Ventral (Abdominal Wall) Hernia

What is a ventral hernia?

Weakness in the abdominal wall can cause the internal organs to push out, forming a bulge. This condition is called a hernia. A ventral hernia is a condition wherein the abdominal wall bulges out due to weakness in the muscles of the abdomen, causing pain and other complications. A ventral hernia most commonly occurs at the midline, but can also be found on any other area of the abdomen.

What are the different types of ventral hernias?

Ventral hernias can be of different types depending on the location of the bulge.

  • Umbilical hernia: A bulge surrounding the belly button or navel
  • Incisional hernia: A bulge around or directly along a prior abdominal surgical incision
  • Epigastric hernia: A bulge above the navel

What are the causes of a ventral hernia?

A ventral hernia may develop at any stage of life. Sometimes, they form in infants, during or after pregnancy, or following a surgery. Ventral hernias are most commonly seen after open abdominal surgeries such as laparotomy, requiring a midline incision. The risk of developing a ventral hernia increases if you are obese, have a history of hernias, have injuries to the bowel region, you begin heavy work relatively early after a surgery, have persistent coughing or develop an infection at the site of a surgical incision.

What are the signs and symptoms of a ventral hernia?

The most common symptom of a ventral hernia is sharp pain in the abdominal region that worsens with physical activities such as lifting heavy objects, coughing or during difficult bowel movements. Sometimes, the abdominal contents or intestines loop into the bulge and become trapped in the weakened muscle layer. If this occurs, the blood supply can get cut off, which may lead to death of the entrapped tissue. This is called strangulation and requires immediate medical attention. Vomiting and constipation, and discolouration of the bulge are common signs of strangulation. Other symptoms of a ventral hernia include bulging of the abdominal wall, accompanied by tenderness in the affected area, difficulty in standing up, pain while coughing and straining during bowel movements.

How is a ventral hernia diagnosed?

When you present to the clinic with severe abdominal pain, your doctor will conduct a medical history and physical examination of your abdomen. Your hernia pouch will be examined when you lie down and stand. Your doctor may try to push the bulge back inside your abdomen, and will ask you to cough to see if there is any change in the size of the bulge.

Your doctor may also order the following tests:

  • Blood tests: complete blood count test (red blood and white blood cell count) to check for infections
  • Ultrasound of the abdomen: to help your doctor determine the part of the abdomen protruding into the bulge
  • CT scan of the abdomen: to ascertain the presence of a hernia, its size and cause 

What are the consequences of not treating a ventral hernia?

Left untreated the herniated section of the intestine can get trapped and strangulated. With no blood supply, the tissue can get infected and die. This is a life-threatening situation and requires immediate attention. It can also put pressure on the neighbouring tissues, causing pain and swelling in the surrounding regions. However, hernia strangulation is only seen in certain circumstances which should be discussed with your surgeon.

What are the options for ventral hernia treatment?

Small ventral hernias that do not cause any symptoms are usually not treated; your doctor may follow a wait-and-watch approach. Surgery is recommended for hernias that show symptoms, are enlarged and entrapped.

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