Encyclopedia of Health and Medicine

H
hernia A separation or tear in the fibers of a
MUSCLE that allows the underlying tissue or structure
to bulge through. Hernias may occur as a
result of congenital weakness or incomplete closure
of a channel in the muscle (such as an umbilical
or inguinal hernia) or because of injury
(unintended or surgical). The common types of
hernia are
• inguinal hernia, which occurs in the inguinal
canal (groin)
• femoral hernia, which occurs in the upper
thigh
• umbilical hernia, which occurs at the umbilicus
(belly button)
• HIATAL HERNIA, which occurs in the DIAPHRAGM
and is not visually perceptible
• incisional hernia, which occurs at the site of a
surgical incision, usually abdominal
Hernias present in children often heal as the
child grows. Hernias in adults are often present
from childhood and become problematic when
some sort of strain puts pressure on them. Hernias
are somewhat more common in men. When the
person or doctor can push the hernia back into
the muscle wall it is reducible; an incarcerated
hernia is a hernia that will not recede. When the
hernia traps a segment of intestine or other tissue
to the extent that it cuts off the BLOOD supply, it is
a strangulated hernia. Though some hernias, particularly
in children, may correct themselves, most
hernias require surgery to repair the defect in the
muscle wall.
Symptoms and Diagnostic Path
A hernia may appear as a painless bulge or may
cause discomfort, depending on its location and
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the extent to which it allows intestinal structure to
protrude through the muscle wall. Many abdominal
hernias are more prominent with coughing or
bearing down. Symptoms of hiatal hernia may
include DYSPEPSIA (heartburn) and difficulty swallowing.
Diagnosis is primarily clinical, based on
the appearance of the symptoms. The doctor may
request an ULTRASOUND examination to confirm the
presence of the hernia and to create a visual image
to help assess the appropriate therapeutic course.
Treatment Options and Outlook
Most hernias require surgery to repair the weakness
in the muscle wall. The doctor may decide to
take an approach of watchful waiting when the
hernia is very small, in a young child, or in a person
for whom surgery is a significant risk. Nonsurgical
approaches such as a truss (a supportive
device that places pressure against the hernia to
keep it within the abdominal wall) may relieve
symptoms for the short term but cannot correct
the hernia. Though some hernias may remain
small and inconsequential for long periods of time
they may become problematic without warning,
at which point they may require immediate or
urgent medical attention. An incarcerated hernia
is a medical emergency that requires immediate
surgery, otherwise the strangulated tissue dies and
is at very high risk for GANGRENE.
Hernia repair surgery, called herniorrhaphy or
hernioplasty, can be OPEN SURGERY (an OPERATION in
which the surgeon makes a two- to three-inchlong
incision over the site of the hernia and
directly exposes the involved muscles) or MINI-
MALLY INVASIVE SURGERY (an operation in which the
surgeon uses a laparoscope and special instruments
to operate through one to three small incisions).
ANESTHESIA may be regional, epidural, or