Clinical Cases Abdominal Hernia

Jim is a 53-year-old male, experiencing extreme pain and swelling in the RLQ following the lifting of a heavy pipe. He felt "something tearing" and the pain has not subsided for approximately 40 minuets. Jim has no history of chronic swelling, but did have an appendectomy about 10 years ago. The hernia can be seen as a hypodense area protruding through the anterior abdominal wall from time 0:17-0:18 at J13.

1. The most common anterior abdominal wall hernia is: (Please click on the best answer choice below)
   
   1. Epigastric (Hernia of Linea Alba)
   2. Umbilical
   3. Spigelian
   4. Incisional

   Correct

   Incorrect

   An incisional hernia is the most common type of hernia

2. Subsequent imaging (ultrasound) prompted an immediate trip to the OR for Jim. What was the likely diagnosis? (Please click on the best answer choice below)
   
   • Incarcerated hernia

     (Wrong- this is one in which adhesions develop between the wall of hernial sac and the wall of intestine.)

   • Obstructed hernia

     (Wrong- these have a patent blood supply, however the lumen of the herniated part of intestine is obstructed)

   • Strangulated hernia
   • Most abdominal wall hernias present with moderate pain.

   Correct

   Incorrect

   Strangulated hernias have the blood supply of the sac cut off, thus, leading to ischemia. The lumen of the intestine may be patent or not. Either way emergency surgery is required to preserve viable bowel

3. Umbilical hernias are typically detected during the newborn abdominal examination. They can help to present themselves when the baby cries due to increased intrabdominal pressure. Most, spontaneously resolve due to the natural closure of the umbilical ring. However, if the hernia is large enough it can resist the closure. If this problem persists for 2 years of life or greater, it will likely require surgical intervention. With respect to umbilical hernias, the hernial sac is covered only by skin and subcutaneous tissue? (Please click on the best answer choice below)
   
   • True
   • False

   Correct

   Incorrect

   This is atypical for hernias as most contain other layers prior to the actual hernial sac like fascia and muscle