II. Types
- Groin Hernia
- Inguinal Hernia
- Indirect Inguinal Hernia (most common Groin Hernias)
- Direct Inguinal Hernia
- Femoral Hernia (10% of Groin Hernias)
- Inguinal Hernia
- Ventral Hernia
- Umbilical Hernia (congenital in children)
- Paraumbilical Hernia (adults)
- Epigastric Hernia
- Incisional Hernia
- Spigelian Hernia
- Obturator hernia
- Obturator foramen Hernia often with Bowel Obstruction
- Most common in women due to a larger obturator canal diameter
- Diastasis Recti
- Not a true Hernia
- May be confused with Umbilical Hernia
III. Findings
- Reducible Hernia
- Symptoms increase with amount of pressure on contents
- Mass present on standing or valsalva
- Mass reduces when supine and relaxed
- Irreducible Hernia (Incarcerated Hernia)
- Mass remains palpable when patient relaxed and supine
- Failed reduction by clinician
- Normal overlying skin without tense contents
- Bowel sounds may be audible from within Hernia
- Strangulated Hernia
- Surgical emergency
- High mortality (up to 8% after first 24 hours)
- Irreducible Hernia with compromised blood supply
- Richter's Hernia: Part of gut circumference pinched
- Early: Small Bowel Obstruction
- Severe pain and inflammation (tenderness, induration, redness) over the Hernia site
- Later: Bowel Infarction, Necrosis and peritonitis
- Abdominal Distention
- Hypoactive bowel sounds
- Toxic appearing febrile patient
- Surgical emergency
IV. Diagnosis
- Hernia is a clinical diagnosis
V. Labs
- Indicated only in evaluating differential diagnosis or in toxicity or dehydartion
VI. Imaging
-
Ultrasound
- Indications
- Groin Hernia differential diagnosis (e.g. Testicular Torsion, Orchitis, abscess, Hydrocele)
- Bedside diagnosis of Inguinal Hernia
- Test Sensitivity 99%
- Test Specificity 97.5%
- Findings of Strangulated Hernia
- Fluid surrounding bowel in Inguinal Canal
- Loss of peristalsis
- Indications
-
Abdominal CT with IV contrast
- Indications
- Suspected incarcerated or Strangulated Hernia with difficult localization (especially in Obesity)
- Small Bowel Obstruction
- Differentiate Femoral Hernia from Inguinal Hernia
- Findings of Small Bowel Obstruction
- Small Bowel loops dilated >2.5 cm
- Findings of bowel ischemia
- IV contrast abnormal bowel wall enhancement
- Bowel wall thickening
- Free fluid
- Pneumatosis
- Indications
- Plain film imaging (e.g. CT unavailable)
- Abdominal flat and upright XRay
- Evaluate for Bowel Obstruction
- Upright Chest XRay
- Evaluate for abdominal free air
- Abdominal flat and upright XRay
VII. Management
- Hernia Reduction (if not contraindicated)
- Strangulated Hernia (with associated peritonitis, Bowel Obstruction)
- Nasogastric suction
- Intravenous Fluids
- Antibiotics
- Surgical Consultation
- Emergent Consultation for Strangulated Hernia, Bowel Obstruction or signs of peritonitis
- Phone Consultation if unsuccessful reduction of Incarcerated Hernia
- Outpatient surgical evaluation within 1-2 weeks if successful Hernia Reduction (for elective repair)
VIII. References
- Broder (2021) Crit Dec Emerg Med 35(9): 12-3
- Stevens (2013) Crit Dec Emerg Med 27(9): 2
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Protrusion of tissue, structure, or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. Hernia may involve tissues such as the ABDOMINAL WALL or the respiratory DIAPHRAGM. Hernias may be internal, external, congenital, or acquired. |
| Definition (MEDLINEPLUS) |
A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen. There are several types of hernias, including
Hernias are common. They can affect men, women, and children. A combination of muscle weakness and straining, such as with heavy lifting, might contribute. Some people are born with weak abdominal muscles and may be more likely to get a hernia. Treatment is usually surgery to repair the opening in the muscle wall. Untreated hernias can cause pain and health problems. |
| Definition (NCI) | The protrusion of part of an organ or fibroadipose tissue through an abnormal opening. |
| Definition (NCI_NCI-GLOSS) | The bulging of an internal organ through a weak area or tear in the muscle or other tissue that holds it in place. Most hernias occur in the abdomen. |
| Definition (CSP) | protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. |
| Concepts | Anatomical Abnormality (T190) |
| MSH | D006547 |
| ICD10 | K40-K46.9 , K46, K40-K46 |
| SnomedCT | 276915000, 362633009, 14778003, 197529008, 359801000, 52515009, 414403008 |
| English | [X]Hernia, Hernias, HERNIA NOS, Hernia - lesion, Hernia, hernia, hernia (diagnosis), Hernia NOS, hernia NOS, Hernia [Disease/Finding], herniations, herniation, hernias, Hernia (K40-K46), Unspecified hernia, Hernia (morphologic abnormality), Hernia - lesion (qualifier value), Unspecified hernia (disorder), [X]Hernia (disorder), HERNIA, Hernia, NOS, Herniation, NOS, Herniated tissue, Herniation, Herniated structure (morphologic abnormality), Herniated structure |
| Dutch | hernia NAO, hernia, Breuk, ingewands-, Hernia, Ingewandsbreuk |
| French | Hernie SAI, Hernie |
| German | Hernie NNB, Hernia, Hernie |
| Italian | Ernia NAS, Ernia |
| Portuguese | Hérnia NE, Hérnia |
| Spanish | Hernia NEOM, hernia (anomalía morfológica), herniación, hernia - lesión (calificador), tejido herniado, [X]hernia, [X]hernia (trastorno), hernia - lesión, hernia, estructura herniada (anomalía morfológica), estructura herniada, Hernia |
| Japanese | ヘルニアＮＯＳ, ヘルニア, ﾍﾙﾆｱ, ﾍﾙﾆｱNOS |
| Swedish | Bråck |
| Czech | kýla, hernie, Kýla, Kýla NOS |
| Finnish | Tyrä |
| Russian | GRYZHA, SODERZHASHCHAIA PETLIU KISHKI, GRYZHI, ENTEROTSELE, ГРЫЖА, СОДЕРЖАЩАЯ ПЕТЛЮ КИШКИ, ГРЫЖИ, ЭНТЕРОЦЕЛЕ |
| Croatian | HERNIJA |
| Polish | Przepuklina |
| Hungarian | Sérv, Sérv k.m.n. |
| Norwegian | Hernie, Brokk, Hernia |
Ontology: Ventral Hernia (C0019326)
| Definition (MSH) | A hernia caused by weakness of the anterior ABDOMINAL WALL due to midline defects, previous incisions, or increased intra-abdominal pressure. Ventral hernias include UMBILICAL HERNIA, incisional, epigastric, and spigelian hernias. |
| Concepts | Anatomical Abnormality (T190) |
| MSH | D006555 |
| ICD10 | K43 , K43.9 |
| SnomedCT | 266442005, 196897000, 6515007, 196898005, 196876001, 359801000, 414396006, 414474001 |
| English | Hernia, Ventral, Hernias, Ventral, Ventral Hernias, Unspecified ventral hernia NOS, abdomen hernia ventral, ventral hernia, ventral abdominal hernia, ventral hernia (diagnosis), ventral hernia (physical finding), Hernia, Ventral [Disease/Finding], Hernia;ventral, abdominal hernia wall, abdominal hernias wall, hernia ventral, ventral hernias, hernia abdominal wall, abdominal wall hernia, Ventral hernia NOS, Ventral hernia (disorder), Ventral hernia NOS (disorder), Unspecified ventral hernia NOS (disorder), hernia; ventral, Ventral hernia, NOS, Ventral hernia (disorder) [Ambiguous], Ventral hernia, Hernia of anterior abdominal wall (disorder), Hernia of anterior abdominal wall, Ventral Hernia |
| Dutch | hernia ventralis, hernia; ventralis, Hernia ventralis, Ventrale hernia |
| German | Bauchwandbruch, Hernia ventralis |
| Portuguese | Hérnia ventral, Hérnia Incisional, Hérnia Ventral |
| Spanish | Hernia ventral, hernia ventral, hernia ventral (trastorno), hernia ventral, SAI, hernia ventral no especificada, SAI, hernia ventral no especificada, SAI (trastorno), hernia ventral, SAI (trastorno), hernia ventral (concepto no activo), hernia de la pared abdominal anterior (trastorno), hernia de la pared abdominal anterior, Hernia Ventral |
| Swedish | Ventralbråck |
| Japanese | ﾌｸﾍｷﾍﾙﾆｱ, 腹壁ヘルニア, ヘルニア-腹壁 |
| Czech | hernie ventrální, Břišní kýla |
| Finnish | Ventraalityrä |
| Russian | GRYZHA VENTRAL'NAIA, VENTRAL'NAIA GRYZHA, GRYZHA ZHIVOTA, ВЕНТРАЛЬНАЯ ГРЫЖА, ГРЫЖА ВЕНТРАЛЬНАЯ, ГРЫЖА ЖИВОТА |
| Korean | 복벽헤르니아 |
| Croatian | HERNIJA, VENTRALNA |
| Polish | Przepuklina brzuszna zewnętrzna, Przepuklina powłok brzusznych |
| Hungarian | Ventralis hernia |
| Norwegian | Hernia ventralis, Brokk i bukveggen, Bukveggsbrokk, Hernie, ventralt, Ventralhernie |
| Italian | Ernia ventrale |
| French | Hernie ventrale |
Ontology: Hernia of abdominal cavity (C0178282)
| Definition (NCI) | The protrusion of abdominal contents through a congenital or acquired defect in the abdominal wall. |
| Definition (MSH) | A protrusion of abdominal structures through the retaining ABDOMINAL WALL. It involves two parts: an opening in the abdominal wall, and a hernia sac consisting of PERITONEUM and abdominal contents. Abdominal hernias include groin hernia (HERNIA, FEMORAL; HERNIA, INGUINAL) and VENTRAL HERNIA. |
| Concepts | Anatomical Abnormality (T190) |
| MSH | D046449 |
| ICD9 | 550-553.99 |
| ICD10 | K46 , K46.9 |
| SnomedCT | 155758000, 196973008, 196968002, 196799009, 359801000, 155737006, 52515009, 30477007, 6515007 |
| English | Hernia of abdominal cavity, Abdominal cavity hernia NOS, Unsp.abd.cavity hernia NOS, Unspecified abdominal cavity hernia NOS, abdominal hernia, hernia of abdominal cavity, abdominal hernia (physical finding), abdomen hernia, intra-abdominal hernia, intra-abdominal hernia (diagnosis), Abdominal hernia NOS, Abdominal herniation, Unspecified abdominal hernia, Hernia, Abdominal [Disease/Finding], hernia abdominal, internal hernia, intraperitoneal hernia, abdominal hernias, abdominal herniation, Abdominal Hernia, Abdominal cavity hernia NOS (disorder), Unspecified abdominal cavity hernia NOS (disorder), Abdominal hernia, Internal hernia, Hernia of abdominal cavity (disorder), Intra-abdominal hernia (disorder), Intra-abdominal hernia, Intraperitoneal hernia, hernia; abdominal, Hernia of abdominal cavity, NOS, Intra-abdominal hernia, NOS, Hernia of abdominal cavity [Ambiguous], Abdominal Hernias, Hernia, Abdominal, Hernias, Abdominal, HERNIA OF ABDOMINAL CAVITY |
| Italian | Ernia interna, Erniazione addominale, Ernia addominale NAS, Ernia addominale |
| Dutch | abdominale hernia NAO, abdominale uitstulping, hernia; abdominalis, abdominale hernia, inwendige hernia, Niet gespecificeerde buikbreuk, Buikwandbreuk, Buikhernia, Hernia, buik- |
| French | Hernie abdominale SAI, Hernie interne, Hernie abdominale, Hernie de la paroi abdominale, Laparocèle |
| German | Hernia abdominalis NNB, abdominale Herniation, Nicht naeher bezeichnete abdominale Hernie, interne Hernie, Abdominalhernie, Hernia abdominalis |
| Portuguese | Herniação abdominal, Hérnia abdominal NE, Hérnia abdominal, Hérnia interna, Hérnia Abdominal |
| Spanish | Hernia abdominal NEOM, hernia de la cavidad abdominal, SAI, hernia de la cavidad abdominal no especificada, SAI, Abdominal cavity hernia NOS, hernia abdominal, hernia de la cavidad abdominal, SAI (trastorno), hernia de la cavidad abdominal no especificada, SAI (trastorno), hernia de la cavidad abdominal (trastorno), hernia de la cavidad abdominal, hernia intrabdominal (trastorno), hernia intrabdominal, Hernia abdominal, Hernia interna, Hernia Abdominal |
| Japanese | 腹部ヘルニア形成, 腹部ヘルニアＮＯＳ, 内ヘルニア, 腹部ヘルニア, ﾌｸﾌﾞﾍﾙﾆｱ, ﾌｸﾌﾞﾍﾙﾆｱNOS, ﾅｲﾍﾙﾆｱ, ﾌｸﾌﾞﾍﾙﾆｱｹｲｾｲ |
| Swedish | Bukbråck |
| Czech | břišní kýla, hernie abdominální, Břišní výhřez, Břišní kýla NOS, Bišní kýla, Vnitřní kýla |
| Finnish | Vatsatyrä |
| Russian | GRYZHA BRIUSHNOI STENKI, GRYZHA BRIUSHNAIA, ГРЫЖА БРЮШНАЯ, ГРЫЖА БРЮШНОЙ СТЕНКИ |
| Korean | 상세불명의 복부헤르니아 |
| Croatian | Not Translated[Hernia, Abdominal] |
| Polish | Przepuklina brzuszna |
| Hungarian | Abdominalis hernia, Abdominalis sérv k.m.n., Abdominalis herniatio, Belső hernia |
| Norwegian | Magebrokk, Abdominalhernie, Hernie, abdominalt, Abdominalt brokk, Brokk, abdominalt, Hernia abdominalis |
Ontology: Richter's inguinal hernia (C0401083)
| Concepts | Acquired Abnormality (T020) |
| SnomedCT | 236025002 |
| English | Richter inguinal hernia, Richter's inguinal hernia, Richter's inguinal hernia (disorder) |
| Spanish | hernia inguinal de Richter (trastorno), hernia inguinal de Richter |
Ontology: Strangulated hernia (C0401116)
| Concepts | Disease or Syndrome (T047) , Acquired Abnormality (T020) |
| SnomedCT | 236043003, 129257004 |
| Dutch | ingeklemde hernia, hernia ingeklemd, gestranguleerd; hernia, hernia; gestranguleerd |
| French | Hernie étranglée |
| German | Hernie stranguliert, strangulierte Hernie |
| Italian | Ernia strozzata |
| Portuguese | Hérnia estrangulada |
| Spanish | Hernia estrangulada, hernia estrangulada (anomalía morfológica), hernia estrangulada, hernia interna estrangulada (trastorno), hernia interna estrangulada |
| Japanese | 絞扼性ヘルニア, ｺｳﾔｸｾｲﾍﾙﾆｱ |
| Czech | Kýla uskřinutá, Uskřinutá břišní kýla |
| English | Hernia strangulated, hernia strangulate, strangulate hernia, hernias strangulated, hernia strangulated, strangulated hernia, Strangulated internal hernia, Strangulated hernia, Strangulated hernia (morphologic abnormality), Strangulated internal hernia (disorder), hernia; strangulated, strangulated; hernia |
| Hungarian | Hernia strangulált, Strangulált hernia |
Ontology: Incarcerated hernia (C0740406)
| Concepts | Acquired Abnormality (T020) |
| SnomedCT | 110418002 |
| English | Hernia incarcerated, hernias incarcerated, hernias irreducible, hernia incarcerated, incarcerated hernia, Incarcerated hernia, Incarcerated hernia (morphologic abnormality), Irreducible hernia, hernia; incarcerated, hernia; irreducible, incarcerated; hernia, irreducible; hernia |
| Spanish | Hernia incarcerada, Hernia encarcerlada, hernia incarcerada (anomalía morfológica), hernia incarcerada, hernia irreductible |
| French | Hernie incarcérée |
| Dutch | beklemde breuk, geïncarcereerd; hernia, hernia; geïncarcereerd, hernia; irreponibel, irreponibel; hernia |
| Portuguese | Hérnia encarcerada |
| German | inkarzerierte Hernie, Hernie inkarzeriert |
| Italian | Ernia incarcerata |
| Japanese | ｶﾝﾄﾝﾍﾙﾆｱ, 嵌頓ヘルニア |
| Czech | Kýla inkarcerovaná, Uskřinutá kýla |
| Hungarian | Kizárt hernia, Kizárt sérv |
