HERNIA (Turun Berok)

From: Sabiston textbook of surgery

Kevin Brevian

Faculty Medicine of Krida Wacana

Hernia = is a rupture (latin words)

As an abnormal protrusion of an organ or tissue through a defect in its surrounding walls

Abdominal wall hernias occur only at sites at which the aponeurosis and
fascia are not covered by striated muscle

Incidence

75% Hernia inguinal region 2/3 of this are indirect

Femoral hernia occurs more in women than woman

Complication
The serious complication of hernia strangulation usually occurs in
femoral and indirect hernia
 Hernia
Inguinalis
Hernia
Medialis
Inguinalis
Lateralis

Patokannya

Pembuluh
darah
epigastrika

Hernia Inguinalis Indirect

Controlled by pressure over internal ring, slides through the inguinal canal, often
descends into the scrotum.

In first 8 months of life, the testicle will be descend into scrotum through canalis inguinalis,
this process will attract the peritoneum into scrotum and make a bulge named processus
vaginalis peritonei.

In the neonatus this processus should be obliterate (gone) when birth. But when this condition
is not complete congenital inguinalis lateralis hernia

In adult, this area is locus minoris resistance which means this area is weaker than the
other area surround it. If sometimes the intra-abdominal pressure increase; it will make a
hernia named Accuisita inguinalis lateralis hernia
 If the component of hernia slide till the scrotum Scrotalis hernia
Hernia Inguinalis Direct

Caused by direct bulging into Trigonum Hasselbach and usually occurs in adult.

Hernia Reponibilis
The contents of hernia can go-in and go-out (reponible) theres no pain and no sign of the
intestines obstruction

Hernia Ireponibilis
The contents of hernia (is not reposition-able) can not go back-in

Hernia Inkarserata = Ireponible hernia + passages defect

Hernia Strangulata = Ireponible hernia + vascularitations defect

Physical Examination
Inspection

A simple way to distinguish between HIL and HIM is when we ask the patient to increase the
intra-abdominal pressure by doing the valsava maneuver or coughing.

HIL The bulge will be oval which occurs from cranio-lateral into caudio-medial

HIM The bulge have a round form

Palpation

There are some test to perform in hernia inguinalis

Invagination Test / tactil test

Use the 2nd finger to put in the canalis inguinalis maximally, after that we ask patient to
doing the valsava maneuver

HIL the bulge is felt the tip of finger

HIM the bulge is felt in the side of the finger

Zieman test

2nd finger anulus internus HIL

3rd finger anulus externus HIM

4th finger fossa ovalis (1 cm above inguinal ligamentum) Femoralis Hernia

After that ask patient to cough or do the valsava maneuver !!!

Auscultation

If Hernia already reach the incarserata state = defect in passage The peristaltic sound is
>> , caused by the ileus obstruction
Terapy
Hernia Reduction (Bimanual)

Note:

If the child have incarcerated hernia = passages defect usually < 2 years old

Try to do the hernia reduction with sedative + ice bag above the hernia
 Reduceable prepare the operation in the next day

Non-Reduceable CITO operation in the 6 hours

Operative treatment

In child

HERNIOTOMY

In adult

HERNIORAPHY = Herniotomy + Hernioplasty