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Abdominal hernias

Last updated: July 21, 2021

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Abdominal hernias are defined as the abnormal protrusion of intra-abdominal contents through congenital/acquired areas of weakness in the abdominal wall. The four categories of anatomically-classified abdominal hernias include the following: ventral hernias (e.g., epigastric, umbilical, incisional hernias), groin hernias (inguinal and femoral hernias), pelvic hernias (obturator, sciatic, and perineal hernias), and flank/lumbar hernias. Groin hernias are discussed in more detail in their respective articles. Inguinal, incisional, and umbilical hernias are the most common types of hernias. Persistently raised intra-abdominal pressure (e.g., due to ascites, pregnancy, intra-abdominal tumors, chronic cough, etc.) increases the risk of developing an abdominal hernia. Uncomplicated hernias are asymptomatic, nontender, and completely reducible with an expansile cough impulse. Complicated hernias include incarcerated, obstructed, and strangulated hernias and are characterized by tenderness, irreducibility, features of bowel obstruction, and an absent cough impulse. Abdominal hernias are often diagnosed on clinical examination. Imaging (e.g., ultrasound, CT scan) is used to confirm the diagnosis and evaluate the contents of the hernia. Complicated hernias and those with a narrow neck (e.g., femoral hernia, obturator hernia, paraumbilical hernia) should be surgically repaired (primary repair/mesh repair). Congenital umbilical hernias typically close spontaneously by 5 years of age, have a wide neck, and a low risk of complications; surgical intervention is rarely necessary.

Ventral hernias

Groin hernias

Pelvic hernias (rare)

Flank hernias


Reducible hernia

  • Hernial contents completely return to the abdominal cavity through the abdominal wall defect on lying down or upon application of mild external pressure.
    • Most reducible hernias manifest as an asymptomatic nontender mass.
      • Increases on straining (e.g., sitting up from a recumbent position)
      • Decreases completely on lying down
    • Visible cough impulse present: expansion of the hernia when the patient is asked to cough
    • Edges of the fascial defect are palpable
    • Bowel sounds may be heard over the mass (if the hernial content is bowel)

Irreducible/incarcerated hernia

  • Hernial contents become adhered to the hernial sac and cannot be reduced into the abdominal cavity.
    • Irreducible nontender mass
    • Visible cough impulse present
    • May decrease partially on lying down
    • Increased risk of obstruction and strangulation

Obstructed hernia

Strangulated hernia

The smaller the hernial orifice, the higher the risk of incarceration.


Abdominal hernias are usually a clinical diagnosis.

The differential diagnoses listed here are not exhaustive.


Congenital vs. acquired umbilical hernia [11]
Congenital umbilical hernia

Acquired umbilical hernia (Paraumbilical hernia)

  • Accounts for ∼ 5% of all adult abdominal hernias
Site of hernial defect
  • Umbilical orifice
  • Adjacent to the umbilical orifice (superior/inferior/lateral)
Risk factors
  • Persistently raised intra-abdominal pressure
Clinical features
  • Mass protruding through the umbilicus and covered by skin
  • Mass increases with ↑ abdominal pressure (e.g., as a result of crying, coughing, straining)
  • Reduced in size on lying down
  • Hernia can be completely reduced (unless incarcerated)
  • Mass protruding adjacent to the umbilical orifice pushing the umbilicus into a crescent shape
  • Fascial defect is small

Risk of developing complications


  • Low
  • High
  • Conservative: ∼ 90% will spontaneously close by 5 years of age
  • Surgery (rarely necessary)
Differential diagnosis

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