Clinical Types of Hernia

Inguinal Hernia (Right sided)

Abdominal hernias are the most common hernias of the human body.

Reducible Hernia:

In this type of abdominal hernia, the contents contained in the hernial sac can be returned into the abdominal cavity, but the sac remains in its position. In other words, reducible hernia is an uncomplicated hernia.

Irreducible Hernia:

In this type of abdominal hernia, the contents of the hernial sac can not be returned to the abdomen assuring that there is no other complications. Irreducibility of hernia can be caused by adhesions of the hernia contents to each other or with the sac, adhesion of one part of sac to the other, sliding hernia and large scrotal hernia.

Irreducible hernia is often confused with strangulated hernia by the newcomer trainees. Clinically a strangulated hernia is also an irreducible hernia, but it is extremely tender and tense and moreover overlying skin may be seen red. These typical signs of strangulated hernia are absent in the patients with reducible hernia.

Obstructed or incarcerated hernia:

Irreducible hernia associated with intestinal obstruction provided that there is no interference with the blood supply is called obstructed hernia. Bear in mind, strangulated hernia also possess two features of obstructed hernia (irreducibility, intestinal obstruction), but it also interferes with blood supply of the intestine. Obstructed hernia does not possess the third feature of strangulated hernia (blood supply compromised or arrested).

Strangulated hernia:

Patient with Obstructed Umbilical Hernia and Meleney's Gangrene

An irreducible hernia that causes intestinal obstruction and arrest of blood supply to the contents is called strangulated hernia. Diagnosis of strangulated hernia is made when it is irreducible, without any impulse on coughing, extremely tender and tense. Strangulated hernia is an emergency and needs immediate surgery.

Inflamed hernia:

The hernia having inflamed viscera (appendicitis, salpingitis, Meckel’s diverticulitis) in its sac is called inflamed hernia. Inflamed hernia is seen with red edematous overlying skin, painful swelling that is tender. Inflamed hernia can be differentiated from the strangulated hernia as it is not tense and does not have the feature of intestinal obstruction.

Sliding hernia, Richter’s hernia, Litre’s hernia and Maydl’s hernia (hernia-en W) are other rare varieties of hernia.

Overview:

Reducible hernia: Simple and can be reduced + No other complication
Irreducible hernia: Simple but can not be reduced + No other complication
Obstructed hernia: Irreducible + Intestinal obstruction
Strangulated hernia: Irreducible + Intestinal obstruction + arrested blood supply + Tense and Tender
Inflamed hernia: Red, painful and tender swelling + Not tense