I have a hernia-but what is a hernia!!!?

Often, when we talk to our patients, we forget that medical language is a kind of "initiatory" language, little understood by those outside the environment. Therefore, the patient knows he has something but does not always know what.

This is especially true for conditions that are considered "minor" (which they are not): if the person in front of me has a tumor, I spend a lot of time explaining his situation well; but if he has an inguinal hernia, or hemorrhoids, I take it for granted that he already knows what it is, and I don't waste too much time in explanations.
But is it really a matter of wasting time? How many people really know what a hernia is-and, consequently, are able to understand whether and how dangerous it is?

Let's try to get some clarity.

What is a hernia

"A hernia is defined as the exit of a viscera from the cavity that normally contains it, through an orifice, an anatomical channel, or otherwise a continuous solution."

This is the classic definition of hernia, of any hernia, from inguinal hernia to herniated disc; but it is not so readily understood unless one has at least some basic knowledge of anatomy.

So let's try to reason by similarity. If you are of my generation, the generation of kids who when they punctured a bicycle tire did not change it but patched the inner tube, it will come easy to you.

Think precisely of a tire; and imagine that the tire tears, and out of the tear comes the inner tube, as in the photograph below: that's what a hernia is: the tear represents "the orifice, anatomical channel or otherwise continuous solution" of the definition from before; what we surgeons call "the herniated defect."

what is a hernia, abdominal hernia, inguinal hernia

The air chamber that comes out of the tear is the "hernial sac": in the case of the inguinal hernia, it is the peritoneum that used to line the "torn" inguinal wall on the inside and now peeps through the tear itself.

If then the sac contains a "viscera" that has pushed through the "tear"-and which in the case of an abdominal hernia (abdominal hernias are, depending on where in the abdominal wall they occur, inguinal hernia, crural hernia, umbilical hernia, epigastric hernia, Spigelius hernia...) is usually fat (the omentum) or a piece of intestine-these are the "herniary contents." Easy, right?

Now that (I hope) it is clear what a hernia is, let's come to the other question: why can a hernia be dangerous and must be operated on? Well, in abdominal hernias--of which the most common are inguino-crural and umbilical--and particularly, paradoxically, in those in which the defect is small, it is possible, as already mentioned, for the herniated content to be an intestinal loop. Sometimes, it happens that the leaked loop cannot be "reduced," that is, relocated to its natural position inside the abdomen. This is referred to in this case as an incarcerated hernia. The incarcerated loop, because of the compression it undergoes, becomes soaked with fluid and "swells," and this can cause compression of the arteries and veins that supply it. This is strangulated hernia, an extremely life-threatening condition because it is at very high risk of necrosis (i.e., death) of the intestinal loop and its perforation (as in the case of the photo opposite).

That is why all hernias should be referred to a surgeon experienced in abdominal wall surgery, the only specialist who can determine whether to operate, when, and with what technique.