If caecum is involved as a pa of the wall of hernial sac and is not its content, then it will be known as:September 2009
Correct Answer: Sliding hernia
Description: Ans. C: Sliding herniaIndirect inguinal herniaAn indirect inguinal hernia follows the tract through the inguinal canal. This results from a persistent process vaginalis. The inguinal canal begins in the intra-abdominal cavity at the internal inguinal ring, located approximately midway between the pubic symphysis and the anterior iliac spine.The canal courses down along the inguinal ligament to the external ring, located medial to the inferior epigastric aeries, subcutaneously and slightly above the pubic tubercle.Contents of this hernia then follow the tract of the testicle down into the scrotal sac.Direct herniaA direct inguinal hernia usually occurs due to a defect or weakness in the transversalis fascia area of the Hesselbach triangle.The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric aeries, and medially by the conjoined tendon.Femoral herniaThe femoral hernia follows the tract below the inguinal ligament through the femoral canal. The canal lies medial to the femoral vein and lateral to the lacunar (Gimbernat) ligament.Because femoral hernias protrude through such a small defined space, they frequently become incarcerated or strangulated.Umbilical herniaThe umbilical hernia occurs through the umbilical fibromuscular ring, which usually obliterates by 2 years of age. They are congenital in origin and are repaired if they persist in children older than age 2-4 years.Richter herniaThe Richter hernia occurs when only the antimesenteric border of the bowel herniates through the fascial defect. The Richter hernia involves only a poion of the circumference of the bowel.As such, the bowel may not be obstructed, even if the hernia is incarcerated or strangulated, and the patient may not present with vomiting.The Richter hernia can occur with any of the various abdominal hernias and is paicularly dangerous, as a poion of strangulated bowel may be reduced unknowingly into the abdominal cavity, leading to perforation and peritonitis Incisional herniaThis iatrogenic hernia occurs in 2-10% of all abdominal operations secondary to breakdown of the fascial closure of prior surgery. Even after repair, recurrence rates approach 20-45%.Spigelian herniaThis rare form of abdominal wall hernia occurs through a defect in the spigelian fascia, which is defined by the lateral edge of the rectus muscle at the arcuate line (costal arch to the pubic tubercle).Obturator herniaThis hernia passes through the obturator foramen, following the path of the obturator nerves and muscles. Obturator hernias occur with a female-to-male ratio of 6:1, because of a gender-specific larger canal diameter.Because of its anatomic position, this hernia presents more commonly as a bowel obstruction than as a protrusion of bowel contentsSliding herniaAs a result of slipping of the posterior parietal peritoneum on the underlying retroperitoneal structures, the posterior wall of the sac is not formed of peritoneum alone, but by the sigmoid colon and its mesentery on the left, the caecum on the right and, sometimes on either side by a poion of the bladder.
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