Tag: Ehlers-Danlos syndrome

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Ehlers-Danlos syndrome

Alternative Name : Cutis hyperelastica

Definition:
Ehlers-Danlos syndrome (EDS)  encompasses several types of inherited connective tissue disorders  that affect your connective tissues — primarily your skin, joints and blood vessel walls. Ehlers-Danlos syndrome is uncommon.

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This results in hyperelastic skin that’s fragile and bruises easily, excessive looseness of the joints, blood vessels that are easily damaged and, rarely, rupture of internal organs.

The syndrome is named after two doctors, Edvard Ehlers of Denmark, and Henri-Alexandre Danlos of France, who identified it at the turn of the 20th century.

There are six major types of EDS, categorised according to signs and symptoms, and the condition can range from mild to life-threatening.

1.Hypermobility -Affects 1 in 10,000 to 15,000 and is caused by an autosomal dominant or autosomal recessive mechanism. Mutations in either of two separate genes (which are also involved in Vascular EDS and Tenascin-X deficiency EDS, respectively) may lead to this variant. Extreme flexibility is the hallmark of this type…...CLICK & SEE

2.Classical -Affects approximately 1 in 20,000 to 50,000 people. It is caused by autosomal dominant mechanism and affects type-V collagen, as well as type I. Type 1 typically presents with severe skin involvement, and type 2 presents with mild to moderate skin involvement. …CLICK & SEE

3.Vascular-Is an autosomal dominant defect in the type-III collagen synthesis; affecting approximately 1 in 100,000 to 250,000 people. The vascular type is considered one of the more serious forms of Ehlers–Danlos syndrome because blood vessels and organs are more prone to tearing (rupture). Patients with EDS type 4 often express a characteristic facial appearance (large eyes, small chin, thin nose and lips, lobeless ears), have a small stature with a slim build, and typically have thin, pale, translucent skin (veins can usually be seen on the chest and abdomen). About one in four people with vascular type EDS develop a significant health problem by age 20 and more than 80 percent develop life-threatening complications by age 40.

4.Kyphoscoliosis-Is an autosomal recessive defect due to deficiency of an enzyme called lysyl hydroxylase; it is very rare, with fewer than 60 cases reported. The kyphoscoliosis type is characterised by progressive curvature of the spine (scoliosis), fragile eyes, and severe muscle weakness....CLICK & SEE

5.Arthrochalasis-Is also very rare, with about 30 cases reported. It affects type-I collagen. The arthrochalasia type is characterised by very loose joints and dislocations involving both hips….CLICK & SEE

6.Dermatosparaxis -Also very rare, with about 10 cases reported. The dermatosparaxis type is characterised by extremely fragile and sagging skin….CLICK & SEE

Epidemiology:–
Ehlers–Danlos Syndrome is an inherited disorder estimated to occur in about 1 in 5000 births worldwide. Ehlers–Danlos affects both males and females of all racial and ethnic backgrounds. Initially, prevalence estimates have previously ranged from 1 in 250,000 to 1 in 500,000 people, but these estimates were soon found to be vastly inaccurate as the disorder received further study and medical professionals became more adept at accurately diagnosing EDS. The prevalence of the six types differs dramatically. The most commonly occurring type is the hypermobility type, followed by the classical type. The other types of EDS are very rare. For example, fewer than 10 infants and children with the dermatosparaxis type have been described worldwide

Symptoms:–
Signs vary widely based on which type of EDS the patient has. In each case, however, the signs are ultimately due to faulty or reduced amounts of collagen. EDS most typically affects the joints, skin, and blood vessels, the major signs and symptoms include:

CLICK  & SEE THE PICTURES

*Highly flexible fingers and toes……..
*Loose, unstable joints that are prone to: sprain, dislocation, subluxation (partial dislocation) and *hyperextension (double jointedness)
*Flat feet
*Joint pain without inflammation
*Fatigue, which can be debilitating
*High and narrow palate, resulting in dental crowding
*Vulnerability to chest and sinus infections
*Easy bruising
*Fragile blood vessels resulting from cystic medial necrosis with tendency towards aneurysm (even abdominal aortic aneurysm)
*Velvety-smooth skin which may be stretchy and is often translucent, with blue veins clearly visible on limbs and particularly in the hands
*Abnormal wound healing and scar formation (scars may appear like cigarette burns)
*Low muscle tone and muscle weakness
*Early onset of osteoarthritis
*Cardiac effects: Dysautonomia typically accompanied by Valvular heart disease (such as mitral valve prolapse, which creates an increased risk for infective endocarditis during surgery, as well as possibly progressing to a life-threatening degree of severity of the prognosis of mitral valve prolapse)
*Unexplained “pins and needles” or numbness in extremities
*Difficulty regulating own body temperature, resulting in a vulnerability to the cold and heat. Many patients suffer fatigue and dizziness when exposed to hot conditions, eg. having to sit outside on a hot day
*Severe mouth ulcers. Many patients complain of having several mouth ulcers at any one time. This is believed to be due to tissue fragility and vulnerability to infection
*Food allergies and intolerances are very common
*Sensitivity to medications. Many pain medications cause Nausea and other GI tract complications. *Functional bowel disorders associated with EDS make it very difficult to find safe, effective pain management
Insensitivity to local anesthetics.
*Migraines and headaches, including postural headaches from spontaneous intracranial hypontension
*Fibromyalgia symptoms: Myalgia and arthralgia.
*Arachnodactyly

Other, less common signs and complications may include:

*Osteopenia (low bone density)
*Talipes equinovarus (club foot), especially in the Vascular type
*Deformities of the spine, such as: Scoliosis (curvature of the spine), Kyphosis (a thoracic hump), Tethered spinal cord syndrome, Occipitoatlantoaxial hypermobility,[9] Arnold-Chiari malformation (brain disorder)
*Functional bowel disorders (functional gastritis, irritable bowel syndrome)
*Nerve compression disorders (carpal tunnel syndrome, acroparesthesia, neuropathy)
*Vascular skin conditions: Raynaud’s phenomenon, Livedo reticularis
*Blue sclera
*Otosclerosis (hearing loss)
*Premature rupture of membranes during pregnancy
*Platelet aggregation failure (platelets do not clump together properly)
*Infants with hypermobile joints often appear to have weak muscle tone (hypotonia), which can delay the development of motor skills such as sitting, standing, and walking
*Arterial/intestinal/uterine fragility or rupture
*Swan neck deformity of the fingers

Because it is often undiagnosed or misdiagnosed in childhood, some instances of Ehlers–Danlos syndrome have been mischaracterized as child abuse. The pain associated with this condition is a serious complication.

Causes:-
The types of Ehlers-Danlos syndrome are caused by a variety of genetic alterations (mutations), passed on from parent to child, that disrupt the normal production of collagen. Collagen is a fibrous protein that gives strength and elasticity to connective tissues — skin, tendons, ligaments, cartilage, and organ and blood vessel walls.

These genetic mutations alter normal enzyme activity, leaving connective tissues weak and unstable.

Variety of inheritance patterns
Most EDS types are passed along in an inheritance pattern called autosomal dominant. This means you need only one copy of the disease-causing mutation, inherited from either parent, to develop signs and symptoms of the disease. If you inherit the mutation, each of your children will have a 50 percent chance of inheriting the mutation from you.

Diagnosis:–
A diagnosis can be made by clinical observation. Both DNA and biochemical studies can be used to help identify affected individuals. In some cases, a skin biopsy has been found to be useful in confirming a diagnosis. Unfortunately, these tests are not sensitive enough to identify all individuals with EDS. If there are multiple affected individuals in a family, it may be possible to perform prenatal diagnosis using a DNA information technique known as a linkage study.

Differential diagnosis:
There are several disorders that have some of the characteristics of Ehlers–Danlos syndrome. For example, in cutis laxa the skin is loose, hanging, and wrinkled. In EDS, the skin can be pulled away from the body but is elastic and returns to normal when let go. In Marfan syndrome, the joints are very mobile and similar cardiovascular complications occur. In the past, Menkes disease, a copper metabolism disorder, was thought to be a form of Ehlers–Danlos syndrome. Because of these similar disorders, a correct diagnosis is very important.
Treatment:–
There is no cure for Ehlers Danlos Syndrome. The treatment is supportive. Close monitoring of the cardiovascular system, physical therapy, occupational therapy, and orthopedic instruments (e.g., wheelchairs, bracing) may be helpful. One should avoid activities that cause the joint to lock or overextend.

Doctor may prescribe bracing to stabilize joints. Surgical repair of joints may be necessary at some time. Physicians may also consult a physical and/or occupational therapist to help strengthen muscles and to teach people how to properly use and preserve their joints. To decrease bruising and improve wound healing, some patients have responded to ascorbic acid (vitamin C) by taking 1 to 4 grams daily.

Physical therapy:
Your doctor may refer you to a physical or occupational therapist with specific exercises to strengthen your muscles without causing injury. For most people with EDS, strengthening muscles helps to stabilize joints and reduce muscle fatigue and pain. In addition, your doctor or physical therapist may recommend specific braces to help stabilize joints.

In general, medical intervention is limited to symptomatic therapy. Prior to pregnancy, patients with EDS should have genetic counseling. Children with EDS should be provided with information about the disorder, so they can understand why contact sports and other physically stressful activities should be avoided. Children should be taught early on that demonstrating the unusual positions they can maintain due to loose joints should not be done as this may cause early degeneration of the joints. Family members, teachers and friends should be provided with information about EDS so they can accept and assist the child as necessary.

Lifestyle and home remedies:-
If you have EDS, it’s important to prevent injuries and protect your skin and joints. Here are a few things you can do to safeguard yourself.

*Avoid injury. Avoid contact sports, weightlifting and other activities that increase your risk of injury.

*Use protective gear. Toddlers and young children with severe EDS often dislocate joints and frequently fall down, especially when learning to walk. Consider using protective clothing, guards or padding to protect your child from tumbles and falls.

*Reduce the clutter. To prevent falls and injuries at home, keep walkways and doorways clear of clutter. Avoid loose rugs and electric cords, which can increase your risk of tripping and falling.

*Use assistive devices. Several devices are available to help decrease stress on your joints, such as jar openers, utensils with wide handles, long-handled combs and bath sponges.

*Use mild soaps and sunscreen. To protect easily damaged skin and to guard against premature aging, use mild soaps and wear sunscreen when you’re outside.

Coping and support:–
Coping with a lifelong illness is challenging. Depending on the severity of your symptoms, you may face challenges at home, at work and in your relationships with others.

Here are some suggestions that may help you cope with the challenges of Ehlers-Danlos syndrome:

*Increase your knowledge. Knowing more about EDS can help you take control of your condition. Find a doctor who’s experienced in the management of EDS and learn as much as you can about the type of EDS you have.

*Tell others. Explain your condition to family members, friends and your employer. Ask your employer about any accommodations that you feel will make you a more productive worker. It’s up to you how much information you divulge to your co-workers. You may want to prepare appropriate responses for people who ask questions.

*Build a support system. Cultivate relationships with family and friends who are positive and caring. It may also help to talk to an unrelated third party, such as a medical social worker, counselor or clergy member. Some people find help by joining a support group for people with EDS or people with chronic illnesses. The Ehlers-Danlos National Foundation’s Web site has information on local and regional support groups.

Helping your child cope:
If you are a parent of a child with EDS, consider these suggestions to help your child:

*Maintain normalcy. As much as possible, treat your child like normal children. Ask others — grandparents, aunts, uncles, teachers — to do the same.Be open. Allow your child to express his or her feelings about having EDS, even if it means being angry at times. Parents of children with EDS have sometimes encountered suspicions of child abuse because of frequent bruises and cuts.Make sure your child’s teachers and other caregivers know about your child’s condition. Review with them appropriate caregiving skills, particularly in the event of a fall or injury.

*Promote activity. Allow your child to participate in physical activities with appropriate boundaries. Discourage contact sports while encouraging non-weight-bearing activities, such as swimming. Your child’s doctor or physical therapist may also have recommendations.

*Find the best routine. Work with your child’s teachers and school administrators to make any necessary modifications in his or her schedule or responsibilities. These modifications may include giving your child extra time to move from class to class, providing him or her with an extra set of textbooks so that these books won’t need to be carried home, and making arrangements for assignments to be sent home when your child misses school because of his or her condition.

Prevention:–
If you have a personal or family history of Ehlers-Danlos syndrome and you’re thinking about starting a family, you may benefit from talking to a genetic counselor — a health care professional trained to assess the risk of inherited disorders. Genetic counseling can help you understand the inheritance pattern of the type of EDS that affects you and the risks it poses for your children.

In other animals:-  CLICK & SEE
Ehlers–Danlos-like syndromes have been shown to be hereditary in Himalayan cats, some domestic shorthair cats, and in certain breeds of cattle. It is seen as a sporadic condition in domestic dogs.

DSLD: Degenerative Suspensory Ligament Desmitis is a similar condition now being researched in all breeds of horses. Though it was originally notated in the Peruvian Paso and thought to be a condition of overwork and older age, the disease is being recognized in all age groups and all activity levels. It has even been noted in newborn foals. The latest research has led to the renaming of the disease after the possible systemic and hereditary components now being delineated by the University of Georgia. Equine Systemic Proteoglycan Accumulation

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Ehlers%E2%80%93Danlos_syndrome
http://www.mayoclinic.com/health/ehlers-danlos-syndrome/DS00706
http://www.bbc.co.uk/health/physical_health/conditions/ehlers1.shtml

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Hernia

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A hernia is a protrusion of a tissue, structure, or part of an organ through the muscular tissue or the membrane by which it is normally contained. The hernia has 3 parts: the orifice through which it herniates, the hernial sac, and its contents.

A hernia may be likened to a failure in the sidewall of a pneumatic tire. The tire’s inner tube behaves like the organ and the side wall like the body cavity wall providing the restraint. A weakness in the sidewall allows a bulge to develop, which can become a split, allowing the inner tube to protrude, and leading to the eventual failure of the tire.

click to see the pictures

Pathophysiology:
By far most hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or “defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. Another common hernia involves the intervertebral disc, and causes back pain or sciatica.

Hernias may present either with pain at the site, a visible or palpable lump, or in some cases by more vague symptoms resulting from pressure on an organ which has become “stuck” in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed by or accompanied by an organ.

Most of the time, hernias develop when pressure in the compartment of the residing organ is increased, and the boundary is weak or weakened.

Weakening of containing membranes or muscles is usually congenital (which explains part of the tendency of hernias to run in families), and increases with age (for example, degeneration of the annulus fibrosus of the intervertebral disc), but it may be on the basis of other illnesses, such as Ehlers-Danlos syndrome or Marfan syndrome, stretching of muscles during pregnancy, losing weight in obese people, etc., or because of scars from previous surgery.
Many conditions chronically increase intra-abdominal pressure, (pregnancy, ascites, COPD, dyschezia, benign prostatic hypertrophy) and hence abdominal hernias are very frequent. Increased intracranial pressure can cause parts of the brain to herniate through narrowed portions of the cranial cavity or through the foramen magnum. Increased pressure on the intervertebral discs, as produced by heavy lifting or lifting with improper technique, increases the risk of herniation.

Epidemiology: Between 1995 and 2005, 16,742 Americans died from hernias.

List of symptoms of Hernia: The list of symptoms mentioned in various sources for Hernia includes: Protruding bulge, Pain, Discomfort, Weakness

Symptoms of a strangulated hernia: Severe pain, Fever, Vomiting, Gangrene

Characteristics

Hernias can be classified according to their anatomical location:

Examples include:

*abdominal hernias

*diaphragmatic hernias and hiatus hernias (for example, paraesophageal hernia of the stomach)

*pelvic hernias, for example, obturator hernia

*hernias of the nucleus pulposus of the intervertebral discs

*intracranial hernias

Each of the above hernias may be characterised by several aspects:

*congenital or acquired: congenital hernias occur prenatally or in the first year(s) of life, and are caused by a congenital defect, whereas acquired hernias develop later on in life. However, this may be on the basis of a locus minoris resistentiae (Lat. place of least resistance) that is congenital, but only becomes symptomatic later on in life, when degeneration and increased stress (for example, increased abdominal pressure from coughing in COPD) provoke the hernia.

*complete or incomplete: for example, the stomach may partially herniate into the chest, or completely.

*internal or external: external ones herniate to the outside world, whereas internal hernias protrude from their normal compartment to another (for example, mesenteric hernias).

*intraparietal hernia: hernia that does not reach all the way to the subcutis, but only to the musculoaponeurotic layer. An example is a Spigelian hernia. Intraparietal hernias may produces less obvious bulging, and may be less easily detected on clinical examination.

*bilateral: in this case, simultaneous repair may be considered, sometimes even with a giant prosthetic reinforcement.

*reducible or irreducible (also known as incarcerated): the hernial contents can or cannot be returned to their normal site with simple manipulation

If irreducible, hernias can develop several complications (hence, they can be complicated or uncomplicated):

*strangulation: pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later necrosisand gangrene, which may become fatal.

*obstruction: for example, when a part of the bowel herniates, bowel contents can no longer pass the obstruction. This results in cramps, and later on vomiting, ileus, absence of flatus and absence of defecation. These signs mandate urgent surgery.

*another complication arises when the herniated organ itself, or surrounding organs start dysfunctioning (for example, sliding hernia of the stomach causing heartburn, lumbar disc hernia causing sciatic nerve pain, etc.)

Causes:
Usually, there is no obvious cause of a hernia, although they are sometimes associated with heavy lifting.

Hernias can be seen in infants and children. This can happen when the lining around the abdominal organs does not close properly before birth. About 5 out of 100 children have inguinal hernias (more boys than girls). Some may not have symptoms until adulthood.

If you have any of the following, you are more likely to develop a hernia:

*Family history of hernias

*Cystic fibrosis

*Undescended testicles

*Extra weight

*Chronic cough

*Chronic constipation, straining to have bowel movements

*Enlarged prostate, straining to urinate

Exams and Tests :

A doctor can confirm the presence of a hernia during a physical exam. The mass may increase in size when coughing, bending, lifting, or straining. The hernia (bulge) may not be obvious in infants and children, except when the child is crying or coughing.

Treatment

It is generally advisable to repair hernias in a timely fashion, in order to prevent complications such as organ dysfunction,gangrene, and multiple organ dysfunction syndrome . Most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. Uncomplicated hernias are principally repaired by pushing back, or “reducing”, the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy). If complications have occurred, the surgeon will check the viability of the herniated organ, and resect it if necessary. Modern muscle reinforcement techniques involve synthetic materials (a mesh prosthesis) that avoid over-stretching of already weakened tissue (as in older, but still useful methods). The mesh is placed over the defect, and sometimes staples are used to keep the mesh in place. Increasingly, some repairs are performed through laparoscopes.

Many patients are managed through surgical daycare centers, and are able to return to work within a week or two, while heavy activities are prohibited for a longer period. Surgical complications have been estimated to be up to 10%, but most of them can be easily addressed. They include surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence.

Generally, the use of external devices to maintain reduction of the hernia without repairing the underlying defect (such as hernia trusses, trunks, belts, etc.), is not advised. Exceptions are uncomplicatedincisional hernias that arise shortly after the operation (should only be operated after a few months), or inoperable patients.

It is essential that the hernia not be further irritated by carrying out strenuous labour.

Prevention:

*Use proper lifting techniques.

*Lose weight if you are overweight.

*Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the bathroom as soon as you have the urge, and exercising regularly.

Types:

There are several types of hernias, based on where it occurs:

*Inguinal hernia — appears as a bulge in the groin or scrotum. This type is common in men than women.

*Fermoral hernia– appears as a bulge in the upper thigh. This type is more common in women than in men.

*Incisional hernia — can occur through a scar if you had abdominal surgery.

*Umbical hernia- a bulge around the belly button. Happens if the muscle around the navel doesn’t close completely.

A sportman’s hernia is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal, although a true hernia is not present.

Inguinal hernia:
Diagram of an indirect, scrotal inguinal hernia ( median view from the left).By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. For a thorough understanding of inguinal hernias, much insight is needed in the anatomy of the inguinal canal. Inguinal hernias are further divided into the more common indirect inguinal hernia (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the direct inguinal hernia type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal. Inguinal hernias are more common in men than women while femoral hernias are more common in women.

Femoral hernia:
Femoral hernias occur just below the inguinal ligament, when abdominal contents pass into the weak area at the posterior wall of the femoral canal. They can be hard to distinguish from the inguinal type (especially when ascending cephalad): however, they generally appear more rounded, and, in contrast to inguinal hernias, there is a strong female preponderance in femoral hernias. The incidence of strangulation in femoral hernias is high. Repair techniques are similar for femoral and inguinal hernia.

Umbilical hernia:
Umbilical hernias are especially common in infants of African descent, and occur more in boys. They involve protrusion of intraabdominal contents through a weakness at the site of passage of the umbilical cord through the abdominal wall. These hernias often resolve spontaneously. Umbilical hernias in adults are largely acquired, and are more frequent in obese or pregnant women. Abnormal decussation of fibers at the linea alba may contribute.

Incisional hernia:
An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in median laparotomy incisions in the linea alba, they are termed ventral hernias. These can be the most frustrating and difficult to treat, as the repair utilizes already attenuated tissue.

Diaphragmatic hernia:
Diagram of a hiatus hernia (coronal section, viewed from the front).Higher in the abdomen, an (internal) “diaphragmatic hernia” results when part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm.

 

A hiatus hernia is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach (esophageal hiatus) serves as a functional “defect”, allowing part of the stomach to (periodically) “herniate” into the chest. Hiatus hernias may be either “sliding,” in which the gastroesophageal junction itself slides through the defect into the chest, or non-sliding (also known as para-esophageal), in which case the junction remains fixed while another portion of the stomach moves up through the defect. Non-sliding or para-esophageal hernias can be dangerous as they may allow the stomach to rotate and obstruct. Repair is usually advised.

 

Frontal chest X-ray showing a hernia of Morgagni.A congenital diaphragmatic hernia is a distinct problem, occurring in up to 1 in 2000 births, and requiring pediatric surgery. Intestinal organs may herniate through several parts of the diaphragm, posterolateral (in Bochdalek’s triangle, resulting in Bochdalek’s hernia), or anteromedial-retrosternal (in the cleft of Larrey/Morgagni’s foramen, resulting in Morgagni-Larrey hernia, or Morgagni’s hernia).

Other types of hernia:
Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms. The above article deals mostly with “visceral hernias”, where the herniating tissue arises within the abdominal cavity. Other hernia types and unusual types of visceral hernias are listed below, in alphabetical order:

Brain hernia: herniation of part of the brain because of excessive intracranial pressure. This may be a life-threatening condition, especially if the brain stem (responsible for some important vital signs) is involved.
Cooper’s hernia: A femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing immediately beneath the skin.

epigastric hernia: hernia through the linea alba above the umbilicus.
Littre’s hernia: hernia involving a Meckel’s diverticulum. It is named after French anatomist Alexis Littre (1658-1726).
lumbar hernia: hernia in the lumbar region (not to be confused with a lumbar disc hernia), contains following entities:
Petit’s hernia – hernia through Petit’s triangle (inferior lumbar triangle). It is named after French surgeon Jean Louis Petit (1674-1750).
Grynfeltt’s hernia – hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle). It is named after physician Joseph Grynfeltt (1840-1913).
obturator hernia: hernia through obturator canal
pantaloon hernia: a combined direct and indirect hernia, when the hernial sac protrudes on either side of the inferior epigastric vessels
perineal hernia: A perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually, is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.
properitoneal hernia: rare hernia located directly above the peritoneum, for example, when part of an inguinal hernia projects from the deep inguinal ring to the preperitoneal space.
Richter’s hernia: strangulated hernia involving only one sidewall of the bowel, which can result in bowel perforation through ischaemia without causing bowel obstruction or any of its warning signs. It is named after German surgeon August Gottlieb Richter (1742-1812).
sliding hernia: occurs when an organ drags along part of the peritoneum, or, in other words, the organ is part of the hernia sac. The colon and the urinary bladder are often involved. The term also frequently refers to sliding hernias of the stomach.
sciatic hernia: this hernia in the greater sciatic foramen most commonly presents as an uncomfortable mass in the gluteal area. Bowel obstruction may also occur. This type of hernia is only a rare cause of sciatic neuralgia.
Spigelian hernia, also known as spontaneous lateral ventral hernia
Velpeau hernia: a hernia in the groin in front of the femoral blood vessels
spinal disc herniation, or “herniated nucleus pulposus”: a condition where the central weak part of the intervertebral disc (nucleus pulposus, which helps absorb shocks to our spine), herniates through the fibrous band (annulus fibrosus) by which it is normally bound. This usually occurs low in the back at the lumbar or lumbo-sacral level and can cause back pain which usually radiates well into the thigh or leg. When the sciatic nerve is involved, the symptom complex is called sciatica. Herniation can occur in the cervical vertebrae too. A nucleoplasty is an operation to repair the herniation.

Complications

Complications may arise post-operation, including rejection of the mesh that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localised swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed.

An untreated hernia may complicate by:Inflamation,Strangulation,Obstruction,Irreducibilty, Hydrocele of the hernial sac

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000960.htm
http://www.cureresearch.com/h/hernia/symptoms.htm
http://en.wikipedia.org/wiki/Hernia

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