Umbilical Herniae-Acquired infantile umbilical hernia-Acquired umbilical hernia of adults -Epigastric Hernia-Incisional Hernia-Separation of the Recti Abdominis

Umbilical Herniae

Congenital umbilical hernia, is caused by a failure of part of the midgut to return to the abdominal cavity from the extraembryonic coelom during fetal life.The hernial sac and its relationship to the umbilical cord are shown below:

Acquired infantile umbilical hernia
is a small hernia that sometimes occurs in children and is caused by a weakness in the scar of the umbilicus in the linea alba. Most become smaller and disappear without treatment as the abdominal cavity enlarges.

Acquired umbilical hernia of adults
referred to as a paraumbilical hernia. The hernial sac does not protrude through the umbilical scar, but through the linea alba in the region of the umbilicus. Paraumbilical herniae gradually increase in size and hang downward. The neck of the sac may be narrow, but the body of the sac often contains coils of small and large intestines and omentum. Paraumbilical herniae are much more common in women than in men

Epigastric Hernia

Epigastric hernia occurs through the widest part of the linea alba, anywhere between the xiphoid process and the umbilicus. The hernia is usually small and starts off as a small protrusion of extraperitoneal fat between the fibers of the linea alba. During the following months or years, the fat is forced farther through the linea alba and eventually drags behind it a small peritoneal sac. The body of the sac often contains a small piece of greater omentum. It is common in middle-aged manual workers.

Incisional Hernia

A postoperative incisional hernia is most likely to occur in patients in whom it was necessary to cut one of the segmental nerves supplying the muscles of the anterior abdominal wall; postoperative wound infection with death (necrosis) of the abdominal musculature is also a common cause. The neck of the sac is usually large, and adhesion and strangulation of its contents are rare complications. In very obese individuals, the extent of the abdominal wall weakness is often difficult to assess.

Separation of the Recti Abdominis

Separation of the recti abdominis occurs in elderly multiparous women with weak abdominal muscles .In this condition, the aponeuroses forming the rectus sheath become excessively stretched. When the patient coughs or strains, the recti separate widely, and a large hernial sac, containing abdominal viscera, bulges forward between the medial margins of the recti. This can be corrected by wearing a suitable abdominal belt

Abdominal Herniae-Indirect Inguinal Hernia-Direct Inguinal Hernia

Abdominal Herniae

A hernia is the protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall. It consists of three parts: the sac, the contents of the sac, and the coverings of the sac. The hernial sac is a pouch (diverticulum) of peritoneum and has a neck and a body. The hernial contents may consist of any structure found within the abdominal cavity and may vary from a small piece of omentum to a large viscus such as the kidney. The hernial coverings are formed from the layers of the abdominal wall through which the hernial sac passes. Abdominal herniae are of the following common types:

Inguinal (indirect or direct)
 Femoral
Umbilical (congenital or acquired)
 Epigastric
Separation of the recti abdominis
 Incisional
Hernia of the linea semilunaris (Spigelian hernia)
Lumbar

Indirect Inguinal Hernia

The indirect inguinal hernia is the most common form of hernia It is more common than a direct inguinal hernia. It is much more common in males than females.  and is believed to be congenital in origin . The hernial sac is the remains of the processus vaginalis (an outpouching of peritoneum that in the fetus is responsible for the formation of the inguinal canal . It follows that the sac enters the inguinal canal through the deep inguinal ring lateral to the inferior epigastric vessels. It may extend part of the way along the canal or the full length, as far as the superficial inguinal ring. If the processus vaginalis has undergone no obliteration, then the hernia is complete and extends through the superficial inguinal ring down into the scrotum or labium majus. Under these circumstances, the neck of the hernial sac lies at the deep inguinal ring lateral to the inferior epigastric vessels, and the body of the sac resides in the inguinal canal and scrotum (or base of labium majus). An indirect inguinal hernia is about 20 times more common in males than in females, and nearly one third are bilateral. It is more common on the right (normally, the right processus vaginalis becomes obliterated after the left; the right testis descends later than the left). It is most common in children and young adults

Direct Inguinal Hernia

The direct inguinal hernia It is common in old men with weak abdominal muscles and it makes up about 15% of all inguinal hernias it is rare in women . The sac of a direct hernia bulges directly anteriorly through the posterior wall of the inguinal canal medial to the inferior epigastric vessels  and The neck of the hernial sac is wide. Because of the presence of the strong conjoint tendon (combined tendons of insertion of the internal oblique and transversus muscles), this hernia is usually nothing more than a generalized bulge; therefore, the neck of the hernial sac is wide. Direct inguinal hernias are rare in women and most are bilateral. It is a disease of old men with weak abdominal muscles.