Hernias

Question 1

An 80 year old woman presents with a 2 day history of vomiting. On examination there is a subtle fullness in the right groin and Howship-ROmberg sign is positive

Answer 1

Obturator Hernia

(Uncomon hernia where abdominal contents may protrude through the obturator foramen. More common in women due to the wider female pelvis, particularly as women get older or lose weight. The Howship-Romberg sign is typical of an obturator hernia)

Question 2

A 65 year old woman presents with a lump on the right side of her abdomen. A requested CT shows a hernia lying lateral to the rectus muscle and below the arcuate line

Answer 2

Spigelian hernia

(uncommon hernia occurring below the line of the umbilicus/arcuate line as there is a lack of posterior rectus sheath here, between the rectus muscle medially and semilunar line laterally)

Question 3

When might you get an incisional hernia?

Answer 3

e.g. after an operation

Question 4

This is a hernia through the linea semilunaris at the lateral border of the rectus sheath?

Answer 4

Spiegelian hernia

Question 5

Littres hernia

Answer 5

A hernia that contains a Meckel’s diverticulum in the sac

Question 6

This hernia occurs through the obturator foramen. It is commoner in elderly females

Answer 6

Obturator hernia

Question 7

Develops in the area of Hasselbach’s triangle and the origin is medially to the inferior epigastric vessels?

Answer 7

Direct inguinal hernia

Question 8

Occurs because of weakness of posterior floor of the inguinal canal (acquired)

Answer 8

Direct inguinal hernia

Question 9

Occurs because of patent processus vaginalis

Answer 9

Indirect (congenital)

-Remember that younger patients are more likely to have indirect hernias and older people, direct

Question 10

Boundaries of Hasselbach’s triangle

Answer 10

Medially: lateral border of rectus abdominis

Laterally: inferior epigastric vessels

Inferiorly: Inguinal ligament