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Abdominal wall hernia
Medical expert of the article
Last reviewed: 07.07.2025
An abdominal wall hernia is the protrusion of abdominal contents through acquired or congenital weak spots or defects in the abdominal wall. Most hernias are asymptomatic, but in some cases, when strangulation or incarceration develops, severe pain occurs, requiring emergency surgical treatment. The diagnosis is clinical. Treatment of an abdominal wall hernia involves selective surgical plastic surgery.
Abdominal hernias are extremely common, especially in men, with approximately 700,000 operations performed in the United States each year.
[ Symptoms of abdominal wall hernia
Most patients with abdominal wall hernias complain only of a visible protrusion, which may cause vague discomfort or be asymptomatic. Most hernias, even large ones, can be manually reduced by gentle pressure in the Trendelenburg position. An irreducible abdominal wall hernia has no specific clinical signs. When a hernia is strangulated, persistent, gradually increasing pain syndrome occurs, usually with the appearance of nausea and vomiting. The hernia itself is painful, and peritonitis may develop depending on the location of the hernia with diffuse tenderness, tension and peritoneal symptoms.
Hernia of the abdominal wall: localization and types
Abdominal hernias are classified into abdominal wall hernias and inguinal hernias. When strangulated, ischemia of the hernial contents develops due to physical constriction and disruption of the blood supply. Gangrene, perforation, and peritonitis may develop. Irreducible and strangulated hernias should not be reduced manually.
Hernias of the abdominal wall include umbilical hernias, epigastric hernias, Spiegel's hernias, and incisional (ventral) hernias. Umbilical hernias (protrusion through the umbilical ring) are mostly congenital, but in some cases are acquired in adulthood and are secondary to obesity, ascites, pregnancy, or chronic peritoneal dialysis. Epigastric hernias exit through the linea alba. Spiegel's hernias exit through a defect in the transversus abdominis muscle, lateral to the rectus sheath, usually below the level of the umbilicus. Incisional hernias exit through defects in the abdominal wall following previous abdominal surgery.
Hernias of the inguinal region include inguinal and femoral hernias. Inguinal hernias are located above the inguinal ligament. Indirect inguinal hernias cross the internal inguinal ring and pass through the inguinal canal, and direct inguinal hernias are located just anteriorly and do not pass through the entire inguinal canal. Femoral hernias are located below the inguinal ligament and pass into the femoral canal.
Approximately 50% of all abdominal hernias are indirect inguinal hernias and 25% are direct inguinal hernias. Incisional hernias account for 10-15%. Femoral and rare forms of hernias account for the remaining 10-15%.
Diagnosis of abdominal wall hernia
The diagnosis of "abdominal wall hernia" is clinical. Since the hernial protrusion is visualized with increased abdominal pressure, the patient should be examined in a standing position. If the hernial protrusion is not determined, the patient should cough or perform the Valsalva maneuver with simultaneous palpation of the abdominal wall by the doctor. The umbilical region, inguinal region (with finger examination of the inguinal canal in men), femoral triangle and areas of all postoperative scars are examined.
Hernia-like lesions in the inguinal region may be due to adenopathy (infectious or malignant), ectopic testicle, or lipoma. These lesions are dense and cannot be reduced. Scrotal lesions may be varicocele, hydrocele, or testicular tumor. Ultrasound is performed to confirm the diagnosis after physical examination.
Treatment of abdominal wall hernia
Congenital umbilical hernias are rarely strangulated and do not require treatment; most such hernias spontaneously disappear within a few years. Very large defects may be closed after 2 years if indicated. Umbilical hernias in adults cause cosmetic problems and may be operated on if indicated; strangulation of such hernias is uncommon, but their contents are usually omentum rather than bowel.
Inguinal hernias should be selectively operated on because of the risk of strangulation, which leads to a higher complication rate (and possible mortality in older patients). Repair can be performed standardly or laparoscopically.