Hernia
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2], Anmol Pitliya, M.B.B.S. M.D.[3]
Overview
Overview
A hernia is “the protrusion of an organ, organic part, or other bodily structure through the wall that usually contains it.[1] Hernias may be congenital or acquired. Based on the protruded body structure and the location of the protrusion, the hernia may be classified into inguinal, femoral, umbilical, diaphragmatic, incisional, and other hernias. Different kinds of hernias, such as central nervous system (CNS), diaphragmatic, lumbar, abdominal, and pelvic hernias have to be differentiated on the basis of clinical manifestations.
Classification
Classification
Major classification of hernias in human body.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Classification
Classification Based on Anatomic Location
Hernias can be classified according to their anatomical location:
Examples include:
- Abdominal hernias.
- Diaphragmatic hernias and hiatal hernias (for example, paraesophageal hernia of the stomach).
- Pelvic hernias, for example, obturator hernia.
- Hernias of the nucleus pulposus of the intervertebral discs.
- Intracranial hernias.
Sportsman’s Hernia
A sportman’s hernia is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal, although a true hernia is not present.
Inguinal Hernia
- Main article: inguinal hernia.
By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. For a thorough understanding of inguinal hernias, much insight is needed in the anatomy of the inguinal canal. Inguinal hernias are further divided into the more common indirect inguinal hernia (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the direct inguinal hernia type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal. Inguinal hernias are more common in men than women while femoral hernias are more common in women.
Femoral Hernia
- Main article: femoral hernia.
Femoral hernias occur just below the inguinal ligament, when abdominal contents pass into the weak area at the posterior wall of the femoral canal. They can be hard to distinguish from the inguinal type (especially when ascending cephalad): however, they generally appear more rounded, and, in contrast to inguinal hernias, there is a strong female preponderance in femoral hernias. The incidence of strangulation in femoral hernias is high. Repair techniques are similar for femoral and inguinal hernia.
Umbilical Hernia
- Main article: umbilical hernia.
Umbilical hernias are especially common in infants of African descent, and occur more in boys. They involve protrusion of intraabdominal contents through a weakness at the site of passage of the umbilical cord through the abdominal wall. These hernias often resolve spontaneously. Umbilical hernias in adults are largely acquired, and are more frequent in obese or pregnant women. Abnormal decussation of fibers at the linea alba may contribute.
Incisional Hernia
- Main article: incisional hernia.
An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in median laparotomy incisions in the linea alba, they are termed ventral hernias. These can be the most frustrating and difficult to treat, as the repair utilizes already attenuated tissue.
Diaphragmatic Hernia
- Main article: diaphragmatic hernia
Higher in the abdomen, an (internal) “diaphragmatic hernia” results when part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm.
A hiatus hernia is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach (esophageal hiatus) serves as a functional defect, allowing part of the stomach to (periodically) herniate into the chest. Hiatus hernias may be either sliding, in which the gastroesophageal junction itself slides through the defect into the chest, or non-sliding (also known as para-esophageal), in which case the junction remains fixed while another portion of the stomach moves up through the defect. Non-sliding or para-esophageal hernias can be dangerous as they may allow the stomach to rotate and obstruct. Repair is usually advised.
A congenital diaphragmatic hernia is a distinct problem, occurring in up to 1 in 2000 births, and requiring pediatric surgery. Intestinal organs may herniate through several parts of the diaphragm, posterolateral (in Bochdalek’s triangle, resulting in Bochdalek’s hernia), or anteromedial-retrosternal (in the cleft of Larrey/Morgagni’s foramen, resulting in Morgagni-Larrey hernia, or Morgagni’s hernia).
Other Types of Hernia
Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms. The above article deals mostly with “visceral hernias”, where the herniating tissue arises within the abdominal cavity. Other hernia types and unusual types of visceral hernias are listed below, in alphabetical order:
- Brain hernia: herniation of part of the brain because of excessive intracranial pressure. This may be a life-threatening condition, especially if the brain stem (responsible for some important vital signs) is involved.
- Cooper’s hernia: a femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing immediately beneath the skin.
- Epigastric hernia: hernia through the linea alba above the umbilicus.
- Littre’s hernia: hernia involving a Meckel’s diverticulum. It is named after French anatomist Alexis Littre (1658-1726).
- Lumbar hernia: hernia in the lumbar region (not to be confused with a lumbar disc hernia), contains following entities:
- Petit’s hernia – Hernia through Petit’s triangle (inferior lumbar triangle). It is named after French surgeon Jean Louis Petit (1674-1750).
- Grynfeltt’s hernia – Hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle). It is named after physician Joseph Grynfeltt (1840-1913).
- Obturator hernia: hernia through obturator canal.
- Pantaloon hernia: a combined direct and indirect hernia, when the hernial sac protrudes on either side of the inferior epigastric vessels.
- Perineal hernia: a perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually, is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.
- Properitoneal hernia: rare hernia located directly above the peritoneum, for example, when part of an inguinal hernia projects from the deep inguinal ring to the preperitoneal space.
- Richter’s hernia: strangulated hernia involving only one sidewall of the bowel, which can result in bowel perforation through ischaemia without causing bowel obstruction or any of its warning signs. It is named after German surgeon August Gottlieb Richter (1742-1812).
- Sliding hernia: occurs when an organ drags along part of the peritoneum, or, in other words, the organ is part of the hernia sac. The colon and the urinary bladder are often involved. The term also frequently refers to sliding hernias of the stomach.
- Siatic hernia: this hernia in the greater sciatic foramen most commonly presents as an uncomfortable mass in the gluteal area. Bowel obstruction may also occur. This type of hernia is only a rare cause of sciatic neuralgia.
- Spigelian hernia, also known as spontaneous lateral ventral hernia.
- Velpeau hernia: a hernia in the groin in front of the femoral blood vessels.
- Spinal disc herniation, or herniated nucleus pulposus: a condition where the central weak part of the intervertebral disc (nucleus pulposus, which helps absorb shocks to our spine), herniates through the fibrous band (annulus fibrosus) by which it is normally bound. This usually occurs low in the back at the lumbar or lumbo-sacral level and can cause back pain which usually radiates well into the thigh or leg. When the sciatic nerve is involved, the symptom complex is called sciatica. Herniation can occur in the cervical vertebrae too. A nucleoplasty is an operation to repair the herniation.
- Traumatic abdominal wall hernia: herniation of viscera occurring after a force is applied to the abdomen in a patient without preexisting abdominal hernia, resulting in disruption of muscles and fascia while maintaining skin continuity.
Classification Based on Characteristics
Each of the above hernias may be characterized by several aspects:
- Congenital or acquired: congenital hernias occur prenatally or in the first year(s) of life, and are caused by a congenital defect, whereas acquired hernias develop later on in life. However, this may be on the basis of a locus minoris resistentiae (Lat. place of least resistance) that is congenital, but only becomes symptomatic later on in life, when degeneration and increased stress (for example, increased abdominal pressure from coughing in COPD) provoke the hernia.
- Complete or incomplete: for example, the stomach may partially herniate into the chest, or completely.
- Internal or external: external ones herniate to the outside world, whereas internal hernias protrude from their normal compartment to another (for example, mesenteric hernias).
- Intraparietal hernia: hernia that does not reach all the way to the subcutis, but only to the musculoaponeurotic layer. An example is a Spigelian hernia. Intraparietal hernias may produces less obvious bulging, and may be less easily detected on clinical examination.
- Bilateral: in this case, simultaneous repair may be considered, sometimes even with a giant prosthetic reinforcement.
- Irreducible (also known as incarcerated): the hernial contents cannot be returned to their normal site with simple manipulation.
If irreducible, hernias can develop several complications (hence, they can be complicated or uncomplicated):
- Strangulation: pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later necrosis and gangrene, which may become fatal.
- Obstruction: for example, when a part of the bowel herniates, bowel contents can no longer pass the obstruction. This results in cramps, and later on vomiting, ileus, absence of flatus and absence of defecation. These signs mandate urgent surgery.
- Another complication arises when the herniated organ itself, or surrounding organs start dysfunctioning (for example, sliding hernia of the stomach causing heartburn, lumbar disc hernia causing sciatic nerve pain, etc.)
References
Differential Diagnosis
Differential Diagnosis
- Different kinds of hernias, such as central nervous system (CNS), diaphragmatic, lumbar, abdominal, and pelvic hernias have to be differentiated upon various history, symptoms, and physical examination findings.
| Location | Diseases | History and Symptoms | Physical Examination | Laboratory Findings | Definition | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Neurological | GI | Neurological | GI | ||||||||||||
| Confusion | Paresthesia | Dysphagia | Heartburn | Nausea | Bowel habits | Loss of Consciousness | Straight leg raise (SLR) | Mass protrusion | Tenderness/Rebound tenderness | Leukocytosis | CRP | ESR | |||
| CNS | Brain hernia[2] | + | + | + | – | + | – | + | – | – | – | – | – | – | Brain tissue herniation through foramen magnum |
| Lumbar disc hernia[3] | – | + | – | – | – | – | – | + | – | – | – | – | – | Nucleus pulposus herniation through annulus fibrosus | |
| Hiatal[4] | Sliding hernia | – | – | + | + | + | – | – | – | – | – | – | + | – | Stomach herniation through diaphragm |
| Paraesophageal hernia | – | – | + | + | + | – | – | – | – | – | – | – | – | Esophagus herniation through diaphragm | |
| Diaphragmatic[5] | Morgagni hernia | – | – | + | – | + | – | – | – | – | – | – | – | – | Congenital herniation of stomach through left side of diaphragm |
| Bochdalek hernia | – | – | + | – | + | – | – | – | – | – | – | – | – | Congenital herniation of stomach through right anterior side of diaphragm | |
| Abdominal | Umbilical hernia[6] | – | – | – | – | + | + | – | – | + | + | + | + | – | Bowels herniation through umbilicus |
| Epigastric hernia[7] | – | – | – | + | + | + | – | – | + | + | + | + | – | Bowels herniation through epigastric abdominal wall | |
| Spigelian hernia[8] | – | – | – | – | + | + | – | – | + | + | + | + | – | Bowels herniation through lateral abdominal wall | |
| Amyand’s hernia[9] | – | – | – | – | + | + | – | – | + | + | + | + | – | Appendix vermiformis herniation through abdominal wall | |
| Littre’s hernia[10] | – | – | – | – | + | + | – | – | + | + | + | + | – | Meckel’s diverticulum herniation through abdominal wall | |
| Richter’s hernia[11] | – | – | – | – | + | + | – | – | + | + | + | + | + | Bowels herniation and strangulation through abdominal wall | |
| Parastomal hernia[12] | – | – | – | – | + | + | – | – | + | + | + | + | + | Bowels herniation through stoma in the abdominal wall | |
| Pelvic | Inguinal hernia[13] | – | – | – | – | – | + | – | – | + | + | – | – | – | Bowels herniation through inguinal ring |
| Obturator hernia[14] | – | + | – | – | – | + | – | – | – | + | – | – | – | Viscera herniation through obturator canal | |
| Perineal hernia[15] | – | – | – | – | – | + | – | – | + | + | + | – | – | Viscera herniation through pelvic floor | |
| Femoral hernia[16] | – | + | – | – | – | + | – | – | + | + | – | – | – | Bowels herniation through femoral ring | |
| Sciatic hernia[17] | – | + | – | – | – | + | – | + | – | + | + | – | + | Viscera herniation through sciatic canal | |
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References
CNS Hernia
CNS Hernia
  |
Brain hernia
- Brain hernia is most commonly due to increase in intracranial pressure (ICP).
- The cardinal features of brain herniation is acute loss of consciousness, ipsilateral pupillary dilation, and contralateral hemiparesis.[20]
- There are 4 types of brain hernation:
- Type 1: Subfalcine herniation
- Type 2: Transalar herniation (ascending and descending)
- Type 3: Transtentorial herniation (uncal herniation)
- Type 4: Extracranial herniation
For more information about brain hernia click here
Lumbar disc hernia
- Lumbar disc hernia is related to old age, lack of physical activity, and all the factors that may result in dehydration of intervertebral discs.
- The cardinal features of lumbar disc herniation is radiculopathy, decreased deep tendon reflexes, and muscular atrophy.
- The mainstay of treatment in lumbar disc hernia is complete bed rest.
- Neurosurgical interventions may be indicated in patients with refractory symptoms unresponsive to medical therapy.[21]
For more information about lumbar disc hernia click here
Diaphragmatic Hernia
Diaphragmatic Hernia
Bochdalek hernia
- Bochdalek hernia is the most common type (80-90%) of congenital diaphragmatic hernia.
- Bochdalek hernia is herniation of stomach through posterior left side of the diaphragm.
- If the Bochdalek hernia occurs in utero, the neonate present with complications including pulmonary hypoplasia and even death.[22]
For more information about Bochdalek hernia click here
Morgagni hernia
- Morgagni hernia is less common (10-20%) than Bochdalek congenital diaphragmatic hernia.
- Morgagni hernia is most commonly retrosternal and on the right side of the diaphragm.
- Morgagni hernia occurs in approximately 50 per 100,000 pregnancies.[23]
For more information about Morgagni hernia click here
Hiatal Hernia
Hiatal Hernia
Sliding hernia
 |
Type I
- Sliding hernia accounts for more than 95% of all cases of hiatal hernia.
- Sliding hernia is herniation of distal esophagus and also gastric cardia into the thoracic space.
- Displacement of less than 2 cm is considered as physiologic displacement, mostly occurred during swallow process.
Paraesophageal hernias
Type II
- Type II of paraesophageal hernias is the classic herniation of a part of gastric fundus, but not gastroesophageal junction, into the thoracic cavity.
- Without surgical repair and fixation of the herniated portion, it leads to incarceration and may lead to complications.
Type III
- Type III of paraesophageal hernias is the combination of both type I and type II.
- In type III, gastric fundus is herniated through the diaphragm along with gastroesophageal junction.
Type IV
- The most severe form of the hiatal hernia is type IV, which consists of herniation of other abdominal organs along with stomach and distal esophagus into thoracic cavity.
- Severe respiratory distress and dyspepsia may occur secondary to type IV paraesophageal hernia.[4]
For more information about hiatal hernia click here
Lumbar Hernia
Lumbar Hernia
 |
Petit’s hernia
- Inferior lumbar region has a triangle formed by the iliac crest, the margins of the latissimus dorsi muscle, and external abdominal oblique muscles.
- Petit’s hernia is defined as herniation of retroperitoneal fat through internal oblique muscle aponeurosis within the inferior lumbar triangle.
- Petit’s hernia commonly occurs on the left side and in males.
- Strangulation rarely occurs in Petit’s hernia, because of wide herniation neck.
Grynfeltt’s hernia
- Superior lumbar region has a triangle formed formed medially by the quadratus lumborum muscle, laterally by the internal abdominal oblique muscle, and superiorly by the 12th rib.
- Grynfeltt’s hernia is defined as herniation of retroperitoneal fat through transversalis muscle aponeurosis within the superior lumbar triangle.
- The mainstay of treatment for lumbar hernias is surgery fixation.[26]
Abdominal Hernia
Abdominal Hernia
    |
Umbilical hernia
- Umbilical hernia consists of 6% of all abdominal hernias in adults.
- The mainstay of treatment for umbilical hernia is surgery, including Mesh repair, Mayo repair, and laparoscopic repair.
- Strangulation and incarceration are very rare in umbilical hernia.[31]
For more information about umbilical hernia click here
Epigastric hernia
- Epigastric hernia is accounted for 0.5-5% of hernias.
- Epigastric hernia is a kind of abdominal wall herniation which is caused by weakness or defect in upper abdominal muscles or tendons.
- The herniated contents are mostly vascular structures and properitoneal fat, rarely abdominal viscera.[32]
Spigelian hernia
- Spigelian hernia is caused by a defect in anterior abdominal wall. It is also named “spontaneous lateral ventral hernia” or “hernia of semilunar line”.
- The mainstay of treatment for Spigelian hernia is surgery, can be done laparoscopically or total exteraperitoneal repair method.
- Incarceration and secondary bowel obstruction are the probable complications of Spigelian hernia.[8]
Incisional hernia
- Incisional hernia occurs in 20% of patients postoperatively.
- The common risk factors for patients with postoperative incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking, and post-operative wound infection.
- The mainstay of treatment for incisional hernia is open abdominal fixation surgery.[33]
Amyand’s hernia
- Amyand’s hernia is a kind of inguinal hernia which contains appendix vermiformis.
- The incidence of Amyand’s hernia is approximately 0.19% to 1.7% of all reported hernias.
- The strangulation and infarction are common complications of Amyand’s hernia.[34]
Littre’s hernia
- Littre’s hernia is incarcerated Meckel’s diverticulum in femoral, inguinal, or umbilical hernia.
- Littre’s hernia is a very rare condition, reported only in 50 cases till date.
- Bowel obstruction and local inflammation are the possible complications.[35]
Richter’s hernia
- Richter’s hernia is first described in 1598.
- Richter’s hernia is the incarceration of a part of bowel in femoral, inguinal, or umbilical hernia.
- Since the high rates of strangulations and bowels infarctions, the mortality rate is very high and emergency surgical intervention is mandatory.[36]
Parastomal hernia
- Parastomal hernia is a common complication of colostomy or ileostomy, actually a type of incisional hernia related to them.
- Parastomal hernia is classified into 4 subtpes:
- Interstitial: The hernial sac lies within the layers of the abdominal wall.
- Subcutaneous: The hernial sac lies in the subcutaneous plane.
- Intrastomal: The hernial sac penetrates into a spout ileostomy.
- Peristomal (prolapse): The hernial sac lies within a prolapsing stoma.[37]
Pelvic Hernia
Pelvic Hernia
Inguinal hernia
- Inguinal hernia accounts for 75% of all hernias. Inguinal hernia repair is one of the most common surgeries in US (28 per 100,000 individuals).
- Inguinal hernia is a bulging lump in groin region, presents commonly without pain or local inflammation.
- Inguinal hernias classification is as follows:
- Direct hernia: The hernia sac herniates directly through the posterior wall of the inguinal canal.
- Indirect hernia: The hernia sac herniates through the internal inguinal ring alongside the spermatic cord.[13]
For more information about inguinal hernia click here
Obturator hernia
- Less than 1% of all hernias are obturator hernia, and majority of times occurs in elderly women with chronic disease.
- Obturator hernia is herniation of small intestine through obturator canal, therefore mechanical small intestine obstruction is the most common complication.
- The most common symptoms of obturator hernia are groin and proximal thigh pain.[38]
Perineal hernia
- Perineal hernia is herniation of intraperitoneal or extraperitoneal contents through a congenital or acquired defect of the pelvic diaphragm.
- Perineal hernia may be anterior or posterior to the superficial perineal muscles.
- Majority of the times perineal hernias are congenital condition, while acquired perineal hernias are incisional hernia secondary to major pelvic surgeries (e.g., abdominoperineal resection of the anorectum and pelvic exenteration).[39]
Femoral hernia
- Femoral hernia is the condition in which bowels herniate through femoral triangle medial to femoral vessels.
- The classification of femoral hernias into prevascular and retrovascular hernias is based on their position related to femoral vessels.
- Strangulation and incarceration of femoral hernias are common.[40]
For more information about femoral hernia click here
Sciatic hernia
- Sciatic hernia is a rare herniation of bowels through the greater or lesser sciatic foramen.
- The symptoms and physical examinations are very similar to obturator hernia.
- Swelling of gluteal region, severe pelvic pain and local paresthesia are the common symptoms of sciatic hernia.
- The mainstay of treatment is surgery and includes transabdominal and transgluteal approaches.[41]
References
- ↑ Webster’s new college dictionary. Boston: Houghton Mifflin Harcourt. 2008. p. 531. ISBN 9780618396016.
- ↑ Fisher CM (1995). “Brain herniation: a revision of classical concepts”. Can J Neurol Sci. 22 (2): 83–91. PMID 7627921.
- ↑ Schoenfeld AJ, Weiner BK (2010). “Treatment of lumbar disc herniation: Evidence-based practice”. Int J Gen Med. 3: 209–14. PMC 2915533. PMID 20689695.
- ↑ 4.0 4.1 Hyun JJ, Bak YT (2011). “Clinical significance of hiatal hernia”. Gut Liver. 5 (3): 267–77. doi:10.5009/gnl.2011.5.3.267. PMC 3166665. PMID 21927653.
- ↑ “Congenital Diaphragmatic Hernia Overview – GeneReviews® – NCBI Bookshelf”.
- ↑ Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ (2003). “Laparoscopic versus open umbilical hernia repair”. JSLS. 7 (4): 323–8. PMC 3021337. PMID 14626398.
- ↑ Muschaweck U (2003). “Umbilical and epigastric hernia repair”. Surg. Clin. North Am. 83 (5): 1207–21. doi:10.1016/S0039-6109(03)00119-1. PMID 14533911.
- ↑ 8.0 8.1 Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M; et al. (2008). “[Not Available]”. J Minim Access Surg. 4 (4): 95–8. PMC 2699222. PMID 19547696.
- ↑ Singal R, Gupta S (2011). ““Amyand’s Hernia” – Pathophysiology, Role of Investigations and Treatment”. Maedica (Buchar). 6 (4): 321–7. PMC 3391951. PMID 22879848.
- ↑ Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006). “Littre hernia: surgical anatomy, embryology, and technique of repair”. Am Surg. 72 (3): 238–43. PMID 16553126.
- ↑ Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006). “Richter hernia: surgical anatomy and technique of repair”. Am Surg. 72 (2): 180–4. PMID 16536253.
- ↑ Gillern S, Bleier JI (2014). “Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials”. Clin Colon Rectal Surg. 27 (4): 162–71. doi:10.1055/s-0034-1394090. PMC 4226750. PMID 25435825.
- ↑ 13.0 13.1 Jenkins JT, O’Dwyer PJ (2008). “Inguinal hernias”. BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
- ↑ Nakayama T, Kobayashi S, Shiraishi K, Nishiumi T, Mori S, Isobe K, Furuta Y (2002). “Diagnosis and treatment of obturator hernia”. Keio J Med. 51 (3): 129–32. PMID 12371643.
- ↑ Levic K, Rosen KV, Bulut O, Bisgaard T (2017). “Low incidence of perineal hernia repair after abdominoperineal resection for rectal cancer”. Dan Med J. 64 (7). PMID 28673377.
- ↑ LUDINGTON LG (1958). “Femoral hernia and its management, with particular reference to its occurrence following inguinal herniorrhaphy”. Ann Surg. 148 (5): 823–6. PMC 1450902. PMID 13595543.
- ↑ Kandpal H, Madhusudhan KS (2010). “Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve”. Br J Radiol. 83 (987): e65–6. doi:10.1259/bjr/47866965. PMC 3473559. PMID 20197431.
- ↑ [<“http://www.gnu.org/copyleft/fdl.html“>GFDL, <“http://creativecommons.org/licenses/by-sa/3.0/“>CC-BY-SA-3.0 or <“https://creativecommons.org/licenses/by-sa/3.0“>CC BY-SA 3.0], <“https://commons.wikimedia.org/wiki/File%3ABrain_herniation_types.svg“>
- ↑ Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. (Own work) [<“http://creativecommons.org/licenses/by/3.0“>CC BY 3.0], <“https://commons.wikimedia.org/wiki/File%3ABlausen_0484_HerniatedLumbarDisc.png“>
- ↑ Stevens RD, Shoykhet M, Cadena R (2015). “Emergency Neurological Life Support: Intracranial Hypertension and Herniation”. Neurocrit Care. 23 Suppl 2: S76–82. doi:10.1007/s12028-015-0168-z. PMC 4791176. PMID 26438459.
- ↑ “Herniated Disc – National Library of Medicine – PubMed Health”.
- ↑ Newman BM, Afshani E, Karp MP, Jewett TC, Cooney DR (1986). “Presentation of congenital diaphragmatic hernia past the neonatal period”. Arch Surg. 121 (7): 813–6. PMID 3718216.
- ↑ Robnett-Filly B, Goldstein RB, Sampior D, Hom M (2003). “Morgagni hernia: a rare form of congenital diaphragmatic hernia”. J Ultrasound Med. 22 (5): 537–9. PMID 12751867.
- ↑ [<“http://creativecommons.org/publicdomain/zero/1.0/deed.en“>CC0], <“https://commons.wikimedia.org/wiki/File%3AHiatus_hernia.svg“>
- ↑ <“https://en.wikipedia.org/wiki/User:Zyryab” class=”extiw” title=”wikipedia:User:Zyryab”>Zyryab at <“https://en.wikipedia.org/wiki/” class=”extiw” title=”wikipedia:”>English Wikipedia [<“http://www.gnu.org/copyleft/fdl.html“>GFDL, <“http://creativecommons.org/licenses/by-sa/3.0/“>CC-BY-SA-3.0 or <“http://creativecommons.org/licenses/by/2.5“>CC BY 2.5], <“https://commons.wikimedia.org/wiki/File%3ALumbarTriangle.jpg“>via Wikimedia Commons
- ↑ Başak F, Hasbahçeci M, Canbak T, Acar A, Şişik A, Baş G; et al. (2017). “Lumbar (Petit’s) hernia: A rare entity”. Turk J Surg. 33 (3): 220–221. doi:10.5152/UCD.2015.2986. PMC 5602318. PMID 28944339.
- ↑ [<“https://creativecommons.org/licenses/by-sa/2.5“>CC BY-SA 2.5], <“https://commons.wikimedia.org/wiki/File%3AErnia_Ombelicale.jpg“>
- ↑ [<“https://creativecommons.org/licenses/by-sa/3.0“>CC BY-SA 3.0], <“https://commons.wikimedia.org/wiki/File%3AHernia_epig%C3%A1strica.png“>
- ↑ [<“https://creativecommons.org/licenses/by-sa/3.0“>CC BY-SA 3.0 or <“http://www.gnu.org/copyleft/fdl.html“>GFDL], <“https://commons.wikimedia.org/wiki/File%3AHernia_spiegheli_01.JPG“>
- ↑ [<“https://creativecommons.org/licenses/by-sa/3.0“>CC BY-SA 3.0], <“https://commons.wikimedia.org/wiki/File%3ADe_Garengeot-Hernie_mit_Appendizitis_-_CT_axial_und_coronar_-_001.jpg“>
- ↑ Polat C, Dervisoglu A, Senyurek G, Bilgin M, Erzurumlu K, Ozkan K (2005). “Umbilical hernia repair with the prolene hernia system”. Am. J. Surg. 190 (1): 61–4. doi:10.1016/j.amjsurg.2004.09.021. PMID 15972174.
- ↑ Grella R, Razzano S, Lamberti R, Trojaniello B, D’Andrea F, Nicoletti GF (2015). “Combined epigastric hernia repair and mini-abdominoplasty. Case report”. Int J Surg Case Rep. 8C: 111–3. doi:10.1016/j.ijscr.2014.10.033. PMC 4353989. PMID 25667986.
- ↑ Kingsnorth A (2006). “The management of incisional hernia”. Ann R Coll Surg Engl. 88 (3): 252–60. doi:10.1308/003588406X106324. PMC 1963672. PMID 16719992.
- ↑ Ivanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR (2014). “Amyand’s hernia: a review”. Med Sci Monit. 20: 140–6. doi:10.12659/MSM.889873. PMC 3915004. PMID 24473371.
- ↑ Malling B, Karlsen AA, Hern J (2017). “Littre Hernia: A Rare Case of an Incarcerated Meckel’s Diverticulum”. Ultrasound Int Open. 3 (2): E91–E92. doi:10.1055/s-0043-102179. PMC 5462611. PMID 28597002.
- ↑ Kadirov S, Sayfan J, Friedman S, Orda R (1996). “Richter’s hernia–a surgical pitfall”. J. Am. Coll. Surg. 182 (1): 60–2. PMID 8542091.
- ↑ Carne PW, Robertson GM, Frizelle FA (2003). “Parastomal hernia”. Br J Surg. 90 (7): 784–93. doi:10.1002/bjs.4220. PMID 12854101.
- ↑ Bjork KJ, Mucha P, Cahill DR (1988). “Obturator hernia”. Surg Gynecol Obstet. 167 (3): 217–22. PMID 3413651.
- ↑ Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P (2010). “Perineal hernia: surgical anatomy, embryology, and technique of repair”. Am Surg. 76 (5): 474–9. PMID 20506875.
- ↑ Paquet M, Penney J, Boerboom D (2008). “Lateral femoral hernias in a line of FVB/NHsd mice: a new confounding lesion linked to genetic background?”. Comp Med. 58 (4): 395–8. PMC 2706040. PMID 18724783.
- ↑ Rather SA, Dar TI, Malik AA, Parray FQ, Ahmad M, Asrar S (2011). “Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report”. Ulus Travma Acil Cerrahi Derg. 17 (3): 277–9. PMID 21935810.
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