• 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
• 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
• 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)
• 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
• 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
• 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
• 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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