Hernia

Reviewed 06/2017
 


BASICS

DESCRIPTION

Hernias are areas of weakness or frank disruption of the fibromuscular tissues of the body wall through which intracavity structures pass. 
  • Types

    • ▪ Inguinal
      • * Direct inguinal: acquired;...

DIAGNOSIS

HISTORY

  • Pain, nausea, vomiting, bloating; relieved with reclining; many are asymptomatic.

  • May observe protrusion through abdominal wall during increased intra-abdominal pressure (Valsalva mane...

TREATMENT

  • Elective setting

    • ▪ Elective surgical repair is associated with significantly lower morbidity and mortality.
  • Acute setting

    • ▪ Pain management is recommended for symptomatic hernias.
    • ▪ Strangulated...

ONGOING CARE

PATIENT EDUCATION

  • Cleveland Clinic: http://my.clevelandclinic.org/disorders/hernia/hic_hernia.aspx

  • Umbilical hernias: Boston Children's Hospital: http://www.childrenshospital.org/az/Site101...

REFERENCES

Winslow  ER, Quasebarth  M, Brunt  LM. Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc. ...

ADDITIONAL READING

  • Abi-Haidar Y, Sanchez V, Itani KM. Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg.  2011;213(3):363–369.

  • Brandt ML. Pediatric hernias....

SEE ALSO

Algorithms: Abdominal Pain, Lower; Intestinal Obstruction; Pelvic Pain 

CODES

ICD10

  • K46.9 Unspecified abdominal hernia without obstruction or gangrene

  • K40.90 Unil inguinal hernia, w/o obst or gangr, not spcf as recur

  • K41.90 Unil femoral hernia, w/o obst or gangrene, not spcf...

CLINICAL PEARLS

  • Inguinal

    • ▪ Direct inguinal: acquired; herniation through defect in transversalis fascia of abdominal wall medial to inferior epigastric vessels
    • ▪ Indirect inguinal: congenital; herniatio...

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