Abdominal Hernia: Symptoms, Types, and Modern Treatment Methods

What is an abdominal hernia?

An abdominal hernia is a condition in which internal organs or parts of them (for example, a loop of the intestine, part of the greater omentum) protrude beyond their anatomical cavity through natural or acquired openings in the abdominal wall. This occurs due to the weakening of muscles or connective tissue, leading to the formation of a hernial sac. Hernias can be either congenital or acquired and are one of the most common surgical diseases.

Factors that increase intra-abdominal pressure contribute to the development of a hernia: chronic cough, constipation, heavy physical labor, pregnancy, and obesity. Although symptoms such as abdominal pain and bloating can be caused by many factors, including gastroparesis [6], reflux disease [3], or even atypical manifestations of a thyrotoxic crisis [2], the presence of a bulge often specifically indicates a hernia.

Main types of abdominal hernias

Abdominal hernias are classified according to their location:

• Inguinal hernias: The most common type, especially in men. They form in the inguinal region.
• Umbilical hernias: Occur in the navel area, more common in infants and women, especially after pregnancy.
• Femoral hernias: Located below the inguinal ligament, more common in women.
• Incisional (ventral) hernias: Form in the area of postoperative scars due to tissue weakening after surgery.
• Diaphragmatic hernias: Occur when a part of the stomach or other abdominal organs enters the chest cavity through an opening in the diaphragm. One type is a hiatal hernia, which is often associated with symptoms of gastroesophageal reflux disease (GERD) [3].

Understanding the type of hernia is critical for choosing the optimal treatment method and prognosis.

Hernia symptoms: when to sound the alarm?

The main symptom of a hernia is the appearance of a bulge under the skin, which may increase with physical exertion, coughing, or straining and disappear in a lying position. Often, the bulge is accompanied by discomfort or pain, which can be dull, aching, or sharp. Abdominal pain and bloating are common gastrointestinal manifestations that can be observed in various conditions, including hernias, as well as during dialysis [7] or after COVID-19 [4].

Hernia complications, such as strangulation, pose a particular danger. A strangulated hernia is an emergency condition in which the contents of the hernial sac are squeezed, blood supply is disrupted, which can lead to tissue necrosis. Symptoms of strangulation include:

• Sudden, sharp pain in the hernia area.
• Irreducibility of the hernia (it does not disappear when relaxing or lying down).
• Nausea and vomiting.
• Absence of stool and gas (in case of intestinal strangulation).
• Redness and swelling of the skin over the hernia.

Such conditions require immediate medical attention, similar in urgency to intestinal ischemia [8] or gastrointestinal bleeding [4], and often require emergency laparotomy [5].

Hernia diagnostics: from examination to modern methods

Hernia diagnosis usually begins with a physical examination, during which the doctor palpates the area of the bulge and evaluates its characteristics. The patient may be asked to cough or strain to better visualize the hernia.

To confirm the diagnosis, clarify the size and contents of the hernial sac, and rule out other pathologies, instrumental studies may be prescribed:

• Ultrasound examination (Ultrasound): A non-invasive method that visualizes soft tissues well and allows for the assessment of hernia dynamics.
• Computed tomography (CT): Provides detailed images of the abdominal cavity, helping to identify hidden hernias, determine their exact location and contents. CT is also used to diagnose other serious conditions, such as gastroparesis [6] or intestinal ischemia [8].
• Upper GI endoscopy: Used when a diaphragmatic hernia is suspected, especially if there are symptoms of GERD, to assess the condition of the esophagus and stomach [3].

Thorough diagnostics allow for the selection of the most appropriate treatment method and minimization of risks.

Hernia treatment: surgical intervention

The only effective treatment method for a hernia is surgical intervention, called hernioplasty. Conservative methods, such as wearing a support belt, can only temporarily relieve symptoms, but do not eliminate the hernia itself and do not prevent its complications.

There are two main approaches to hernioplasty:

• Open hernioplasty: A traditional method in which the surgeon makes an incision over the hernia, reduces its contents, and strengthens the abdominal wall. A synthetic mesh is often used to reinforce weakened tissues.
• Laparoscopic hernioplasty: A minimally invasive method in which the operation is performed through several small punctures using a video camera and special instruments. This method is usually associated with less postoperative pain, faster recovery, and a better cosmetic result.

The choice of method depends on the type of hernia, its size, the patient's condition, and the surgeon's experience. Complex abdominal surgeries, such as pylorus-preserving procedures [1] or emergency laparotomy [5], require careful anesthetic and perioperative management, as well as a multidisciplinary approach to achieve the best results [5].

Prevention and life after surgery

After hernia surgery, it is important to follow the doctor's recommendations to prevent recurrence and ensure complete recovery. This includes limiting physical activity, avoiding heavy lifting, weight control, combating chronic constipation and coughing. Adequate postoperative management and adherence to recommendations contribute to a quick return to normal life.

Although an abdominal hernia is a serious condition, timely diagnosis and adequate surgical treatment allow most patients to fully recover and avoid dangerous complications.

Sources

1. Suspected biliary gastritis and dumping syndrome after pylorus-preserving procedures: tertiary medical center experience. https://pubmed.ncbi.nlm.nih.gov/40614929/
2. Atypical thyrotoxic crisis presenting with refractory hypoglycemia and fulminant hepatic failure in an elderly woman: a case report. https://pubmed.ncbi.nlm.nih.gov/42226431/
3. Upper gastrointestinal endoscopy in patients with symptoms of gastroesophageal reflux disease: correlation of endoscopic findings with symptoms and pH-impedance monitoring results. https://pubmed.ncbi.nlm.nih.gov/41607384/
4. COVID-19-induced gastrointestinal vascular anomalies: not just fatigue and lungs. https://pubmed.ncbi.nlm.nih.gov/42422617/
5. Anesthetic perspective on a multidisciplinary approach to optimal perioperative management of a patient with giant peptic ulcer perforation caused by physiological stress of thyrotoxic crisis requiring emergency laparotomy. https://pubmed.ncbi.nlm.nih.gov/36585054/
6. Severe diabetic gastroparesis mimicking emphysematous gastritis and "acute abdomen". https://pubmed.ncbi.nlm.nih.gov/41841100/
7. Differences in the risk of gastrointestinal manifestations in patients on peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/42004711/
8. Barium-associated intestinal ischemia complicated by massive hepatic portal venous gas: a successful survival case. https://pubmed.ncbi.nlm.nih.gov/42315327/

Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional consultation, diagnosis, or treatment provided by a qualified medical specialist. Always seek the advice of your physician or other qualified healthcare provider with any questions regarding your health or medical condition.