Definition
The "abdominal hernia is the escape of a bowel - or part of it - from the abdominal cavity where" it is normally contained.
The herniation makes its way through a pre-formed orifice or area of weakness in the cladding wall.
Abdominal hernias are called external since the viscera, slipping between the different structures that form the abdominal wall, push outwards becoming evident. In this sense, abdominal hernias differ from internal herniations (eg disc herniation, diaphragmatic hernia, cervical hernia), where the movement of the bowel occurs at the "indoor of the body, therefore from the outside there is no protuberance.
Abdominal hernias are estimated to be the most frequent herniation of all, affecting 5-6% of the entire global population.
Classification and causes
The term "abdominal hernia" is quite generic since numerous forms of herniation fall into this category. The abdominal hernia can be congenital or acquired: the first group includes umbilical, inguinal and cryptorchid hernias, while weakness (eg crural hernia) and exertion hernias are acquired forms.
All abdominal hernias acquired they share some predisposing factors:
- Alterations of the abdominal anatomy
- Ascites
- Weight loss
- Severe breathing difficulties
- Multiple pregnancies
- Traumatic injuries in the abdominal area (e.g. caused by surgery)
- Obesity / overweight
- Constipation
Abdominal hernias congenital they are generally the expression of an arrest in the development of the abdominal wall during the embryonic period.
Common features
For further information: Abdominal Hernia Symptoms
Despite the numerous forms of abdominal herniation, it is possible to identify three constant elements in all the different variants:
- Hernial gate: it is the opening from which the bowel comes out. The hernia port can consist of the umbilical ring (umbilical hernia), the inguinal canal (inguinal hernia) or any area where the muscles have a weaker area or a stretch mark.
- Sack: it is an "everted loop of the peritoneum (serous membrane that acts as a lining of the abdominal organs) in which the herniated bowel is positioned. When the phenomenon occurs from birth, it is called a congenital abdominal hernia.
- Contents of the abdominal hernia: it is the organ or portion of the bowel that has moved from its original location.
Inguinal abdominal hernia
The inguinal hernia is the most common among the abdominal hernias, of which it constitutes approximately 80% of cases. It occurs mainly in subjects between the ages of 20 and 60; however, peaks are also recorded between elderly and children This variant of abdominal hernia mainly affects males: it is estimated that men are affected 7 to 10 times more than women.
The congenital inguinal hernia generally occurs during early childhood due to a lack of occlusion of the vaginal peritoneum duct, a canaliculus present in the fetal phase used for the migration of the testicle from its place of origin (lumbar site, near the kidney downwards ) to the scrotum.
The acquired inguinal hernia is an expression of a progressive weakening of the abdominal muscles near the groin: the collapse of the muscular scaffold is favored by overweight, age, type of heavy work, pregnancy, excessive effort or metabolic pathologies (collagen abnormalities ).
The inguinal hernia may or may not be painful: the amount of pain increases if the herniation compresses an area rich in nerve endings.
In severe cases, the inguinal hernia degenerates into a strangulated or incarcerated hernia, with the risk of death from syncope, shock and gangrene. The strangulation of the hernia occurs when the herniated bowel is literally constricted by the ligamentous and muscular structures of the abdominal wall or by a stenosis (narrowing) of the hernial port. This phenomenon causes a stagnation of intestinal material and prevents blood from reaching the other neighboring sites.
This form of abdominal hernia must be treated surgically.
It is not uncommon for the inguinal hernia to be associated with a failure of the testicle to descend inside the scrotal bag: this pathological condition is called hernia-cryptorchidia.
Abdominal umbilical hernia
An umbilical hernia is an abdominal herniation that develops at the umbilical scar. Umbilical hernia is typical of children but can also affect adults and the elderly.
More often, the umbilical hernia in children is the result of a defect in the abdominal wall after the fall of the umbilical cord. However, some young patients are affected by this abdominal herniation due to disorders of collagen and polysaccharide metabolism, hypothyroidism congenital, Down syndrome or fetal hydantoin syndrome (drug used to treat epilepsies).
In adults, umbilical hernia is caused by an increase in intra-abdominal pressure, in turn induced by ascites, cirrhosis, pregnancy, extreme strain or neoplasms.
In the newborn, the umbilical hernia tends to regress spontaneously within a few months, without necessarily requiring surgery. On the contrary, in the adult, the umbilical hernia is generally subjected to surgery to minimize the risk of extremely dangerous complications (incarcerated hernia and strangulated hernia).
Crural abdominal hernia
Also called femoral, the crural hernia constitutes 2-5% of all abdominal hernias.
To understand...
The crural region is located lower than the inguinal fold, in an extremely weak anatomical site. The crural region is a space delimited by the femoral arch, the horizontal branch of the pubis and the femoral vein and artery.
Crural hernia has a strong predilection for female sex and, generally, the first symptoms appear after the age of 30. This form of abdominal hernia is a consequence of an excessive weakening of the ileo-pubic fascia, in turn due to pregnancy or extreme physical exertion.
Compared to the inguinal hernia, the crural hernia tends to degenerate more easily into a strangulated or incarcerated hernia. The herniation can sometimes be asymptomatic, but in an upright position it can cause pain in the root of the thigh. In most cases, the pain - when present - is not accentuated by coughing or sneezing.
Also in this case, the only solution for the treatment of the crural hernia is surgery: during the operation the hernial sac is removed and the damage to the abdominal wall is repaired.
