragm into one of the pleural cavities.

posterior vaginal hernia

A hernia of Douglas' sac downward between the rectum and posterior vaginal wall. Synonym: enterocele (2)

properitoneal hernia

A hernia located between the parietal peritoneum and the transversalis fascia.REDUCIBLE HERNIA: Umbilical HerniaREDUCIBLE HERNIA: Hernia reduces with digital pressure

reducible hernia

A hernia whose contents can be replaced by manipulation. See: illustration

retroperitoneal hernia

A hernia protruding into the retroperitoneal space, e.g., duodenojejunal hernia, Treitz's hernia.

Richter's hernia

A hernia in which only a portion of intestinal wall protrudes, the main portion of the intestine being excluded from the hernial sac and the lumen remaining open. The patient may present with groin swelling and vague abdominal complaints; when incarcerated the hernia may produce bowel ischemia and related complications.

scrotal hernia

A hernia that descends into the scrotum.

sliding hernia

A hernia in which a portion of the wall of the herniated structure forms part of the hernia sac, e.g. an inguinal hernia in which a wall of the cecum or sigmoid colon forms a portion of the sac, the remainder of the sac being parietal peritoneum.

Spigelian hernia

A defect that occurs at or below the linea semicircularis but above the point at which the inferior epigastric vessels cross the lateral border of the rectus abdominis muscle. This type of hernia may contain preperitoneal fat or may be a peritoneal sac containing intraperitoneal contents. It is rare and difficult to diagnose unless large, because it is typically not palpable when small. Large Spigelian hernias may be mistaken for sarcomas of the abdominal wall. Ultrasonography or computed tomography scans are often used in diagnosis.

Treatment

Small Spigelian hernias are easily repaired; larger ones may require a prosthesis.

sports hernia

Athletic pubalgia.

strangulated hernia

A hernia in which the protruding viscus is so tightly trapped that gangrene results, requiring prompt surgery. Once strangulation of the contents occurs, a nonsurgical attempt to reduce it may severely compromise treatment and outcome.

synovial hernia

Protrusion of a portion of synovial membrane through a tear in the stratum fibrosum of a joint capsule.

umbilical hernia

A hernia occurring at the navel, seen mostly in children. Usually it requires no therapy if small and asymptomatic. An umbilical hernia usually resolves when the child begins to walk (and muscles strengthen).

uterine hernia

The presence of the uterus in the hernial sac.

vaginal hernia

Pelvic organ prolapse.

vaginolabial hernia

A hernia of a viscus into the posterior end of the labia majora.

ventral hernia

A hernia through the abdominal wall. See: incisional hernia