Abdominal hernia refers to a tear in the abdominal wall that allows the abdominal organs or fatty tissues to protrude through the cavity holding the organ. The tear occurs due to the weakness of the muscles surrounding the wall and causes a bulge in the affected area. The bulge tends to enlarge with cough or any other activity that puts pressure on the abdominal muscles and the size of the hernia reduces when the patient is rested or made to lie down. Hernias normally occur in males; however infants and women are also prone to this condition.
Abdominal hernia can be classified into reducible hernia and non reducible hernia. In case of reducible hernia, bulge can be pushed back into the sack with mild pressure and surface can be flattened in the affected area. But in few acute cases, hernia cannot be pushed back into the cavity and this condition is known as non reducible hernia. This is a medical emergency as it poses the risk of strangulation. In case of strangulation, blood supply to the herniated tissue will be cut off leading to the death of the tissue. If the intestines get strangulated and eventually lose blood supply, patient may develop gangrene (dead bowel) and this may prove fatal if medical attention is not given immediately.
Different types of abdominal hernia
Inguinal hernia or groin hernia develops in the groin region due to the natural anatomical weakness present in that area. Hernia that develops in the internal ring within the groin area is called indirect inguinal hernia whereas hernia that develops near the groin area is called direct inguinal hernia. It is the most common type of abdominal-wall hernia that occurs mostly in men.
Femoral hernias appear in upper thigh region and these hernias are most common in women than men. Cause is usually the result of pregnancy and childbirth. Incidence rate is highest in middle-aged and elderly women, especially women who have had one or more pregnancies.
Umbilical hernia develops near the naval area. Most common in infants but can affect adults also. Medical attention is mandatory when hernia turns tender, discolored, swollen and/or when the infant seems to be suffering from abdominal pain.
Epigastric hernia occurs at upper abdominal area lying between the chest and naval. Develops in the middle of the upper abdomen between the breastbone and the umbilicus.
Spigelian hernia happens at the side of abdominal wall.
Incisional hernia develops at the place of incision that has occurred during earlier surgery. The place is a weak area usually an incompletely healed surgical wound. Symptoms are bulge or knot beneath the skin near the scar, sharp pains in the abdomen and/or constipation.
Causes of abdominal hernia
Abdominal hernia may be congenital (present at birth) or acquired later in life due to the weakening of abdominal muscles. Some other factors can also contribute to developing an abdominal hernia.
Symptoms and warning signs of abdominal hernia
Mild to intense pain and bulge on the abdomen or groin area are the significant indications of hernia. However, in few cases, patient may not experience any pain or may have only occasional pain and the swelling also may not appear. Almost all hernias swell up and enlarge with cough, continuous sneezing or any other condition that puts pressure on the abdomen. If the hernia involves intestines, patient will suffer from bowel obstruction and may have fever, nausea and vomiting.
Abdominal hernia treatment
Hernia is usually palpable and a surgeon can easily diagnose the condition during the clinical examination. Hernias are normally corrected through surgery as there is always a risk of strangulation associated with hernia. Reducible hernias are not a medical emergency; hence surgery appointments can be fixed according to the convenience of the patient and doctor. Irreducible hernias with painful lumps require immediate medical attention and surgery is performed as an emergency. During surgery the protruded organs are pushed back into the sack and if the intestines are strangulated, they will be removed. Sometimes, a synthetic mesh is placed behind the weakened abdominal muscle which will eventually merge with adjoining tissues and act as a protective wall against future recurrences.
Preventing Abdominal hernia
Some types of abdominal hernia cannot be prevented. Steps can be taken to avoid further complications and to prevent recurrence.
Abdominal ultrasound is specifically used to detect any abnormalities of the abdominal organs and other structures in the upper abdominal regions. An abdominal ultrasound can aid in determining the cause of abdominal pain or monitoring an abdominal aneurysm. It is mainly used to detect gall stones and tumors. Problems of the liver such as jaundice, cirrhosis or fatty deposits can be evaluated with abdominal ultrasound. Enlarged spleen, Pancreatitis and blocked bile ducts can be diagnosed with an abdominal ultrasound. Extreme obesity and gas or other materials in the stomach or intestines can affect the accuracy of an abdominal ultrasound. An abdominal ultrasound can aid placement of needle or other instrument during biopsy. Any fluid buildup in the abdominal cavity can be detected.
Adhesions are formed in the body as repair process response to previously incurred surgery, infection and radiological procedures. Adhesions contain fragments of scar tissues that are arranged between previously damaged tissues. Adhesions are often significant post-operative complications, which predominantly occur in the pelvic and cardiac regions. Many cases of obstructive bowel disorders have been reported after pelvic surgeries due to the presence of abdominal adhesions.
Abdominal adhesions are asymptomatic in most but they gradually produce significant symptoms leading to complications. In case of obstructive diseases, abdominal adhesions result in ischemia of the intestines. Along with the abdominal region, adhesions also occur in the uterus, ovaries, fallopian tubes post cesarean sections, hysterectomy and treatments of pelvic inflammatory disease. Adhesions in the heart cause conditions such as rheumatic fever by affecting the pericardial region of the heart. It also causes damage to the valves in decreasing the cardiac activity resulting in ischemic heart disease.
Clinical manifestations of abdominal adhesions
Abdominal adhesions prevent the movement of intestines by adhering to their surfaces. Adherence of these adhesions gradually results in the formation of fiber-like structures along the intestinal region constricting the blood flow leading to the onset of tissue necrosis and inflammation. Abdominal adhesions occur as a result of surgical procedures. Some of the predisposing factors include the handling of the internal organs during surgeries, incisions, preexisting infections, and contacts with surgical instruments and absorbent materials such as gauze and cotton swabs which dry the tissues, remnants of blood clots after the surgical procedure and radiation. Other factors include appendicitis.
Symptoms of abdominal adhesions include vomiting, constipation, improper bowel movement, bloating and abdominal swelling. The classical symptom indicating the presence of abdominal adhesions is chronic abdominal pain followed by gastrointestinal bleeding. These symptoms are further correlated with the patient's history associated with previous surgical procedures.
Diagnosis and prevention
Abdominal adhesions can only be detected using laparoscopic procedure. However, X rays determine the presence of intestinal obstructions. Hence abdominal surgeries are only recommended when it is absolutely necessary. Abdominal adhesions can only be prevented by administering minimal invasive procedures such as laparoscopy. In cases of surgeries that require large incisions, a thin absorbable material called seprafilm is placed between the tissues to prevent the occurrence of adhesions. Seprafilm is gradually digested by the tissue fluids. Many studies indicate that the usage of latex free gloves can prevent adhesions to a greater extent. Tissue rehydration is very important during surgical procedure to prevent abdominal adhesions.
Treating of Abdominal adhesions
Abdominal adhesions are removed surgically followed by analgesic medication. An alternative to surgery in the treatment of these lesions includes the administration of complementary and alternative medicine (CAM). The CAM procedure consists of methodologies such as acupuncture and physical therapy.
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Bibliography / Reference
Collection of Pages - Last revised Date: August 26, 2019