H

hernia A separation or tear in the fibers of a
MUSCLEthat allows the underlying tissue or struc-
ture to bulge through. Hernias may occur as a
result of congenital weakness or incomplete clo-
sure of a channel in the muscle (such as an umbil-
ical or inguinal hernia) or because of injury
(unintended or surgical). The common types of
hernia are

• inguinal hernia, which occurs in the inguinal
  canal (groin)


• femoral hernia, which occurs in the upper
  thigh


• umbilical hernia, which occurs at the umbilicus
  (belly button)


• HIATAL HERNIA, which occurs in the DIAPHRAGM
  and is not visually perceptible


• incisional hernia, which occurs at the site of a
  surgical incision, usually abdominal

Hernias present in children often heal as the
child grows. Hernias in adults are often present
from childhood and become problematic when
some sort of strain puts pressure on them. Hernias
are somewhat more common in men. When the
person or doctor can push the hernia back into
the muscle wall it is reducible; an incarcerated
hernia is a hernia that will not recede. When the
hernia traps a segment of intestine or other tissue
to the extent that it cuts off the BLOODsupply, it is
a strangulated hernia. Though some hernias, par-
ticularly in children, may correct themselves, most
hernias require surgery to repair the defect in the
muscle wall.

Symptoms and Diagnostic Path

A hernia may appear as a painless bulge or may
cause discomfort, depending on its location and

the extent to which it allows intestinal structure to

protrude through the muscle wall. Many abdomi-

nal hernias are more prominent with coughing or

bearing down. Symptoms of hiatal hernia may

include DYSPEPSIA(heartburn) and difficulty swal-

lowing. Diagnosis is primarily clinical, based on

the appearance of the symptoms. The doctor may

request an ULTRASOUNDexamination to confirm the

presence of the hernia and to create a visual image

to help assess the appropriate therapeutic course.

Treatment Options and Outlook

Most hernias require surgery to repair the weak-

ness in the muscle wall. The doctor may decide to

take an approach of watchful waiting when the

hernia is very small, in a young child, or in a per-

son for whom surgery is a significant risk. Nonsur-

gical approaches such as a truss (a supportive

device that places pressure against the hernia to

keep it within the abdominal wall) may relieve

symptoms for the short term but cannot correct

the hernia. Though some hernias may remain

small and inconsequential for long periods of time

they may become problematic without warning,

at which point they may require immediate or

urgent medical attention. An incarcerated hernia

is a medical emergency that requires immediate

surgery, otherwise the strangulated tissue dies and

is at very high risk for GANGRENE.

Hernia repair surgery, called herniorrhaphy or

hernioplasty, can be OPEN SURGERY(an OPERATIONin

which the surgeon makes a two- to three-inch-

long incision over the site of the hernia and

directly exposes the involved muscles) or MINI-

MALLY INVASIVE SURGERY(an operation in which the

surgeon uses a laparoscope and special instru-

ments to operate through one to three small inci-

sions). ANESTHESIAmay be regional, epidural, or

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