Managing Abdominal Hernias

Kiran Panesar, BPharmS (Hons), MRPharmS, RPh, CPh

Disclosures

US Pharmacist. 2017;42(8):HS10-HS16. 

In This Article

Abstract and Introduction

Abstract

An abdominal hernia is a protrusion of the bowel through the abdominal wall. Abdominal hernias can be classified as internal or external and/or complete or incomplete. There are different types of abdominal hernias, based upon their location. The occurrence of each of these varies in the population, as does the risk of complications and mode of treatment. Abdominal hernias are usually managed surgically, but in certain circumstances, trusses may be used. In most cases, trusses may be measured, supplied, and fitted in an outpatient setting or in a pharmacy. Surgical treatment generally involves the use of a prosthetic device, although some cases may require suturing. In patients who have undergone surgery, pharmacists can provide useful advice on the aftercare of the wound.

Introduction

Abdominal hernias are protrusions of the bowel through a weakened part of the abdominal muscle wall.[1] The hernia may be classified as external when it extends beyond the abdominal cavity and is visible on the body surface; it is classified as internal when the protrusion is limited to the peritoneal pockets.[2] Depending upon size of the protrusion, the hernia may be complete or incomplete, and based upon its formation it may be classified as a congenital or acquired hernia.[2] Hernias may also be divided according to their site of occurrence, such as abdominal, diaphragmatic, perineal, or lumbar hernia.[3] This article will focus on three types of abdominal hernias: inguinal, umbilical, and femoral.

Inguinal Hernias

The most common type of hernia in both sexes, inguinal hernias constitute 75% of hernias.[2,4] It has been shown that of the one million abdominal wall hernia repairs performed each year in the United States, inguinal hernia repairs constitute nearly 770,000 of these cases.[5] They may occur in people of any age, ranging from infants (especially in premature babies) to the elderly. Inguinal hernias should be repaired early to reduce the risk of strangulation and to minimize stretching of the abdominal wall musculature, thereby reducing the rate of recurrence. Strangulation is said to occur if the blood flow to the hernia is cut off due to incarceration— that is, when the hernia becomes trapped in the abdominal wall.[4]

Umbilical Hernias

Umbilical hernias can develop at any age in the natural opening of the umbilicus. They account for about 14% of hernias and are the third most common disorder in children after hydroceles and inguinal hernias.[2,5] Most umbilical hernias in children are asymptomatic, even though they may seem unsightly. Umbilical hernias that occur in infants disappear by the age of 2 years in 90% of cases. Furthermore, complications such as strangulation of omentum or intestine and evisceration occur in only about 4% of cases. Surgical repair of such hernias is indicated only in patients who have complaints or complications, or if the hernia persists beyond the age of 2 years.[2]

In adults, however, umbilical hernias are indirect herniations through the umbilical canal that have a high tendency to incarcerate and strangulate and do not resolve spontaneously. Most of these patients are women or overweight adults.[1,2] Surgery is recommended in these patients since the risk of incarceration is as high as 30%.[2]

Femoral Hernias

Femoral hernias make up only 3% to 5% of hernias and involve the protrusion of the peritoneum into the potential space of the femoral canal.[4] Up to 75% of femoral hernia cases occur in females; inguinal hernias are predominantly seen in males (80% to 90% in males and 10% in females).[2] Furthermore, femoral hernias are more common in multiparous women and are rare in children.[4]

Since the femoral canal is small, femoral hernias strangulate readily; although most patients present with signs and symptoms of small-bowel obstruction, repair should be undertaken at the earliest opportunity even in asymptomatic patients.[4] Treatment of femoral hernia involves operative therapy, preferably with the use of a mesh.[2]

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