Classification of Hernia

Classification of Hernia

1. ileocecal hernia

2. hiatal hernia

3 . epigastric hernia

4. umbilical hernia

5. inguinal hernias – direct and indirect, femoral, obturator, crural, incisional hernias, Spigelian, perineal & perirenal & sciatic nerve entrapment(snip), false aneurysm of the artery of hemorrhoid commonly known as dentata phlegmon    (splenic artery). Laparoscopic cholecystectomy is followed by internal strangulation of the intestines causing pain in the lower right quadrant.

It is the most common cause of acute abdomen after laparoscopic cholecystectomy. However, it can be prevented by placing a purse-string suture around the cystic duct during surgery to reduce the internal pressure & also prevent biliary perforation.

6. mesenteric hernia

7. direct inguinal hernias – high and low, oblique inguinal hernias , femoral hernia

8. lumbar hernia

9. scrotal hernia

10. lesser sac or peritoneum (omphalocele and gastroschisis)

11. incarceration of omentum, mesentery, and blood vessels

12. diaphragmatic hernia

13. appendicular muscle hernia

14 .rectus sheath & linea alba hernias

15. hiatus aortic hernia

16 .herniation of the spleen is also known as splenic avulsion injury. The splenic artery crosses from left to right side from behind the pancreas to enter into the superior mesenteric vein in front of the neck of the pancreas, so when there is an increase in intra-abdominal pressure, it results in ileocecal valve obstruction resulting in ileum loops inside the lesser sac with venous congestion at porta hepatis and congestion of hepatic veins results in hepatomegaly, jaundice, and acute abdomen.

17. hiatus hernia (Zenker’s diverticulum)

18. gastroesophageal reflux disease with or without hiatal hernia post-operative edema and ileus is the most common complication in laparoscopic cholecystectomy. In addition, post-operative fever, nausea, and vomiting can be due to cholangitis if any biliary injury during surgery, pancreatitis & pain in the upper right quadrant can be because of retention of contrast medium/pancreatic pseudocyst formation, etc. which may require surgical repair. Painless jaundice can also develop after laparoscopic cholecystectomy in rare cases.

19. Spigelian hernia

20. recurrent diaphragmatic hernia

21. pressure on the superior mesenteric vein & inferior vena cava can cause abdominal pain, leg swelling & edema of the lower extremities, also known as Laplace’s syndrome. This condition occurs more commonly in obese people with increased intra-abdominal pressure due to strenuous physical exercise, heavy weight lifting, or malnutrition states like kwashiorkor.

Intestinal angina can develop if part of the stomach becomes incarcerated within a spastic stricture of the gastroesophageal junction causing severe chest pain radiating to the neck, back, and abdomen.

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22. intussusception

23. hiatal hernia is the most common type of hiatal hernia presenting with epigastric pain, dysphagia (painful swallowing), odynophagia, post-prandial fullness, vomiting & weight loss which are also the common symptoms in peptic ulcer disease.

Hiatus hernia can be primary or secondary depending on whether it develops by itself without any cause or because of some underlying condition like obesity, pregnancy, etc. It can also be caused after surgery or trauma to the abdomen & chest.

24. internal herniation of the bowel may occur due to diaphragmatic paralysis if left untreated, resulting in intestinal obstruction and respiratory distress.

25. incarcerated lumbar disc herniation resulting in acute sciatica and lower limb paralysis, while the hernia can be seen at other places like the inguinal region, pelvic cavity, trochanteric part causing discomfort and pain in that particular region depending on its location.

Psoas muscle hematoma is also a cause of acute anterior thigh pain after laparoscopic colectomy, which can lead to compartment syndrome if not treated properly, leading to renal dysfunction & tissue necrosis under the fascia.

Gilbert classification of hernia:

● a strangulated hernia occurs when the blood supply of the herniated organ is compromised, and subsequent tissue necrosis occurs.

● Reducible hernia:

all or part of the bowel content protrudes through a normally functioning sac and can be returned to its normal position spontaneously, usually without surgery.

● Incarcerated hernia:

bowel becomes trapped in an abnormal opening in which it cannot return to its routine work within the abdominal wall, also called a volvulus (or twisted loop).

● Nonstrangulated, nonincarcerated hernia:

bowel and omentum protrude through a weak spot in the abdominal wall; this type of defect does not pose a risk for incarceration or strangulation because some of the contents are covered by normal peritoneum. If tissue strangulation occurs, the hernia will become incarcerated, and surgery is necessary to release the bowel.

● Obturator hernia:

occurs when part of the intestine passes through the muscle near the groin (obturator foramen) into the canal formed by an abnormality in its roof; this type of defect usually affects children.

● Femoral hernia:

occur when some portion of bowel protrudes or becomes trapped in a pelvic ring defect or through which it can enter directly into the thigh (femoral canal).

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● Umbilical hernia:

omentum protrudes into a congenital opening that remains after incomplete obliteration of a fetal remnant due to failure of tissues to completely fuse at the site where the umbilical cord was attached during fetal life.

● Epigastric hernia:

protrusion of abdominal contents into a congenital opening that remains after incomplete obliteration of a fetal remnant due to failure of tissues to completely fuse at the site where the stomach was attached to the anterior wall of the body cavity during fetal life.

● Incisional hernia:

occurs when part or all of an incision becomes stretched and forms a defect through which the bowel may protrude; it usually results from poor surgical technique, but some people are predisposed because weakened tissue allows for this problem.

● A ventral hernia occurs at any age when tissue weakness permits part of the intestine to protrude through the muscular wall under cover of the rectus abdominis muscle. It usually results when a surgical wound or trauma causes damage to the standard structure of this region.

● A lumbar hernia occurs when part of the bowel protrudes through weak spots in the abdominal wall below the eleventh thoracic vertebrae, which functions as a barrier that would otherwise prevent these types of defects; most common after midlife.

● Paraesophageal hernia:

occurs when some portion of the bowel protrudes into the esophagus behind its lower end. It becomes trapped between two sphincters (lower esophageal and cardiac sphincter) because they are unable simultaneously to relax properly allow passage of food from the stomach into the intestine.

● Hiatus hernia:

occurs when some portion of small bowel protrudes through the opening in the diaphragm (hiatus) between two pleural sacs (left and right) that generally allow passage of vessels, nerves, lymph glands, etc.; if any part of the stomach protrudes into this hiatus, it is termed a Spigelian hernia.

● Epiploic foramen hernia:

Omentum becomes trapped within an abnormal opening in a region where several tiny blood vessels (arteries and veins both) penetrate the abdominal wall; defects exist at the surface of the top edge of the rectus abdominis muscle.

European classification of hernia:

Types of hernias by location:

Inguinal, femoral, and ventral hernias are the most common types. Rarely, a defect such as an umbilical or para esophageal hernia may occur. Less common types include:

● Lumbar, epigastric, intercostal, and spigelian hernias.

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● Epiploic foramen.

● Incisional and recurrent incisional herniae. These last two usually result from incomplete suture lines after abdominal surgery (such as Cesarean section) or trauma to the tissues of the abdominal wall. Lifestyle factors such as obesity further increase the risk of developing these conditions. In addition, persons with diabetes have a higher rate of incisional herniae.

● Epigastric abdominal wall hernias.

European classification of inguinal hernias:

The most common types are indirect, direct, femoral, and obturator (or high laceration). Rarely, other styles such as high epigastric or paraesophageal may occur. In addition, hiatal and Spigelian hernias can also affect the region.

European classification of femoral hernia:- Types of femoral hernia by location: It is rarely possible for a person to be affected by more than one type at the same time; this is because the different types are either caused by defects in other regions or move through different pathways to reach their specific locations.

Types of ventral hernias by location:

The most common types are umbilical, paraumbilical, epigastric, sub-xiphoid, subcostal, sub-diaphragmatic, Spigelian / hernia of Morgagni, and incisional. They can occur at several sites along the linea alba (the midline region). The most common type is the inguinal type.

Rarely an obturator hernia may also develop. European classification for incisional abdominal wall herniae:- Types of incisional abdominal wall herniae by location Incisional abdominal wall hernias are uncommon, accounting for only 5-10% of all abdominal wall hernias. They can occur at any site where a surgical incision has been made to gain entry into the abdomen, e.g., in the region of Cesarean section or midline laparotomy incisions.

Nyhus classification of hernia:

● Indirect ininal hernias are more common than direct inguinal hernias.

● Paraesophageal herniae are almost always associated with Hiatal abnormalities, whether congenital or acquired.

● Incisional herniae are the most common type among abdominal wall incisional defects after midline laparotomy incisions. For this reason, wound infections in patients with incisional abdominal wall defects should be treated with antibiotics specifically directed against anaerobic bacteria (such as clindamycin) rather than broad-spectrum antibiotics such as cefoxitin do not discriminate between normal and anaerobic flora.

A hernia is the abnormal passage of structures (usually an organ or tissue) through a defect in the associated wall. A hiatus is an opening, mouth, entrance, or beginning; this word originates from Latin “hiatus,” meaning gap or space.

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