Section: Abdominal wall and retroperitoneum Sub-section: Hernias Curriculum: Curriculum, page 2
Definition
- Abnormal protrusion of intra-abdominal contents (usually preperitoneal fat) through the linea alba
Incidence
- 3-5% of population (in autopsy studies)
- M > F
- Most common between ages of 20-50
Clinical
- Most are asymptomatic
- May cause vague upper abdo pain & tenderness +/- nausea
- Usually palpable in non-obese pts
- Usually small & contain only preperitoneal fat → May cause pain; prone to incarceration
- 80% occur just off the midline
- 20% are multiple
Pathogenesis
- Develop through one of the foramina of the small para-midline nerves/vessels or a congenital weakness in the linea alba
- Preperitoneal fat is forced out of the canal, followed by adherent peritoneum
Management
- Repair recommended
- Defect can usually be closed primarily after the contents are dissected free
- For multiple hernias: incise linea alba to incorporate multiple hernias into one defect
- Then close longitudinally