Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
A hernia is the protrusion of an organ or piece of tissue from its normally contained space. In the abdomen, a hernia usually involves a piece of bowel, or its lining (called omentum), protruding through a weak area in the abdominal wall. The abdominal wall is made up of layers of different muscles and tissues. Weak spots may develop in these layers to allow contents the abdominal cavity to protrude. The most common hernias are in the groin (inguinal hernias) and in the diaphragm (hiatal hernias). Hernias may be present at birth (congenital), or they may develop at any time thereafter (acquired).
What are the different types of abdominal hernias?
Inguinal hernias are the most common of the abdominal hernias. The inguinal canal is the opening that allows the spermatic cord and testicle to descend from within the abdomen where they develop in a fetus into the scrotum. After the testicle descends, the opening is supposed to close tightly but sometimes the muscles that attach to the pelvis leave a weak area. In women, therefore, inguinal hernias are less likely to occur because there is no need for a permanent opening in the inguinal canal.
A femoral hernia may occur through the opening in the floor of the abdomen where the femoral artery and vein pass through to the leg. Because of their wider bone structure, femoral hernias tend to occur more frequently in women.
Obturator hernias are the least common hernia of the pelvic floor. These are mostly found in women who have had multiple pregnancies or who have lost significant weight. The hernia occurs through the obturator canal, another connection of the abdominal cavity to the leg, and contains the obturator artery, vein, and nerve.
Hernias of the anterior abdominal wall
The abdominal wall is made up of muscles that mirror each other from right and left. These include the rectus abdominus as well as the internal obliques, the external obliques, and the transversalis. Diastasis recti is not a true hernia but rather a weakening of the membrane where the two rectus abdominus muscles from the right and left come together.
When epigastric hernias occur in infants, they occur because of a weakness in the midline of the abdominal wall where the two rectus muscles join together between the breastbone and belly button. Sometimes this weakness does not become evident until later in adult life as it becomes a bulge in the upper abdomen.
The belly button, or umbilicus, is where the umbilical cord attached the fetus to mother allowing blood circulation to the fetus. Umbilical hernias cause abnormal bulging in the belly button and are very common in newborns and often do not need treatment unless complications occur. Some umbilical hernias enlarge and may require repair.
Spigelian hernias occur on the outside edges of the rectus abdominus muscle and are rare. Incisional hernias occur as a complication of abdominal surgery, where the abdominal muscles are cut to allow the surgeon to enter the abdominal cavity to operate. Although the muscle is usually repaired, it becomes a relative area of weakness, potentially allowing abdominal organs to herniate through the incision.
Hernias of the diaphragm
Hiatal hernias occur when part of the stomach slides through the opening in the diaphragm where the esophagus passes from the chest into the abdomen. A sliding hiatal hernia is the most common type and occurs when the lower esophagus and portions of the stomach slide through the diaphragm into the chest. Paraesophageal hernias occur when only the stomach herniates into the chest alongside the esophagus. This can lead to serious complications of obstruction or the stomach twisting upon itself (volvulus).
Traumatic diaphragmatic hernias may occur due to major injury where blunt trauma weakens or tears the diaphragm muscle allowing immediate or delayed herniation of abdominal organs into the chest cavity. This may also occur after penetrating trauma from a stab or gunshot wound.
Congenital diaphragmatic hernias are rare and are caused by failure of the diaphragm to completely form and close during fetal development. This can lead to failure of the lungs to fully develop and decreased lung function if abdominal organs migrate into the chest. The most common type is a Bochdalek hernia at the side edge of the diaphragm. Morgagni hernias are rare and are a failure of the front of the diaphragm.
Picture of different types of hernias.
Reviewed by Melissa Conrad Stöppler, MD on 10/14/2013
Medical Authors Editors: William C. Shiel, Jr., MD, FACP, FACR and Melissa Stöppler, M.D.
Before surgery, it is important to be informed about all aspects of the procedure, including an understanding of what to expect following the procedure, and the length of recovery time. The following "Questions to Ask your Surgeon" will help keep you informed as a patient, and hopefully ease any fears or concerns you may have.
What is the recommended procedure? Ask your surgeon for a simplified explanation of the type of
operation, technique used, and reasons it should be performed.
(Pictures and drawings can tell patients and family a great deal.)
Why was this specific procedure chosen over possible alternatives?
What is the surgeon's experience with this procedure? Ask the surgeon about his/her experience with this procedure, its outcome, and the hospital or setting in which the operation will be performed. Is the nursing staff accustomed to caring for patients who have had this procedure?