Abdominal Hernias Workup

  • Author: Kimberly McCrudden Erickson, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Sep 19, 2011
 

Laboratory Studies

  • Stain or culture of nodal tissue can help diagnose atypical tuberculous adenitis.
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Imaging Studies

  • Plain radiographs taken tangentially may show air in the intestine outside the abdomen, as may contrast studies of the bowel. Unfortunately, poor visualization of the perineum and pelvis occurs with the studies.
  • Higher yields result from dynamic changes in position and/or intra-abdominal pressure during the imaging studies. Better assessments of the perineum and pelvis are possible via external views of the intestine and their domain with herniography.
  • The careful instillation of water-soluble nonionic contrast through the abdominal wall helps to define most hidden hernias, such as interparietal, pelvic, obturator, sciatic, and other poorly palpable hernias (eg, small recurrent hernias).[10] However, unintentional luminal contrast injection may lead to infection.
  • Computed tomography (CT) scanning of the abdomen and pelvis with oral and IV contrast can help detect many elusive hernias by demonstrating extracoelomic location of the bowel, bladder, or female internal reproductive organs.[11]
  • Ultrasonography is helpful in narrowing the differential on both scrotal masses and masses below the inguinal ligament. Ultrasonography can also aid in the decision to drain or aspirate a nodal abscess.
  • Infants with omphaloceles require prompt, thorough evaluations to detect associated anomalies. Initial studies should include bilateral renal ultrasonogram, echocardiogram, karyotype, and plain radiographic films of the sacrum.
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Other Tests

  • Evaluation for potential reversal of provocative factors such as prostatism, chronic cough, severe constipation, rectal cancer, and ascites is important.
  • Sigmoidoscopy is no longer recommended as a screening test.
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Histologic Findings

Pathologic evaluation of pediatric hernia sacs offers little relevant clinical information. Tubular structures found during pathologic examination may indicate aberrant ductuli of Haller or duplications instead of segments of the vas deferens. Ductuli are 50-100 µm in size, much smaller than even the infant vas deferens; duplications can be proved only through reexploration.

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Contributor Information and Disclosures
Author

Kimberly McCrudden Erickson, MD  Assistant Professor of Pediatric Surgery, University of North Carolina at Chapel Hill School of Medicine

Kimberly McCrudden Erickson, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and Children's Oncology Group

Disclosure: Nothing to disclose.

Coauthor(s)

Eustace Stevers Golladay, MD  Emeritus Clinical Professor of Pediatric Surgery, University of Michigan Medical Center; Consulting Staff, Department of Pediatric Surgery, Mott Children's Hospital

Eustace Stevers Golladay, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Surgical Association, Central Surgical Association, Johns Hopkins Medical and Surgical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Alex Jacocks, MD  Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael A Grosso, MD  Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital

Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

References

  1. Coelho JC, Claus CM, Michelotto JC, et al. Complications of laparoscopic inguinal herniorrhaphy including one case of atypical mycobacterial infection. Surg Endosc. Apr 8 2010;[Medline].

  2. Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. May 15 2007;165(10):1154-61. [Medline].

  3. Walker SH. The natural history of umbilical hernia. A six-year follow up of 314 Negro children with this defect. Clin Pediatr (Phila). Jan 1967;6(1):29-32. [Medline].

  4. deVries PA. The pathogenesis of gastroschisis and omphalocele. J Pediatr Surg. Jun 1980;15(3):245-51. [Medline].

  5. Chen CP. Syndromes and disorders associated with omphalocele (II): OEIS complex and Pentalogy of Cantrell. Taiwan J Obstet Gynecol. Jun 2007;46(2):103-10. [Medline].

  6. Mattix KD, Winchester PD, Scherer LR. Incidence of abdominal wall defects is related to surface water atrazine and nitrate levels. J Pediatr Surg. Jun 2007;42(6):947-9. [Medline].

  7. Chen J, Lv Y, Shen Y, et al. A prospective comparison of preperitoneal tension-free open herniorrhaphy with mesh plug herniorrhaphy for the treatment of femoral hernias. Surgery. Mar 30 2010;[Medline].

  8. London JA, Utter GH, Sena MJ, et al. Lack of insurance is associated with increased risk for hernia complications. Ann Surg. Aug 2009;250(2):331-7. [Medline].

  9. Abi-Haidar Y, Sanchez V, Itani KM. Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg. Sep 2011;213(3):363-9. [Medline].

  10. Hamlin JA, Kahn AM. Herniography: a review of 333 herniograms. Am Surg. Oct 1998;64(10):965-9. [Medline].

  11. Toms AP, Dixon AK, Murphy JM, Jamieson NV. Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias. Br J Surg. Oct 1999;86(10):1243-9. [Medline].

  12. Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am. Aug 1998;45(4):773-89. [Medline].

  13. Parelkar SV, Oak S, Gupta R, et al. Laparoscopic inguinal hernia repair in the pediatric age group--experience with 437 children. J Pediatr Surg. Apr 2010;45(4):789-92. [Medline].

  14. Esposito C, Montinaro L, Alicchio F, et al. Laparoscopic Treatment of Inguinal Hernia in the First Year of Life. J Laparoendosc Adv Surg Tech A. Mar 31 2010;[Medline].

  15. Niyogi A, Tahim AS, Sherwood WJ, et al. A comparative study examining open inguinal herniotomy with and without hernioscopy to laparoscopic inguinal hernia repair in a pediatric population. Pediatr Surg Int. Apr 2010;26(4):387-92. [Medline].

  16. Manoharan S, Samarakkody U, Kulkarni M, Blakelock R, Brown S. Evidence-based change of practice in the management of unilateral inguinal hernia. J Pediatr Surg. Jul 2005;40(7):1163-6. [Medline].

  17. Bell C, Dubose R, Seashore J, Touloukian R, Rosen C, Oh TH, et al. Infant apnea detection after herniorrhaphy. J Clin Anesth. May 1995;7(3):219-23. [Medline].

  18. Pavlin DJ, Horvath KD, Pavlin EG, Sima K. Preincisional treatment to prevent pain after ambulatory hernia surgery. Anesth Analg. Dec 2003;97(6):1627-32. [Medline].

  19. Bonnard A, Zamakhshary M, de Silva N, Gerstle JT. Non-operative management of gastroschisis: a case-matched study. Pediatr Surg Int. Jul 2008;24(7):767-71. [Medline].

  20. Carlson GW, Elwood E, Losken A, Galloway JR. The role of tissue expansion in abdominal wall reconstruction. Ann Plast Surg. Feb 2000;44(2):147-53. [Medline].

  21. Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege RV, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. Jan 2000;24(1):95-100;discussion 101. [Medline].

  22. van Eijck FC, Wijnen RM, van Goor H. The incidence and morbidity of adhesions after treatment of neonates with gastroschisis and omphalocele: a 30-year review. J Pediatr Surg. Mar 2008;43(3):479-83. [Medline].

  23. Henrich K, Huemmer HP, Reingruber B, Weber PG. Gastroschisis and omphalocele: treatments and long-term outcomes. Pediatr Surg Int. Feb 2008;24(2):167-73. [Medline].

  24. Collaboration EH. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg. Jul 2000;87(7):860-7. [Medline].

  25. Schier F. Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg. Jun 2006;41(6):1081-4. [Medline].

  26. Martin DF, Williams RF, Mulrooney T, Voeller GR. Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia. Aug 2008;12(4):379-83. [Medline].

  27. Ballantyne A, Jawaheer G, Munro FD. Contralateral groin exploration is not justified in infants with a unilateral inguinal hernia. Br J Surg. May 2001;88(5):720-3. [Medline].

  28. Given JP, Rubin SZ. Occurrence of contralateral inguinal hernia following unilateral repair in a pediatric hospital. J Pediatr Surg. Oct 1989;24(10):963-5. [Medline].

  29. Holcomb GW 3rd. Diagnostic laparoscopy for contralateral patent processus vaginalis and nonpalpable testes. Semin Pediatr Surg. Nov 1998;7(4):232-8. [Medline].

  30. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg. Mar 2000;231(3):436-42. [Medline].

  31. Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children. Anesth Analg. Jul 1998;87(1):52-6. [Medline].

  32. Snyder CL. Current management of umbilical abnormalities and related anomalies. Semin Pediatr Surg. Feb 2007;16(1):41-9. [Medline].

 
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A 3-month-old girl with a large right inguinal hernia.
In this baby with gastroschisis, the bowel is uncovered and presents to the right inferior aspect of the cord.
Hernia of the umbilical cord.
Note the translucent sac in this baby with a large omphalocele. Umbilical vessels attach to the sac.
Hernia content balloons over the external ring when reduction is attempted.
Hernia can be reduced by medial pressure applied first.
Infant with a Silon chimney placed in the treatment of gastroschisis.
Atrophy of the right testis after hernia repair. Note the adult-type incision.
An iatrogenic cryptorchid testis in a child. Taking care to position the testis in the scrotum is an integral part of completion of hernia repair in a boy.
Erythematous edematous left scrotum in a 2-month-old boy with a history of irritability and vomiting for 36 hours. Local signs of this magnitude preclude reduction attempts.
The testis at operation in a 2-month-old boy with a history of irritability and vomiting for 36 hours (same patient as in above image). A capsulotomy was performed, but atrophy occurred. He also required a bowel resection.
A 6-month-old boy with a ventriculoperitoneal shunt, decreased activity, and acute scrotal swelling.
A 6-month-old boy with a ventriculoperitoneal shunt, decreased activity, and acute scrotal swelling (same patient as in above image). Abdominal radiograph shows incarcerated shunt within a communicating hydrocele. Repair of the hydrocele relieved the increased intracranial pressure.
Bassini-type repair approximating transversus abdominis aponeurosis and transversalis fascia to iliopubic tract and inguinal ligament.
 
 
 
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