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  • • Typically manifests clinically with an asymptomatic bulge or small bowel obstruction

    • The abdominal wall defects are sometimes discovered during radiographic evaluation for vague abdominal discomfort or an unrelated condition

    • Incarceration and strangulation are frequently presenting symptoms due to the elusive nature of these fascial defects

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Epidemiology

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  • • Noninguinal abdominal wall hernias are much less common than inguinal or incisional hernias

    • Littre and Richter hernias occur in the setting of other hernia and are not an anatomically distinct herniatype (ie, a hernia subtype)

    • Lumbar hernias occur most frequently in young athletic women

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Symptoms and Signs

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  • Spigelian hernia: Pain and abdominal wall bulge at the lateral edge of the rectus muscle at the level of the umbilicus

    Lumbodorsal hernia: Persistent flank bulge (hernia sac usually filled with retroperitoneal fat)

    • -Grynfeltt: Superior lumbar triangle

      -Petit: Inferior lumbar triangle

    Obturator hernia: Pelvic sidewall mass appreciated on rectal or pelvic exam; pain extending down medial aspect of the thigh on abduction, extension, or internal rotation of the knee indicates a positive Howship-Romberg sign

    Perineal hernia: Typically manifests as easily reducible perineal bulges but may also include pain, dysuria, bowel obstruction, or perineal skin breakdown

    Interparietal hernia: Abdominal wall mass that occurs primarily or in the setting of a muscle-splitting appendectomy incision; this hernia defect is often confused with an abdominal wall tumor

    Sciatic hernia: Rarely appreciated externally; bowel obstruction is usually presenting symptom, and the hernia defect is discovered during abdominal exploration

    Traumatic hernia: Ecchymosis and abdominal wall bulge detected in the setting of significant blunt abdominal trauma

    Supravesicular hernia: Laterally displaced suprapubic mass associated with urinary or bowel obstruction symptoms

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Imaging Findings

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  • • Imaging findings specific to type of hernia

    • US can detect an abdominal wall mass and differentiate between tumor, abscess, and hernia

    • CT scan most useful method for identifying noninguinal abdominal wall hernias and differentiating between tumor, abscess, hematoma, and hernia

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  • Richter hernia: Any strangulated hernia in which only part of the bowel wall becomes ischemic and gangrenous, thus complete bowel obstruction does not occur; typically occurs in the setting of a ventral hernia

    Littre hernia: A hernia that contains Meckel diverticulum in the hernia sac

    Spigelian hernia: Acquired ventral hernia through the linea semilunaris, located at the junction between the rectus abdominals muscle and the abdominal oblique musculature

    Lumbodorsal hernia: Hernia defects through the posterior abdominal wall at different levels in the lumbar region

    • -Grynfeltt: Superior lumbar triangle

      -Petit: Inferior lumbar triangle

    Obturator hernia: Herniation through the obturator canal

    Perineal hernia: Myofascial defects of the perineum, usually following perineal surgery

    Interparietal hernia: Hernia between the layers of the abdominal wall

    Sciatic hernia: Outpouching of the intra-abdominal contents through the greater sciatic foramen

    Traumatic hernia: Direct blunt traumatic abdominal injury with resulting myofascial defect

    Supravesicular ...

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