II. Types

  1. Groin Hernia
    1. Inguinal Hernia
      1. Indirect Inguinal Hernia (most common Groin Hernias)
      2. Direct Inguinal Hernia
    2. Femoral Hernia (10% of Groin Hernias)
  2. Ventral Hernia
    1. Umbilical Hernia (congenital in children)
    2. Paraumbilical Hernia (adults)
    3. Epigastric Hernia
    4. Incisional Hernia
    5. Spigelian Hernia
    6. Obturator hernia
      1. Obturator foramen Hernia often with Bowel Obstruction
      2. Most common in women due to a larger obturator canal diameter
    7. Diastasis Recti
      1. Not a true Hernia
      2. May be confused with Umbilical Hernia

III. Findings

  1. Reducible Hernia
    1. Symptoms increase with amount of pressure on contents
    2. Mass present on standing or valsalva
    3. Mass reduces when supine and relaxed
  2. Irreducible Hernia (Incarcerated Hernia)
    1. Mass remains palpable when patient relaxed and supine
    2. Failed reduction by clinician
    3. Normal overlying skin without tense contents
    4. Bowel sounds may be audible from within Hernia
  3. Strangulated Hernia
    1. Surgical emergency (high mortality)
    2. Irreducible Hernia with compromised blood supply
      1. Richter's Hernia: Part of gut circumference pinched
    3. Early: Small Bowel Obstruction
      1. Severe pain and inflammation (tenderness, induration, redness) over the Hernia site
    4. Later: Bowel Infarction, Necrosis and peritonitis
      1. Abdominal Distention, hypoactive bowel sounds in a toxic appearing febrile patient

IV. Diagnosis

  1. Hernia is a clinical diagnosis

V. Labs

  1. Indicated only in evaluating differential diagnosis or in toxicity or dehydartion

VI. Imaging

  1. Ultrasound indications
    1. Groin Hernia differential diagnosis (e.g. Testicular Torsion)
  2. Abdominal flat and upright XRay
    1. Evaluate for Bowel Obstruction
  3. Upright Chest XRay
    1. Evaluate for abdominal free air
  4. Abdominal CT indications
    1. Suspected incarcerated or Strangulated Hernia with difficult localization (especially in Obesity)
    2. Differentiate Femoral Hernia from Inguinal Hernia

VII. Management

  1. Hernia Reduction (if not contraindicated)
  2. Strangulated Hernia (with associated peritonitis, Bowel Obstruction)
    1. Nasogastric suction
    2. Intravenous Fluids
    3. Antibiotics
  3. Surgical Consultation
    1. Emergent Consultation for Strangulated Hernia, Bowel Obstruction or signs of peritonitis
    2. Phone Consultation if unsuccessful reduction of Incarcerated Hernia
    3. Outpatient surgical evaluation within 1-2 weeks if successful Hernia Reduction (for elective repair)

VIII. References

  1. Stevens (2013) Crit Dec Emerg Med 27(9): 2

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Related Studies

Ontology: Hernia (C0019270)

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

  • Inguinal, in the groin. This is the the most common type.
  • Umbilical, around the belly button
  • Incisional, through a scar
  • Hiatal, a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.
  • Congenital diaphragmatic, a birth defect that needs surgery

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
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
Korean 복벽헤르니아
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, フクブヘルニア, フクブヘルニアNOS, ナイヘルニア, フクブヘルニアケイセイ
Swedish Bukbråck
Czech břišní kýla, hernie abdominální, Břišní výhřez, Břišní kýla NOS, Bišní kýla, Vnitřní kýla
Finnish Vatsatyrä
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