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Ventral Hernia

(Abdominal hernia; Incisional hernia; Spigelian hernia; Epigastric hernia)

Definition

An abdominal hernia occurs when soft tissue has pushed through the abdominal wall. A ventral hernia is a hernia that develops in the front of the abdomen. Types of ventral hernias include:
  • Incisional hernia—develops along a previous surgical incision
  • Epigastric hernia—develops along the upper abdominal wall below the chest
  • Spigelian hernia—rare and develops along the side of the abdominal wall
Some hernias may not need treatment. Others can require surgery. Some hernias can be serious and require immediate medical attention.
Ventral Hernia
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Causes

The abdominal wall covers the front of the body from the ribs to the pelvis. It normally keeps abdominal tissue in place. When this wall tears or weakens, tissue pushes out. This creates a hernia. The tissue pushed through can be loops of intestine, fat, or other tissue. The weakness may be caused by:
  • Increased abdominal pressure
  • Surgery or injury to abdomen
Weak spots may be present at birth. Others may develop later in life from general weakness, injury, or from surgery.

Risk Factors

Factors that may increase your risk for ventral hernia include:
  • Heavy lifting
  • Coughing
  • Straining during bowel movements
  • Increased age
  • Excess body weight
  • Previous abdominal surgery
  • Surgical wound infection
  • Pregnancy

Symptoms

Hernias produce a bulge under the skin. It may not cause any other symptoms. Sometimes you may notice pain that increases during the day. Activities that may cause pain include:
  • Coughing
  • Straining during bowel movements or urination
  • Heavy lifting
  • Sitting or standing for long periods of time
Sometimes a loop of intestine becomes trapped in the abdominal wall. This may lead to a blockage of the intestine. Strangulation can also occur if the hernia is slowing or blocking blood flow. Symptoms of a strangulated hernia include:
  • Continuous, severe pain
  • Redness
  • Nausea and vomiting
  • High fever
  • Increased sweating
  • Constipation
A strangulated hernia is a medical emergency. It requires immediate surgery.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Images may be taken of your abdomen and intestines. Tests to create these images may include:
  • Abdominal ultrasound
  • CT scan

Treatment

Many hernias enlarge over time. A hernia may be easily pushed back in, without causing any symptoms. In this case, your doctor may choose to watch it. Otherwise, surgery is usually performed to fix the weakened area of the abdominal wall.

Surgery

Hernias are repaired with surgery. During the surgery, the displaced organs are put back into place. The damaged wall is repaired. A piece of mesh may also be placed over the area to provide extra support.

Prevention

To help reduce your chance of getting a ventral hernia, take these steps:
  • Learn proper lifting techniques.
  • Maintain a normal weight.

RESOURCES

American College of Surgeons http://www.facs.org

American Society of General Surgeons http://www.theasgs.org

CANADIAN RESOURCES

The Canadian Association of General Surgeons http://www.cags-accg.ca

Health Canada http://www.hc-sc.gc.ca

References

Hernias of the abdominal wall. Merck Manual for Health Care Professionals website. Available at: http://www.merckmanuals.com/professional/gastrointestinal%5Fdisorders/acute%5Fabdomen%5Fand%5Fsurgical%5Fgastroenterology/hernias%5Fof%5Fthe%5Fabdominal%5Fwall.html?qt=ventral hernia&alt=sh. Updated October 2013. Accessed March 20, 2014.

Mittal T, Kumar V, et al. Diagnosis and management of Spigelian hernia: A review of literature and our experience. J Minim Access Surg. 2008;4(4):95-98.

Patient information for laparoscopic ventral hernia repair from SAGES. Society of American Gastrointestinal Endoscopic Surgeons website. Available at: http://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-ventral-hernia-repair-from-sages. Accessed March 20, 2014.

Spigelian hernias. Pediatric Surgery Update. 2004 Apr;22(4):1

Ventral hernia. Dartmouth-Hitchcock website. Available at: http://patients.dartmouth-hitchcock.org/hernia/ventral%5Fhernia.html. Accessed March 20, 2014.

Ventral hernia. UCSF Medical Center website. Available at: http://www.ucsfhealth.org/conditions/ventral%5Fhernia. Accessed March 20, 2014.

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