Hernia Overview (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is an abdominal hernia?
- What are the different types of abdominal hernias?
- What causes an abdominal hernia?
- What are the signs and symptoms of an abdominal hernia?
- How are abdominal hernias diagnosed?
- What is the treatment for an abdominal hernia?
- What non-surgical treatments are available for an abdominal hernia?
- What is the prognosis for an abdominal hernia?
- Can an abdominal hernia be prevented?
- Find a local Surgeon in your town
How are abdominal hernias diagnosed?
For inguinal hernias, most patients notice a feeling of fullness or a lump in the groin area with pain and burning. Physical examination can usually confirm the diagnosis. Femoral or obturator hernias are more difficult to appreciate and symptoms of recurrent inguinal or pelvic pain without obvious physical findings may require a CT scan to reveal the diagnosis. Umbilical hernias are much easier to locate with the bulging of the belly button.
Hernias that are incarcerated or strangulated present a greater challenge since the potential complication of dead bowel increases the urgency. The health care professional seeks clues of obstruction including the presence of pain, nausea, vomiting, or fever. X-rays or CT scan may be required to assess the bowel but if the clinical diagnosis is made, emergency referral to a surgeon is usually required.
Hiatal hernias associated with GERD are often diagnosed by history and physical exam. The diagnosis may be confirmed by chest X-ray that can reveal part of the stomach within the chest. If there is concern about complications including esophageal inflammation (esophagitis), ulcers, or bleeding, an endoscopy by a gastroenterologist may be required.
What is the treatment for an abdominal hernia?
Inguinal hernia repair is one of the most common surgical procedures performed in the U.S. with almost a million operations occurring each year. Most abdominal wall hernias are repaired electively when the health of the patient can be maximized to decrease the risk of both the surgery and the anesthetic.
The inguinal hernia surgery may be performed by laparoscope or by an open procedure called a herniorrhaphy, where the surgeon directly repairs the hernia through an incision in the abdominal wall. The type of operation depends upon the clinical situation and the urgency of surgery and the decision is made by the surgeon tailored to that specific patient.
Other abdominal wall hernias can similarly be repaired to strengthen the defect in the abdominal wall and decrease the complication risk of bowel incarceration and strangulation.
Sliding hiatal hernias may be treated surgically to place the stomach back into the abdominal cavity and to strengthen the gastroesophageal junction. However, surgery is not routinely done because most symptoms are due to GERD. Medications, diet, lifestyle changes, and weight loss may help control symptoms and minimize the need for surgery.
Paraesophageal hernia repair is done to prevent the complication of strangulation or volvulus.
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