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Management principles An abdominal wall hernia does not necessarily require repair. A patient may request surgery for relief of symptoms or for cosmesis. The surgeon should recommend repair when compli cations are likely , the most worrying being bowel obstr...

Mesh in hernia repair The term ‘mesh’ refers to prosthetic material, either a net or a flat sheet, that is used to strengthen a hernia repair. Mesh can be used to: /uni25CF bridge a defect: the mesh is simply fixed over the defect as a tension-free patch; /uni25...

Neoplasms of the abdominal wall As the abdominal wall is composed of muscle, fascia and bone, benign and malignant tumours can arise from each, although these are rare. This is usually considered by pathologists to be a hamartoma and is more common in women. ...

Parastomal hernia When surgeons create a stoma, such as a colostomy or ileostomy , they are e ff ectively creating a hernia by bringing bowel out through the abdominal wall. The muscle defect created tends to increase in size over time and can ultimately lead t...

Rare external hernias Perineal hernia Primary perineal hernias are very rare. The majority of perineal hernias encountered are some form of incisional hernia arising after previous pelvic floor surgery or trauma. This type of hernia includes: Paul H Sugarbake...

SPECIFIC HERNIA TYPES Hernia sites are shown in Figure 64.9 .

Spigelian hernia These hernias are uncommon although probably underdiagnosed. They a ff ect men and women equally and are most common in elderly people. They have also been described in infants, reflecting incomplete di ff erentiation of through a defect in the a...

Sportsman’s groin This specific entity is well described and presents with severe - pain in the groin area, often extending into the upper thigh and the scrotum in men. It is seen in both men and women - who play contact sports such as football and rugby . The ...

Surgical approaches to hernia In general, modern surgical repairs follow these principles: /uni25CF Reduction of the hernia contents into the abdominal cav - ity with excision of any non-viable tissue and bowel repair if necessary . /uni25CF Excision and cl...

Synergistic gangrene This rare condition is due to the synergistic action of non-haemolytic streptococci and staphylococci causing rapid tissue necrosis and overwhelming systemic infection ( Figure 64.29 ). It requires immediate administration of high- dose, ...

THE ABDOMINAL WALL Basic anatomy and function related to pathology The abdominal wall is a complex structure composed primar ily of muscle, bone and fascia. Its major function is to protect the enclosed organs but it must also enable mobility and be able to fl...

Traumatic hernia These hernias arise through non-anatomical defects caused by injury . They can be classified into three types: 1 Hernias through abdominal stab wound sites. These are e ff ectively incisional hernias. 2 Hernias protruding through splits or tears...

UMBILICAL CONDITIONS IN THE ADUL T Chronic infection in the umbilical area is common, particularly in patients with poor hygiene due to a plug of keratin causing chronic irritation. It is often encountered during elective Friedrich Trendelenburg , 1844–1924, ...

Umbilical hernia The umbilical defect is present at birth but closes as the stump of the umbilical cord heals, usually within a week of birth. This process may be delayed, leading to the development of herniation in the neonatal period. The umbilical ring ma...

VENTRAL HERNIA This term refers to hernias of the anterior abdominal wall. Inguinal and femoral hernias are not included, however lumbar hernia is included despite being dorsolateral. The European Hernia Society classification (2009) distinguished primary vent...

ACKNOWLEDGEMENTS The author would like to acknowledge the artistic support of Dara Walsh, who generated all digital images and videos. He would also like to acknowledge Mr Kevin Byrnes for his work on the development of the mesentery and abdominal digestive s...

ANATOMY OF THE MESENTERY AND PERITONEUM All abdominal digestive organs develop in or on the mesentery and then remain directly connected to it ( Figure 65.3 ). In the adult setting, these collectively comprise a discrete anatomical unit, the mesenteric domain ...

Abdominal fluid collections Abdominal collections are subdivided into intraperitoneal and retroperitoneal collections. Retroperitoneal collections are further subdivided into those limited to the retroperitoneal space (e.g. in pancreatitis) and collections aris...