HERNIA

protrusion of an organ or tissue from its normal cavity. The herniation may be of any of a number of the bodily tissues. Brain tissue, for example, may protrude through a defect in the skull. The protrusion may extend outside the body or between cavities within the body, as when loops of intestine escape from the abdominal cavity into the chest through a defect in the diaphragm, the muscular partition between the two cavities. The term is usually applied, however, to an external herniation of tissue through the abdominal wall. An abdominal hernia, or rupture, may occur at any weak point in the abdominal wall. The common sites are the groin (inguinal), the upper part of the thigh (femoral), and the navel (umbilical). Hernias may be congenital or may be acquired later in life. In inguinal hernia, the protruding tissue descends along the canal that holds the spermatic cord in the male and the round ligament in the female. If such a hernia occurs bilaterally, it is called a double hernia. A femoral hernia lies on the inner side of the large femoral blood vessels. An umbilical hernia protrudes through the navel. A hernia may be present at birth as the result of defective development of the abdominal wall, or it may occur later in life as the result of a strain or injury. An acquired hernia usually is caused by overexertion, as in lifting a heavy weight, jumping off a high wall, or violent coughing. Men develop hernias more frequently than do women because of their greater physical exertions and because the canal for the spermatic cord leading through the abdominal wall is wider than the canal for the round ligament. A special type of acquired hernia is the incisional hernia, which occurs at an incision after surgery. The hernia may be classified as reducible, irreducible, or strangulated. A reducible hernia is one in which the contents can be pushed back into the abdomen and often may be held in place by a truss. A reducible hernia may increase in size or may form adhesions, becoming irreducible. A strangulated hernia is one in which the circulation of blood through the hernial contents is impeded by the pinching at the narrowest part of the passage. Congestion is followed by inflammation, infection, and gangrene. The tighter the constriction, the more rapidly these events take place; unrelieved strangulation may be fatal within a few hours or days. Surgery is often necessary for the permanent relief of reducible hernia, and it is the only safe treatment for more advanced forms.