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Hernia

View profile for Kimmo Boote
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A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.


A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin.

The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

Types of Hernia

Inguinal hernias occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. This is the most common type of hernia and it mainly affects men. It's often associated with ageing and repeated physical strain on the abdomen.

Femoral hernias also occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. They're much less common than inguinal hernias and tend to affect more women than men.

Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the abdomen.

Umbilical hernias occur when fatty tissue or a part of your bowel pokes through your abdomen near your belly button (navel).

This type of hernia can occur in babies if the opening in the abdomen through which the umbilical cord passes doesn't seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

Hiatus hernias occur when part of the stomach pushes up into your chest by squeezing through an opening in the diaphragm (the thin sheet of muscle that separates the chest from the abdomen).This type of hernia may not have any noticeable symptoms, although it can cause heartburn in some people.

It's not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.

Other types of hernia

Other types of hernia that can affect the abdomen include:

  • incision hernias – where tissue pokes through a surgical wound in your abdomen that hasn't fully healed
  • epigastria hernias – where fatty tissue pokes through your abdomen, between your navel and sternum
  • spigelian hernias – where part of your bowel pokes through your abdomen at the side of your abdominal muscle, below your navel
  • diaphragmatic hernias – where organs in your abdomen move into your chest through an opening in the diaphragm; this can also affect babies if their diaphragm doesn't develop properly in the womb
  • muscle hernias – where part of a muscle pokes through your abdomen; they also occur in leg muscles as the result of a sports injury

   Complications

An important complication that can be seen with hernias is the development of a bowel obstruction

Obstruction means that there is part of the bowel that has passed outside the abdominal cavity (usually it is only bowel although other gut contents can also go through the breach) which cannot go back into the abdomen. The blood supply to this herniated bowel may diminish or become absent and the bowel may die. The integrity of the bowel will become compromised and bacterial invasion of the bowel wall and ultimately into the patient’s blood circulation occurs – this sequence of events can lead to systemic infection and the development of septicaemia. Bowel obstruction, if untreated, can be fatal.

The treatment for obstructed (or strangulated hernia) is for it to be reduced. This may involve surgery, with the type of operation depending on its location.

Bowel obstruction must be considered in any patient experiencing severe vomiting, or bile stained vomiting (green in appearance) bloated abdomen and increased bowel sounds. It is a crucial diagnosis to consider in any patient complaining of abdominal pain.

An examination of the patient should include a note of any previous operations, any lumps or bumps in the groin and a history taken if there have been any other recent attempts to reduce a hernia.

Missing an obstructed hernia may be life threatening.

MEDICOLEGAL ASPECTS

There have been legal implications that hernias are due to trauma, but this is not often the case. Indeed empirical evidence has shown that trauma by itself is seldom a cause. This is important in terms of industrial claims. The other area that involves litigation includes incision hernia and where there is a failure to repair the hernia. These types of cases are now less common due to the greater emphasis on the use of laparoscopy (keyhole surgery) so reducing the risk of incision hernia occurring. Also, when taking consent for the operation to deal with the hernia, there is usually mention that there is a risk of failure from the operation. This should be checked for during the analysis of any claim.

If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim for Clinical Negligence - or indeed any other type of injury, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email k.marden@duttongregory.co.uk  

NB This article does not constitute legal advice and should not be relied on as such. No responsibility for the accuracy and/or correctness of the information and commentary set out in the article or for any consequences of relying on it, is assumed or accepted by any member of Dutton Gregory LLP.