Strangulation most commonly occurs in____ hernia.
Ans. c (Femoral ) (Ref LB 25th/ 979)Although inguinal hernia may be 10 times more common than femoral hernia, a femoral hernia is more likely to strangulate because of the narrowness of the neck and its rigid surrounds.HERNIA# Vital factsFemoral hernia# third most common type of primary hernia# cannot be controlled by a truss.# That of all hernias it is the most liable to become strangulated, mainly because of the narrowness of the neck of the sac and the rigidity of the femoral ring.# Strangulation is the initial presentation of 40 per cent of femoral hernias.# Femoral canal contains fat, lymphatic vessels and the lymph node of Cloquet. It is closed above by the septum crurale.# Right side is affected twice as often as the left# rare before puberty# female to male ratio is about 2:1# female patients are frequently elderly, the male patients are usually between 30 and 40 years of age.# A fully distended femoral hernia assumes the shape of a retort and its bulbous extremity may be above the inguinal ligament.# Laugier's femoral hernia. This is a hernia through a gap in the lacunar (Gimbernat's) ligament. The diagnosis is based on unusual medial position of a small femoral hernia sac. The hernia has nearly always strangulated.# Narath's femoral hernia. This occurs only in patients with congenital dislocation of the hip and is due to lateral displacement of the psoas muscle. The hernia lies hidden behind the femoral vessels.# Cloquet's hernia. Cloquet's hernia is one in which the sac lies under the fascia covering the pectineus muscle. Strangulation is likely. The sac may coexist with the usual type of femoral hernia sac.# RX:The constant risk of strangulation is sufficient reason to recommend operation, which should be carried out soon after the diagnosis has been made. A truss is contraindicated because of this risk.# Operative treatment.Several approaches to the femoral hernia have been advocated including the low operation (Lockwood), the high operation (McEvedy) and the inguinal operation (Lotheissen). In all cases the bladder must be emptied by catheterisation immediately before commencing surgery.Morgagni hernia# Commonly occurs through Right anterior diaphragm.# Usually contains omentum and transverse colon.Bochdalek hernia# Congenital diaphragmatic hernia# Occurs through posterior pleuroperitoneal canal/ defect.# 80% occur on left side.# Best predictor of prognosis is Pulmonary hypertensionExomphalos (syn. omphalocele)# Herniation or protrusion of the abdominal contents into the base of the umbilical cord.# In contrast to the more common umbilical hernia, the sac is covered with peritoneum without overlying skin.# Associated with chromosomal abnormalities (50%) and severe malformations like cardiac anomalies (50%), and neural tube defects (40%), hence mortality rate is high in omphalocele.Gastroschisis# Paramedian full-thickness abdominal fusion defect usually on right side of umbilical cord; may involve thorax; bowel is nonrotated and lacks secondary fixation to dorsal abdominal wall.Umblical hernia# Repaired After 1 year of age, if required.Spigelian hernia repair# Interparietal hernia occurring at the level of the arcuate line.# The patient is often corpulent and usually over 50 years of age, men and women being equally affected.# Retraction of External oblique, internal oblique, and transversus abdominis muscles laterally is done during its surgical repair.Indirect inguinal hernia# It is congenital in origin.# It is more common than a direct inguinal hernia.# It is much more common in males than in females.# It is more common on the right side.# It is most common# An indirect inguinal hernial sac travels down the canal on anterolateral aspect of spermatic cord. # The neck of the sac is narrow.# The hernial sac may extend through the superficial inguinal ring above and medial to the pubic tubercle. (Femoral hernia is located below and lateral to the pubic tubercle)# The hernial sac may extend down into the scrotum or labium majus.Direct inguinal hernia# Occurs through Hasselbach's triangle (Deep Inguinal Ring) as a result of weakness of the posterior wall of the inguinal canal.# An inguinal hernia can be differentiated from femoral by sac neck relation to medial end of inguinal ligament and pubic tubercle, i.e., in inguinal hernia neck is above and medial while in femoral it is below and lateral to medial end of inguinal ligament and pubic tubercle.# So, direct hernia -sac is posterior, Indirect hernia -sac anterolateral.# Direct hernias do not often attain a large size or descend into scrotum.# In contrast to an indirect inguinal hernia, a direct inguinal hernia lies behind the spermatic cord.# As neck of the sac is wide, direct hernias do not often strangulate.# A direct inguinal hernia is always acquired (Smoking, occupation that involves straining & heavy lifting & damage to ilioinguinal nerve)# Women practically never develop a direct inguinal hernia (It is common in old men with weak abdominal muscles and is rare in women).Hiatus hernia# Most common complication esophagitis.# Best diagnosed by Ba meal.# Rx: Heller's operation# Paraoesophageal ('rolling') hiatus hernia are dangerous.Paraduodenal HerniaAthletic pubalgiaParastomal hernia# Congenital defect in descending mesocolon.# Sports Hernia; Gilmore's Groin/Groin Disruption.# Most commonly seen with End Colostomy.
Ritcher's
Spigelian
Femoral
Sliding
Hernia