Posterior Herniation Types: Disc, Hiatal, Inguinal, Femoral, Diaphragmatic, and Congenital

Posterior herniation refers to protrusion through a posterior defect. The term applies to several distinct anatomical entities.

1. Intervertebral Disc Herniation (Most Common)

• Nucleus pulposus extrudes through annular tear posteriorly/posterolaterally.
• Compresses traversing nerve root (e.g., L5 at L4–L5).
• Symptoms: radiculopathy, myelopathy if central.

2. Hiatal Hernia

• Stomach protrudes through esophageal hiatus into thorax.
• Type I (sliding) = 95%; Types II–IV (paraesophageal) risk volvulus/strangulation.
• GERD, dysphagia, chest pain.

3. Inguinal Hernia

• Abdominal contents through internal inguinal ring (indirect) or Hesselbach’s triangle (direct).
• Male:female 9:1. Right > left.
• Repair: Lichtenstein (open mesh) or laparoscopic (TAPP/TEP).

4. Femoral Hernia

• Through femoral canal (medial to femoral vein).
• Female predominance. High strangulation risk → urgent repair.

5. Diaphragmatic Hernia (Acquired)

• Blunt/penetrating trauma → diaphragmatic rupture → abdominal viscera into chest.
• Left side > right (liver buffers right).

6. Congenital Diaphragmatic Hernia (CDH)

• Posterolateral defect (Bochdalek) → lung hypoplasia, pulmonary hypertension.
• Neonatal emergency; ECMO, delayed repair.

Unifying Principle

All involve posterior defect → visceral/structural displacement → compression/ischemia → symptoms. Management ranges from observation to emergency surgery.