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VALUE OF OBSERVATION AND REVIEW In the case of acute abdominal pain, there will be a subset of patients in whom, after full clinical assessment, the surgeon remains uncertain about the need for an urgent operation. This is probably the most di ffi cult group to...

ABDOMINAL HERNIA e A hernia is an abnormal protrusion of an organ or tissue through an opening in the layer that normally con�nes it. There are many varieties of hernia arising through areas of weakness in the abdominal wall. Because they ‘push’ from t...

ABDOMINAL WALL The skin of the abdominal wall, similar to all skin, is prone to develop superficial infection that may be spontaneous, due to minor trauma or infection of skin lesions such as an epider moid cyst. Although antibiotics will su ffi ce in most pati...

ACKNOWLEDGEMENT The authors are grateful to Andrew C de Beaux MBChB MD FRCS FEBS AWS, Consultant General and Upper GI Surgeon, Royal Infirmary of Edinburgh, Edinburgh, UK, for his input to this chapter. Henriksen NA, Montgomery A, Kaufmann R et al . Guidelines...

Abdominal compartment syndrome Surgeons are increasingly aware of the harmful e ff ect of high - intra-abdominal pressures that can occur in severe intra- abdominal sepsis, such as pancreatitis and also following aortic aneurysm rupture. High pressure leads ...

Anatomical causes of abdominal wall herniation These may be classified as areas of natural weakness due to absence of muscle, natural defects that allow structures to enter or leave the abdomen, developmental abnormalities and disruptions of the abdominal wa...

Clinical history and diagnosis in hernia cases Patients are usually aware of a lump on the abdominal wall under the skin. Self-diagnosis is common. The hernia is usually painless but patients may complain of an aching or heavy feeling. Sharp, intermittent pa...

Common principles in abdominal hernia An abdominal wall hernia has two essential components: a defect in the wall and the content, i.e. tissue that has been forced outwards through the defect. The weakness may be through fascia and muscle, or through fascia al...

Cutaneous fistula Because of the thickness of the abdominal wall, it is rare for abdominal inflammatory conditions to discharge sponta neously through the wall to the skin. Chronic intraperitoneal abscesses arising after occult bowel perforation, appendicitis,...

Epigastric hernia These hernias arise through the midline raphe (linea alba) anywhere between the xiphoid process and the umbilicus. They begin with a transverse split in the midline raphe so the defect is elliptical and usually less than 1 /uni00A0 cm in diam...

Examination for hernia The patient should be examined lying down initially and then standing, as this will usually increase hernia size. Some hernias will only be apparent with the patient standing. The patient may be asked to cough or to perform the Valsalva ...

Femoral hernia Basic anatomy The external iliac artery and vein pass below the inguinal ligament to become the common femoral vessels in the leg. The vein lies medially and the artery is lateral to the vein, with the femoral nerve lateral to the artery . They ...

Incisional hernia These arise through a defect in the musculofascial layers of the abdominal wall at the site of a postoperative scar. Thus, they may appear anywhere where a laparotomy has been made. Incidence and aetiology Incisional hernias have been repor...

Inguinal hernia Inguinal hernia, often referred to as a ‘rupture’ by patients, is the most common hernia in men and is around 10 times more common in men than in women. There are two basic types that are fundamentally di ff erent in anatomy , causation and comp...

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Investigations for hernia For most hernias, the diagnosis is made on clinical examina - tion. However, the patient may have symptoms suggesting a hernia but no hernia is found, or the patient may have a swelling suggestive of hernia but with clinical uncertai...

Learning objectives To know and understand: Basic anatomy of the abdominal wall and its weaknesses • Causes of abdominal hernia • Types of hernia and classi /f_i cations • Clinical history and examination /f_i ndings in hernia • Complications of abdominal hern...

Lumbar hernia Most primary lumbar hernias occur through the inferior lumbar triangle of Petit, bounded below by the crest of the ilium, laterally by the external oblique muscle and medially by latissimus dorsi ( Figure 64.23 ). Less commonly , the sac comes ...