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401© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
S. H. Yale et al., Gastrointestinal Eponymic Signs,
https://doi.org/10.1007/978-3-031-33673-7_12
Chapter 12
Hernia Signs
12.1 Introduction
A hernia is the Latin term for a rupture or protrusion. The sufx “cele” remained in
use in the 1800s in connotation to a hernia [1]. The word “bubonocele” is an archaic
term coined by the Roman medical writer Aulus Cornelius Celsus (c. 25BC–c.
50AD) in reference to an inguinal hernia, and “enterocele” is an old term coined by
the Greeks of antiquity and used today when referring to a hernia containing the
intestines [1]. Celsus apologetically used the term hernia to describe a protrusion of
an internal organ in the rst century AD [2]. In a translation of his work in De
Medicina (On Medicine) on inguinal hernia:
Now under this several diseases occur; sometimes arising from a rupture of the tunica,
which I have stated to take their origin from the groins; and sometimes happening while
these remain entire. Indeed, sometimes inammation takes place from disease, and then a
rupture from a weight of the parts; or that tunic peritoneum, which is designed to separate
the intestines from the lower parts, the genitals, is ruptured at ounce by some violence: then
either the omentum alone, or that and the intestine together, protrude into that part by their
own weight, and by this a passage formed, they press down gradually from the groin into
the inferior parts, and by degrees separate the nervous-membranous-coats, which naturally
yield to this dilation. The Greeks term a descent of the intestines enterocele, the omentum
epiplocele: with us the term hernia is in becoming, but common to them both [2, p.269].
In addition to an inguinal hernia, Celsus described eight others, both umbilical and
intestinal, and omental in the abdomen. Covered are signs of a hernia: enterocele,
obturator, vitelline, and inguinal hernia. Their methods of diagnosis are named
eponymously in honor of the person and their discovery.
402
12.2 Eponymous Signs
12.2.1 Laugier Sign
Stanislas Laugier (1799–1872) was born in Paris, France, and received his medical
degree in 1828 [3]. He was an intern under the auspices of Baron Guillaume
Dupuytren (1777–1835) at the Hôtel-Dieu and appointed associate professor of the
Faculty of Medicine, Paris, in 1830, a surgeon at the central surgical ofce in 1831,
Necker Hospital in 1832, and Beaujon Hospital in 1835 [3, 4]. He was selected as
professor and chair of the surgical clinic at La Pitié Hospital in 1848 and the Hôtel-
Dieu in 1854 [3, 4]. Laugier was elected member of the French National Academy
of Medicine in 1844, president in 1848, and to the Academy of Sciences in 1868 [3].
His name is eponymously associated with a hernia, fractures, and sign [5, 6].
As to a description of his character:
He was full of good sense and a gifted speaker who sought neither success from either the
Academy or his patients. He wrote with elegance; as shown in his Tribute to Jean-Louis
Petit, in the articles in the 30 volumes of Dictionary of Medical Sciences, and in the New
Dictionary of Practical Medicine and Surgery [4, p.545].
Laugier described a method for distinguishing a small and large bowel hernia and
differentiated it from a hernia involving the epiploic appendages (Table12.1):
The extent, form, and cause of meteorism of the abdomen occurring during a strangulated
hernia vary depending upon whether the hernia is epiploic or intestinal, as the latter contains
fat and small or large intestines. Its extent also varies depending upon whether the incarcer-
ated portion of the small intestine lies close to the stomach. In an epiploic hernia, before the
development of peritonitis, the abdomen is soft even in the vicinity of the hernia without
meteorism. The meteorism is present within the rst hours of the strangulated intestinal
hernia. When the hernia contains the large intestine, the proximal portion of the intestine of
the meteorism causes the abdomen to assume a cylindrical shape. If the small intestine or
omentum is within the hernial sac, the anks and epigastric regions are supple and
depressed. The bloated abdomen occupies the hypogastric and umbilical regions. It is
spherical, or nearly so in shape, like an encysted tumor or pregnancy at six or seven months.
(…) When the strangulation of the small intestines occurs near the stomach, abdominal
distention is less pronounced for the same duration of the disease because the upper end is
shorter [7, p.370–371].
Thus, Laugier sign refers to the appearance of the abdomen in small and large intes-
tinal hernias. The hernia is cylindrical when the large bowel is involved, while the
anks and epigastric regions are depressed in small intestinal or omental hernias.
12.2.2 Howship–Romberg Sign
12.2.2.1 John Howship
John Howship (1781–1841) was born in London, England, and attended medical
school in 1799. He was appointed assistant surgeon at St. George’s Inrmary,
12 Hernia Signs
403
London, in 1805, and served as an assistant surgeon in 1834 and chief surgeon in
1836 to the Charing Cross Hospital [8]. He was a member of the Royal College of
Surgeons from 1828 to 1841 and delivered the Hunterian Oration at the Royal
College of Surgeons in 1833. Howship was a member of the Royal Medico-
Chirurgical Society of London; Medico-Chirurgical Society and Royal Medical
Society of Edinburgh, England; Copenhagen Royal Academy of Medicine; Society
for Natural and Medical Sciences, Dresden; German Academy of Natural Sciences,
Bonn; and corresponding member of the Paris Emulation Medical Society [9].
His contributions spanned the elds of gastroenterology, genitourinary, and dis-
order of bone. Another eponym attributed to his namesake is the Howship lacunae,
the histological ndings of the groove or pit containing osteoclast cells indicative of
bone resorption [10].
In his book Practical Remarks on the Discrimination and Appearance of Surgical
Disease, Howship described the symptoms in a case titled “Strangulated thyroidal
hernia, diagnostic symptom, appearances on dissection,” involving an aged female
under the care of Mr. Weathereld:
In November she was seized with violent spasmodic pain in the left side of the abdomen,
running down the left leg, with sickness, vomiting, and, as she said diarrhea [11, p.323].
March 23, 1839—Mr. W[eathereld] found her again suffering under extreme pain and
tenderness in the abdomen, especially in the left side, with constant vomiting, preceded by
diarrhea, and attended with the same pain as before, down the left leg. The symptoms, those
of strangulated hernia, Mr. W. made a careful inquiry and examination but could nowhere
ascertain outward tumor [11, p.324].
On postmortem examination, he found:
On opening the abdomen, a portion of small intestine was seen stretched towards the left
obturator foramen, where a knuckle was rmly impacted, forming a small hernia, no larger
than a nutmeg, protruding through the opening. The intestine, high inamed, was almost
gangrenous. The parts were carefully removed and admirably dissected; demonstrating the
hernia to the best advantage [11, p.324].
Thus, Howship described the symptoms in patients with an obturator hernia
(Table12.1).
12.2.2.2 Moritz Romberg
Moritz Heinrich Romberg (1795–1873) was born in Meiningen, Saxony, Germany,
in 1795 and received his medical degree from the University of Berlin in 1817 [12].
He was appointed a medical ofcer for the poor in 1820 and was associate professor
in 1830. He served as director of the Cholera Hospitals in Berlin in 1830, 1836, and
1838. Romberg was appointed extraordinary professor of medicine and director of
the university polyclinic in 1838 and an ordinary professor at the University of
Berlin in 1845 [13, 14].
Ramberg’s most widely recognized work, published from 1840 to 1846 and
translated into English in 1853, was a treatise on the nervous system of man where
12.2 Eponymous Signs
404
he described another better-known neurological sign involving the dorsal column of
the spinal cord in patients with tabes dorsalis. He authored other works on cholera
and respiratory paralysis [15]. He described the signicance of his ndings of an
obturator hernia in 1847 (Table12.1):
What gives this case a special interest is not that it is rare, but elucidating the diagnosis by
its neurologic phenomenon. Pressure and distortion of the obturator nerve may be found in
every obturator hernia and if the content of the hernia is bowel, symptoms of nerve entrap-
ment is associated with the intestinal entrapment. Both the sensory bers of the obturator
nerve, which spread as cutaneous nerves on the inner side of the thigh as well as the motor-
bers, destined for the gracilis and adductors of the thigh, conrm this disorder by the
presence of severe pain located in the inner thigh, paresthesia, and the inability to adduct the
thigh. In some older observations, we nd mention of this pain accompanying an existing
ileus, without any value placed in diagnosis [16, p.624].
He explained the diagnostic criteria for an obturator hernia:
For the obturator hernia is a diagnostic criterion as it is associated with pain, disturbed
movement of the thigh, and altered intestinal movement. Most important, because this con-
dition is chronic it rarely forms a tumor visible from the outside, and is subjected to tempo-
rary, repeated incarceration. Circumstances occurring in the female sexes, where this hernia
is more likely to occur, may lead one to misinterpret that this pain represent a nervous,
hysterical affection. Knowing that the pain on the thigh is a neuralgic assist in conrming
the diagnosis [16, p.625].
Hence, Howship was the rst to describe the clinical syndrome, while Romberg
reported on the diagnostic criteria and explained the pathophysiology of an incar-
cerated obturator hernia (Table12.1). The Howship–Romberg sign was identied in
11 of 30 (37%) of patients with obturator hernia [17]. In another small study, the
Howship–Romberg sign was present in only 3 of 13 (23%) patients [18]. It has been
shown to be present in 15–50% of cases of obturator hernia [19].
The obturator hernia may follow the route of the branch of the anterior or poste-
rior obturator nerve or between the internal and external obturator membranes. The
different route that the obturator hernia takes as it enters the obturator canal explains
the lower detection rate of this sign in some patients. The sign was shown to occur
more commonly in patients when the hernia follows the anterior branch of the obtu-
rator nerve, which innervates the muscles of the pectineus, adductor brevis and lon-
gus, and gracilis [20].
In a study of 43 patients, comparing those with obturator hernia before and after
the advent of computed tomography (CT) of the pelvis showed a better preoperative
diagnostic accuracy and a lower rate of intestinal resection and surgical mortality
with preoperative CT scan [21]. In another small study, no difference was found in
the time to operation, length of stay, need for bowel resection, and mortality rate,
regardless of whether a patient received a preoperative CT scan [17].
The Howship–Romberg sign refers to pain at the medial side of the thigh in an
obturator hernia.
12 Hernia Signs
405
12.2.3 Ladd Sign
William Eduard Ladd (1880–1967) was born in Milton, Norfolk County,
Massachusetts, USA, and received his medical degree from Harvard Medical School
in 1906 [22–26]. He completed a surgical internship at Boston City Hospital from
1906 to 1908. He was appointed assistant visiting surgeon to the Infants and
Children’s Hospital from 1909 to 1913, assistant visiting surgeon to the Boston City
Hospital from 1910 to 1913, and visiting surgeon to Milton Hospital beginning in
1910 [23]. He was an assistant in surgery beginning in 1912, an instructor in 1917
at the Harvard Graduate School of Medicine, and a surgeon-in-chief at Boston
Children’s Hospital in 1927 [23]. He served as a clinical professor of surgery at
Harvard Medical School in 1931 [22, 25]. The William E.Ladd Professor of Child
Surgery was named in his honor at Harvard Medical School from 1941 to 1947 [22,
25, 26]. He cofounded the American Board of Surgery, the Surgical Section of the
American Board of Surgery, and the American Board of Plastic Surgery [22, 25]. He
is credited for writing with his colleague Robert Edward Gross (1905–1988) the
book Abdominal Surgery of Infancy and Childhood in 1941 [26, 27].
As to a description of his character by Donald Watson:
At the patient’s bedside, in the operating room, and the informal surroundings of the sur-
geon’s dressing room or private ofce, there have been few teachers as effective as this
kindly, impressive, stimulating man. A whole generation of surgeons and untold numbers of
children will forever be in his debt [22, p.296].
His name is eponymously recognized in association with congenital brous bands
that cause the cecum to attach to the posterior abdominal wall leading to duodenal
obstruction (Ladd bands) and the surgical procedure used to resolve the intestinal
malrotation (Ladd procedure).
Ladd described a method for examining an inguinal hernia in infants (Table12.1):
When an infant is presented with this complaint, a method of examination different from
that employed in the older child or adult is used. The practice used in the adult of invert-
ing the scrotum, palpating the external ring and the impulse on coughing is almost val-
ueless. Instead of this, the cord is palpated as it emerges from the external ring and, if
hernia be present, it will be found to be thicker than that of the other side. If the hernia
extends only part way down the canal, the nger is placed at over the inguinal canal
and the cord rolled back and forth underneath it. If hernia be present, this give a sensa-
tion to the nger of thickening of the cord, which is quite unmistakable to the trained
nger [28, p.235].
Ladd sign is the palpatory method of examining an infant for an inguinal hernia.
12.2.4 Hannington-Kiff Sign
There is limited historical information on John. GareldHannington-Kiff. He was
appointed consultant anesthetist and director of the Pain Relief Centre at the Frimley
12.2 Eponymous Signs
406
Park Hospital in Surrey, England, in the 1980s [29]. Hannington-Kiff was the recip-
ient of the Jacksonian Prize from the Royal College of Surgeons of England in 1981
for his dissertation titled “The relief of dystrophic inammatory and spastic condi-
tions of limbs by the local deposition of high doses of drugs administered during
regional circulatory occlusion with a tourniquet” [30]. He was the rst anesthetist to
receive this award. The commendation is given to fellows and members who “aspire
to high place in surgery, dentistry, and anesthetics” [30].
His areas of medical practice and research interest were pain management and
anesthesia. He developed a stellate ganglion block technique and a regional intrave-
nous sympathetic block using guanethidine [31, 32].
Hannington-Kiff described the percussion method, the thigh adductor stretch
reex, for diagnosing a strangulated obturator hernia (Table12.1) (Fig.12.1):
A rm blow from a patellar hammer over the thumb or index nger laid at right angles
across the adductor muscle about 5cm above the medial epicondyle of the femur. In this
way any contraction of the adductor muscle can be felt as well as seen, and the patient will
be saved some discomfort from the blow of the hammer [29, p.180].
Thus, Hannington-Kiff described the percussion method for detecting the adductor
stretch reex used for the diagnosis of an obturator hernia. A positive sign is due to
the pressure exerted on the irritated obturator nerve by the obturator hernia.
Table 12.1 Hernia signs
Name Year Description of sign Signicance
Laugier [7] 1840 When the hernia contains the proximal portion of the
large intestine, the meteorism gives the abdomen an
almost cylindrical shape. If the small intestine or
omentum is within the hernial sac, the anks and
epigastric region are supple and depressed. At the same
time, the bloated abdomen occupies the hypogastric
and umbilical regions and is spherical
Small and large
bowel hernia
(enterocele)
Howship–
Romberg [11,
16]
1840
1847
Severe pain located in the inner thigh, paresthesia, and
the inability to adduct the thigh. An ileus may also be
present
Obturator
hernia
Ladd [28] 1941 The cord is palpated as it emerges from the external
ring. If a hernia is present, it is thicker compared to the
other side. If the hernia extends only part way down the
canal, the nger is placed at across the inguinal canal,
and the cord is rolled back and forth. If a hernia is
present, a thick cord is palpated
Inguinal hernia
(infants)
Hannington-
Kiff [29]
1980 A rm blow is delivered from a patellar hammer over
the thumb or index nger placed at a right angle to the
adductor muscle about 5cm above the medial
epicondyle of the femur. Contraction of the adductor
muscle is observed or palpated
Strangulated
obturator hernia
12 Hernia Signs
407
Fig. 12.1 Hannington- Kief sign (by Ryan Yale)
12.3 Conclusion
There are four eponymic named hernia signs, one of which (Ladd) is found in
infants. These signs employ the physical examination skills of observation, palpa-
tion, and percussion as the method for eliciting these diagnostic ndings. Howship–
Romberg and Hannington-Kiff signs are used to assist in the diagnosis of obturator
hernia. The Hannington-Kiff sign, unlike the Howship–Romberg, represents an
objective means for diagnosing a strangulated obturator hernia. The Howship–
Romberg sign is the best well-studied of these signs, found in only 15–50% of
cases. The lack of description of what constitutes a positive test limits the ability to
interpret ndings from these studies. Despite these limitations, we contend that the
signs should be taught as they provide a more in-depth understanding of the patho-
physiologic process and anatomical variations, which may account for the inability
to elicit a positive sign.
References
1. Skinner HA.The origin of medical terms. Baltimore: Williams & Wilkins; 1949.
2. Celsus AC. On medicine in eight books, vol. 1. (trans: L.Targa). Lee A, editor. London:
E.Cox; 1831.
References
408
3. Broca P.Laugier, Stanislas. Comité des travaux historiques et scientiques. 2020. https://cths.
fr/an/savant.php?id=124583#. Accessed 15 Nov 2022.
4. [No author]. Nécrologie scientique: Stanislas Laugier. L’Année scientique et industrielle.
1873;16:544–5.
5. Marcucci L. Handbook of medical eponyms. Philadelphia: Lippincott Williams & Wilkins;
2002.
6. Birrer RB, Birrer CD.Medical diagnostic signs: a reference collection of eponymic bedside
signs. Springeld: Charles C.Thomas; 1982.
7. Laugier S. Sur un signe nouveau dans l’histoire des hernies étranglées. C R Acad Sci.
1840;10:370–1.
8. Royal College of Surgeons of England. Howship, John (1781–1841). https://aim25.com/
cats/9/10031.htm. Accessed 25 Nov 2022.
9. Howship J.Practical observation in surgery and morbid anatomy. London: Longman, Hurst,
Rees, Orme and Brown; 1816.
10. Bir SC, Kalakoti P, Notarianni C, Nanda A.John Howship (1781–1841) and growing skull
fracture: historical perspective. J Neurosurg Pediatr. 2015;16:472–6.
11. Howship J. Practical remarks on the discrimination and appearance of surgical disease.
London: John Churchill; 1840.
12. Firkin BG, Whitworth JA.Dictionary of medical eponyms. Boca Raton: Parthenon Publishing;
2002.
13. [No author]. Obituary record: Romberg M.Med News. 1873;31–32:135.
14. [No author]. Obituary: Moritz Heinrich Romberg. Med Times Gaz. 1873;2:81.
15. [No author]. News and miscellany: death of Romberg. Med Surg Rep. 1873;29:88.
16. Romberg MH.Die Operation des eingeklemmten Bruches des eirunden Loches: Operatio her-
niae foraminis ovalis incarceratae. In: Dieffenbach JF, editor. Die operative Chirurgie, Bd. 2.
Leipzig: F.A.Brockhaus; 1847. p. 619–25.
17. Nasir BS, Zendejas B, Ali SM, Groenewald CB, Heller SF, Farley DR.Obturator hernia: the
mayo clinic experience. Hernia. 2012;16:315–9.
18. Yip AWC, AhChong AK, Lam KH. Obturator hernia: a continuing diagnostic challenge.
Surgery. 1993;113:266–9.
19. Mantoo SK, Mak K, Tan TJ. Obturator hernia: diagnosis and treatment in the modern era.
Singap Med J. 2009;50:866–70.
20. Karasaki T, Nakagawa T, Tanaka N.Obturator hernia: the relationship between anatomical
classication and the Howship–Romberg sign. Hernia. 2014;18:413–6.
21. Kammori M, Mafune KI, Hirashima T, Kawahara M, et al. Forty-three cases of obturator her-
nia. Am J Surg. 2004;187:549–52.
22. Watson D.Dr. William E.Ladd. J Pediatr Surg. 1967;2:295–6.
23. [No author]. William Edward Ladd. In: Harvard college, class of 1902—Secretary’s fth
report. Cambridge: Harvard University Press; 1917. p. 184–5.
24. Lim PW, Martin ND, Hicks BA, Yeo CJ, Cowan SW. William Edwards Ladd, MD (1880–
1967): the description of his bands. Am Surg. 2013;79:11–3.
25. Bill H, William E, Ladd MD.Great pioneer of north American pediatric society. Progr Pediatr
Surg. 1986;20:52–9.
26. Wiedermann HRK.William E.Ladd (1880–1967). Eur J Pediatr. 1990;149:669.
27. Ladd WE, Gross RE. Abdominal surgery of infancy and childhood. Philadelphia:
W.B.Saunders; 1941.
28. Ladd WE.Hernia in infancy and childhood. Nebraska Med J. 1941;26:235–9.
29. Hannington-Kiff JG.Absent thigh adductor reex in obturator hernia. Lancet. 1980;315:180.
30. [No author]. News and notices: award of the Jacksonian prize of the Royal College of Surgeons
of England. Anaesthesia. 1981;36:731–6.
31. Hannington-Kiff JG. Intravenous regional sympathetic block with guanethidine. Lancet.
1974;303:1019–20.
32. Hannington-Kiff JG.Relief of causalgia in limbs by regional intravenous guanethidine. Br
Med J. 1979;2:367–8.
12 Hernia Signs
409
Epilogue
The current book follows in the steps of the authors’ rst book, Cardiovascular
Eponymic Signs (2021), which received international acclaim among clinicians,
researchers, medical students, and medical historians for its unique approach uncov-
ering otherwise dormant rst-hand accounts that should continue to serve a role in
modern medical practice.
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2023
S. H. Yale et al., Gastrointestinal Eponymic Signs,
https://doi.org/10.1007/978-3-031-33673-7
411
A
Aaron, Charles Dettie, 179–180
Aaron sign, 179–180
Abdominal reex, 173, 359, 379, 380, 389,
392, 393
Abdominal wall, 62, 64, 73, 75, 77, 87, 95, 96,
117, 128, 131, 132, 135, 139, 142,
144, 147, 148, 153, 157, 165, 166,
168, 169, 173, 189, 192–196, 199,
227, 233, 246, 278, 284, 295, 302,
303, 324, 329, 335, 344, 357–395
Abrahams, Robert, 254, 268
Abrahams sign, 254
Acute pancreatitis, 247, 293, 295, 296, 302,
303, 377, 388, 391, 394
Acute septic peritonitis, 226
Addison, Christopher, 55, 2258
Addison, Thomas, 55
Adhesions, 61, 76, 135, 146, 182, 194, 217,
219–221, 229, 232, 233, 247, 267,
307, 317, 323, 324, 332, 333, 335,
336, 338, 345–347
Albert, Eduard, 322–323
Albertin, Henri Alphonse, 331
Alders, Nicholas, 193–194, 204
Alders sign, 193–194
Altschüler, Emil, 193, 204
Altschüler sign, 193
Anfallsfrei appendicitis, 223
Anschütz, Alfred Wilhelm, 97–98, 117
Anschütz sign, 97–98
Appendicitis, 100, 113, 127–206, 217–234,
247, 317, 333, 371, 385, 390, 392
Arapov, Dmitry Alekseyevich, 194–195
Arapov sign, 194–195
Aristotle, 85
Arloing, Saturnin, 257
Ascites, 65, 77, 91, 101–103, 237, 238, 249,
264, 267, 270, 278, 307, 313, 334,
337, 338, 340, 343, 344, 346–349,
368, 386
Atrophic gastritis, 55, 76
Auenbrugger, Leopold, 357–358, 389
Auenbrugger sign, 357–358
Avicenna (Ibn Sina), 53
B
Baid, Jai Chand, 302, 303
Baid sign, 302
Baillie, Matthew, 237
Baldwin, James Fairchild, 185–186, 202
Baldwin sign, 185–186
Ballance, Charles Alfred, 279–280
Ballance sign, 279–280
Banks, William Mitchell, 380
Barkman, Ake, 379–380, 392
Barkman sign, 379–380
Barnard, Harold Leslie, 324, 345
Barnard sign, 324
Baron sign, 196–197
Barth, Henri, 248
Bassler, Anthony, 180, 181, 201
Bassler sign, 180–181
Bastedo sign, 178–179
Bastedo, Walter Arthur, 178–179, 200
Bayer, Carl, 95, 116
Bayer sign, 95–96
Beevor, Charles Edward, 363–364
Beevor sign, 363–364
Index
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2023
S. H. Yale et al., Gastrointestinal Eponymic Signs,
https://doi.org/10.1007/978-3-031-33673-7