Hernia indd

Indirect inguinal hernia
Femoral hernia
Femoral hernias comprise 7% of all abdominal wall hernias. They 
are more commonly found on the right and have a male to female 
distribution of approximately 1 to 2 
(5)
. Femoral hernias are com-
monest in middle aged and elderly women (in this group they can 
be as common as inguinal hernias). They are rare in children 
(6)
. In-
creased intra-abdominal pressure is implicated in their formation, 
Perhaps more so than in other hernias.
It is difficult to differentiate a femoral hernia from an enlarged groin 
lymph node (US is helpful here). Differentiation however is impor-
tant due to their frequency of incarceration. De Garengeot’s hernia 
is a rare subtype where there is incarceration of the appendix within 
a femoral hernia.
Umbilical Hernias
Umbilical hernias are the most common of the ventral hernias and 
constitute approximately 14% of all abdominal wall hernias. During 
the embryonic period, the abdominal contents herniate through the 
umbilicus and are normally returned to the abdominal cavity by the 
10th week of gestation. In children, umbilical hernias are congeni-
tal and result from failure of the umbilical ring to close. Prematurity 
and low birth weight have both been identified as predisposing fac-
tors. 
In adults, umbilical hernias are rare. They occur secondary to fail-
ure of a thinned umbilical ring and fascia as a result of increased 
abdominal compartment pressure 
(5,7)
. The incidence of umbilical 
hernias is equal between male and females in children but is far 
more common in adult women than men 
(5,7)
. Incidence is further 
increased in people of African ethnicity. The risk factors for their 
formation include multiple pregnancies, ascites, obesity and large 
intra-abdominal masses 
(6)
.