perineal hernia

(redirected from pudendal hernia)

per·i·ne·al her·ni·a

a hernia protruding through the pelvic diaphragm.

per·i·ne·al her·ni·a

(per'i-nē'ăl hĕr'nē-ă)
A hernia protruding through the pelvic diaphragm.

hernia

(her'ne-a ) [L. hernia, rupture]
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COMMON LOCATIONS OF HERNIAS
The protrusion of an anatomical structure through the wall that normally contains it. Synonym: rupture (2) See: illustration; herniotomyhernialhernioid, adjective

Etiology

Hernias may be caused by congenital defects in the formation of body structures, defects in collagen synthesis and repair, trauma, or surgery. Conditions that increase intra-abdominal pressures, e.g., pregnancy, obesity, weight lifting, straining (the Valsalva maneuver), and abdominal tumors, may also contribute to hernia formation.

Treatment

Surgical or mechanical reduction is the treatment of choice.

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ABDOMINAL WALL HERNIA

abdominal hernia

A hernia through the abdominal wall.
See: illustration

acquired hernia

A hernia that develops any time after birth in contrast to one that is present at birth (congenital hernia).

bladder hernia

The protrusion of the bladder or part of the bladder through a normal or abnormal orifice. Synonym: cystic hernia

Cloquet hernia

See: Cloquet, Jules G.

complete hernia

A hernia in which the sac and its contents have passed through the aperture.

concealed hernia

A hernia that is not easily palpated.

congenital hernia

A hernia existing from birth.

crural hernia

A hernia that protrudes behind the femoral sheath.
Synonym: femoral hernia.

cystic hernia

Bladder hernia.

diaphragmatic hernia

Herniation of abdominal contents into the thoracic cavity through an opening in the diaphragm. The condition may be congenital, acquired (traumatic), or esophageal.

direct inguinal hernia

Inguinal hernia.

diverticular hernia

The protrusion of an intestinal congenital diverticulum.

encysted hernia

A scrotal protrusion that, enveloped in its own sac, passes into the tunica vaginalis.

epigastric hernia

A hernia through a defect in the linea alba above the umbilicus.

fascial hernia

Protrusion of muscular tissue through its fascial covering.

fatty hernia

The prolapse of fat from its normal, anatomical position, e.g., from behind the peritoneum into the inguinal canal.

femoral hernia

Crural hernia.

hiatal hernia

The protrusion of the stomach into the chest through the esophageal hiatus of the diaphragm.
;

incarcerated hernia

A hernia in which the presenting content cannot be returned to its site of origin, e.g., a hernia in which a segment of intestine cannot be returned to the abdominal cavity. It may produce pain or intestinal obstruction. If left untreated, an incarcerated hernia may cause strangulation of the bowel.

incisional hernia

A hernia through a surgical scar.

incomplete hernia

A hernia that has not gone completely through the aperture.

indirect inguinal hernia

Inguinal hernia.

inguinal hernia

The protrusion of a hernial sac containing intraperitoneal contents (e.g., intestine, omentum, or ovary) at the superficial inguinal ring. In an indirect inguinal hernia, the sac protrudes lateral to the inferior epigastric artery through the internal inguinal ring into the inguinal canal, often descending into the scrotum (in males) or labia (in females). In a direct inguinal hernia, the sac protrudes through the abdominal wall within Hesselbach's triangle, a region bounded by the rectus abdominis muscle, inguinal ligament, and inferior epigastric vessels. The sliding hernia is a kind of indirect inguinal hernia, in which a portion of the wall of the protruding cecum or sigmoid colon is part of the sac, the rest composed of parietal peritoneum. Femoral hernias occur where the femoral artery passes into the femoral canal. Indirect and direct inguinal hernias and femoral hernias are collectively referred to as groin hernias. Inguinal hernias account for about 80% of all hernias. Synonym: direct inguinal hernia; indirect inguinal hernia ; hernia inguinalis; lateral hernia; medial hernia; oblique hernia

Patient care

Preoperative: The surgical procedure and expected postoperative course are explained to the patient. The patient should understand that the surgery will repair the defect caused by the hernia but that surgical failures can occur. If the patient is undergoing elective surgery, recovery usually is rapid; if no complications occur, the patient probably will return home the same day as surgery and usually can resume normal activity within 4 to 6 weeks. Patients who undergo emergency surgery for a strangulated or incarcerated hernia may remain hospitalized longer commensurate with the degree of intestinal involvement. The patient is prepared for surgery.

Postoperative: Vital signs are monitored. The patient is instructed on the changing of position to avoid undue stress on the wound area. Stool softeners may be administered to prevent straining during defecation, and the patient is instructed in their use. Early ambulation is encouraged, but other physical activities are modified according to the surgeon's instructions. The patient should void prior to discharge and be able to tolerate oral fluids. The patient is taught to check the incision and dressing for drainage, inflammation, and swelling and to monitor his/her temperature for fever, any of which should be reported to the surgeon. Analgesics are administered as prescribed, and the patient is taught about their use and supplied with a prescription for home use. Male patients are advised that scrotal swelling can be reduced by supporting the scrotum on a rolled towel and applying an ice bag. The patient is warned to avoid lifting heavy objects or straining during bowel movements. Drinking plenty of fluids should help the patient prevent constipation and maintain hydration. The patient is advised to make and keep a postoperative surgical visit and to resume normal activity and return to work only as permitted by the surgeon.

hernia inguinalis

Inguinal hernia.

inguinocrural hernia

A hernia that is both femoral and inguinal.

internal hernia

A hernia that occurs within the abdominal cavity. It may be intraperitoneal or retroperitoneal.

interstitial hernia

A form of inguinal hernia in which the hernial sac lies between the layers of the abdominal muscles.

irreducible hernia

A hernia that cannot be returned to its original position out of its sac by manual methods.
See: incarcerated hernia

labial hernia

The protrusion of a loop of bowel or other intraperitoneal organ into the labia majora.

lateral hernia

Inguinal hernia.

lumbar hernia

A hernia through the inferior lumbar triangle (Petit) or the superior lumbar triangle (Grynfelt). It occurs most often in association with surgery on the kidneys or ureters.

medial hernia

Inguinal hernia.

mesocolic hernia

A hernia between the layers of the mesocolon.

Nuckian hernia

A hernia into the canal of Nuck.

oblique hernia

Inguinal hernia.

obturator hernia

A hernia through the obturator foramen.

omental hernia

A hernia containing a portion of the omentum.

ovarian hernia

The presence of an ovary in a hernial sac.

parastomal hernia

A hernia in the abdominal wall adjacent to a constructed stoma, e.g., a colostomy or iliostomy.

perineal hernia

Perineocele.

phrenic hernia

A hernia projecting through the diaphragm into one of the pleural cavities.

posterior vaginal hernia

A hernia of Douglas' sac downward between the rectum and posterior vaginal wall. Synonym: enterocele (2)

properitoneal hernia

A hernia located between the parietal peritoneum and the transversalis fascia.
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REDUCIBLE HERNIA: Umbilical Hernia
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REDUCIBLE HERNIA: Hernia reduces with digital pressure

reducible hernia

A hernia whose contents can be replaced by manipulation.
See: illustration

retroperitoneal hernia

A hernia protruding into the retroperitoneal space, e.g., duodenojejunal hernia, Treitz's hernia.

Richter's hernia

A hernia in which only a portion of intestinal wall protrudes, the main portion of the intestine being excluded from the hernial sac and the lumen remaining open. The patient may present with groin swelling and vague abdominal complaints; when incarcerated the hernia may produce bowel ischemia and related complications.

scrotal hernia

A hernia that descends into the scrotum.

sliding hernia

A hernia in which a portion of the wall of the herniated structure forms part of the hernia sac, e.g. an inguinal hernia in which a wall of the cecum or sigmoid colon forms a portion of the sac, the remainder of the sac being parietal peritoneum.

Spigelian hernia

A defect that occurs at or below the linea semicircularis but above the point at which the inferior epigastric vessels cross the lateral border of the rectus abdominis muscle. This type of hernia may contain preperitoneal fat or may be a peritoneal sac containing intraperitoneal contents. It is rare and difficult to diagnose unless large, because it is typically not palpable when small. Large Spigelian hernias may be mistaken for sarcomas of the abdominal wall. Ultrasonography or computed tomography scans are often used in diagnosis.

Treatment

Small Spigelian hernias are easily repaired; larger ones may require a prosthesis.

sports hernia

Athletic pubalgia.

strangulated hernia

A hernia in which the protruding viscus is so tightly trapped that gangrene results, requiring prompt surgery. Once strangulation of the contents occurs, a nonsurgical attempt to reduce it may severely compromise treatment and outcome.

synovial hernia

Protrusion of a portion of synovial membrane through a tear in the stratum fibrosum of a joint capsule.

umbilical hernia

A hernia occurring at the navel, seen mostly in children. Usually it requires no therapy if small and asymptomatic. An umbilical hernia usually resolves when the child begins to walk (and muscles strengthen).

uterine hernia

The presence of the uterus in the hernial sac.

vaginal hernia

Pelvic organ prolapse.

vaginolabial hernia

A hernia of a viscus into the posterior end of the labia majora.

ventral hernia

A hernia through the abdominal wall. See: incisional hernia

hernia

the abnormal protrusion of part of an organ or tissue through the structures normally containing it.
In this condition, a weak spot or other abnormal opening in a body wall permits part of the organ to bulge through. A hernia may develop in various parts of the body; most commonly in the region of the abdomen.
A layman's term for hernia is rupture. A hernia is either acquired or congenital.
Anatomically specific hernias are listed under their individual sites.

caudal abdominal h's
see inguinal, femoral, scrotal hernias (below).
cerebral hernia
see brain herniation.
cord hernia
a type of umbilical hernia in which the midgut has failed to return to the abdominal cavity during fetal development and remains within the umbilical cord.
crural hernia
femoral hernia.
external hernia
protrusion of abdominal contents through an opening in the abdominal wall.
false hernia
a structural defect with contents but without a peritoneal sac.
fat hernia
hernial protrusion of peritoneal fat through the abdominal wall or through the vulvar wall during a difficult calving.
incarcerated hernia
hernia so occluded that it cannot be returned by manipulation; it may or may not become strangulated.
incisional hernia
hernia after operation at the site of the surgical incision, owing to improper healing or to excessive strain on the healing tissue; such strain may be caused by excessive muscular effort, activity, or by obesity, which creates additional pressure on the weakened area.
inguinoscrotal hernia
see scrotal hernia (below).
irreducible hernia
incarcerated hernia.
mesenteric hernia
hernia of a loop of small intestine through a traumatic tear in the mesentery.
muscle hernia
the belly of the muscle protrudes through a tear in the fascia and epimysium.
paraesophageal hernia
hiatal hernia in which part or almost all of the stomach protrudes through the hiatus into the thorax to the left of the esophagus, with the gastroesophageal junction remaining in place.
pelvic hernia
hernia caused by a loop of intestine becoming incarcerated in a hiatus between the wall of the pelvis and the ductus deferens, caused by tearing of the fold of the ductus at castration. May occur many months after the castration operation. Can be resolved, if diagnosed early enough, by traction on the taut mesentery per rectum.
pericardial hernia
perineal hernia
see perineal hernia.
pleuroperitoneal hernia
see diaphragmatic hernia.
prepubic hernia
the result of avulsion of the cranial pubic tendon.
reducible hernia
one that can be returned by manipulation.
scrotal hernia
inguinal hernia which has passed into the scrotum. When these become strangulated they cause severe abdominal pain and acute local swelling. In large animals the tightened spermatic cord can be felt disappearing into the inguinal canal. See also intestinal obstruction.
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Scrotal hernia in a horse. By permission from Knottenbelt DC, Pascoe RR, Diseases and Disorders of the Horse, Saunders, 2003
sliding hiatal hernia
hiatal hernia in which the stomach and the cardioesophageal junction protrude into the caudal mediastinum; the protrusion, which may be fixed or intermittent, is partially covered by a peritoneal sac.
slip hernia, slipped hernia
sliding hernia.
strangulated hernia
one that is tightly constricted. As any hernia progresses and bulges out through the weak point in its containing wall, the opening in the wall tends to close behind it, forming a narrow neck. If this neck is pinched tight enough to cut off the venous return, the hernia will quickly swell and become strangulated. This is a very dangerous condition that can appear suddenly and requires immediate surgical attention. Unless the blood supply is restored promptly, gangrene can set in and may cause death.
traumatic hernia
protrusion of abdominal viscera into a subcutaneous site because of traumatic injury to the abdominal muscles.
uterine hernia
a gravid uterus can prolapse through an inguinal hernia in dogs and cats.
vaginal hernia
hernia into the vagina; called also colpocele.
ventral hernia
trauma with tearing of the body wall results in prolapse of abdominal contents into the subcutaneous tissue. Also reported in ewes from violent straining during parturition.

perineal

pertaining to the perineum.

perineal body
central tendon of the perineum. The fibromuscular mass in the median plane of the perineum where the bulbospongiosus and external anal sphincter muscles, and the levator ani and transverse perineal muscles attach.
perineal fistula
see perianal fistula.
Gelpi perineal retractor
a small self-retaining tissue retractor.
perineal hernia
a defect in the pelvic diaphragm that permits deviation of the rectum and protrusion of pelvic fat and abdominal contents, particularly the prostate and urinary bladder. Clinical signs include a uni- or bilateral ventrolateral perianal swelling with constipation or straining. Seen most often in middle-aged, male dogs, but occurs rarely in females and in cats.
perineal laceration
laceration of the perineal area such as by the birth of a foal. Three degrees of severity are recognized. First degree laceration is when only the mucosa of the vulva and vagina are involved. Second degree is when the submucosa and muscularis layers of the vulva, the anal sphincter and the perineal body are involved. Third degree is when there is also tearing through the rectovaginal septum, the muscles of the vagina and rectum, and the perineal body.
perineal reconstruction
various surgical techniques are used to repair perineal lacerations. It is necessary to reconstruct the rectal floor and vaginal roof.
perineal reflex
stimulation of the perineum causes contraction of the anal sphincter and flexion of the tail. It is a test of the integrity of the caudal spinal segments and the pudendal nerve. Called also the anal reflex.
perineal sling
a surgical technique that uses a fascial strip under the urethra to increase resistance to urine flow in the treatment of urinary incontinence.