Internal and Congenital Hernias

Internal and congenital hernias are common and under-reported emergency surgical diagnoses. Internal hernias can develop through congenital or acquired intraperitoneal defects and may present with acute or subacute symptoms, often abdominal pain with or without obstruction. Prompt investigations are necessary to rule out ischaemia of the herniated bowel, and this diagnosis should be considered even in the absence of definitive radiological evidence. Diagnostic laparoscopy is more reliable than CT scan in identifying bowel ischaemia, and therefore early operation is indicated in cases where the clinical suspicion of ischaemia is high. Mobilisation of the herniated bowel and repair of the defect are the key steps of the procedure, and cautious division of the hernial neck may be required. Omphalocele and gastroschisis are the two most common conditions among congenital abdominal wall defects after inguinal and umbilical hernias. They are typically diagnosed prenatally via ultrasound and surgically treated with the aim of fascial closure providing adequate abdominal domain. Omphalocele is a herniation of membrane-covered abdominal viscera through a midline abdominal wall defect. Gastroschisis is a herniation of the bowel, and possibly other organs, through a right paraumbilical abdominal wall defect without a membranous covering. Management of these conditions should be carried out in tertiary centres where neonatological support and paediatric surgical expertise are available.