It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenuous event.
BACKGROUND
There is a commonly held belief that the development of a hernia can be attributed to a single strenuous or traumatic event. Hence, many litigants are successful in compensation claims, causing mounting financial burdens on employers, the courts, insurance companies and the tax-payer. However, there is very little scientific evidence to support this assertion. The aim of this study was to ascertain whether there was any causal link in this process.


METHODS
A total of 133 new patients with 135 abdominal herniae of all varieties (115 inguinal, 3 femoral, 9 umbilical, 4 incisional, and 4 ventral or epigastric), of which 25 were recurrent received structured questionnaires on arrival in the surgical clinic. These questionnaires covered all possible aetiological factors for hernia development (type of work, COAD, smoking, pregnancy, obesity, chronic bladder outflow obstruction, previous surgery including appendicectomy), in addition to any possible attribution to a single strenuous or traumatic event. We then reviewed the GP records in the surgery of all patients who answered positively to the latter possible cause.


RESULTS
In the study group, 119 (89%) reported a gradual onset of symptoms. Of the 15 (12 male, 3 female; 11%) who believed that their hernia might be related to a single strenuous or traumatic event, 5 had no other aetiological factors. However, not one of the 15 was found to have contemporaneous forensic medical evidence to support their possible claim.


CONCLUSIONS
We conclude that we are unable to find any clinical evidence to support the hypothesis that a hernia might develop as the result of one single strenuous or traumatic event. While we accept that this mechanism might still possibly occur, we believe that, at best, it is extremely uncommon. If a medical expert is preparing a report on such a case in a claim for personal injury, then they have a duty to the court to examine carefully all the contemporaneous medical records. If no clinical evidence exists to support the claim, then they have a duty to the court not to support the plaintiff's claim.
Pathak
Samir
S
Department of Surgery, University Hospital Aintree and Royal Liverpool University Hospital, Liverpool, UK.
Poston
Graeme J
GJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004739:England; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology*; D013180:Sprains and Strains / Q000150:complications*; D011795:Surveys and Questionnaires; D014942:Workers' Compensation / Q000331:legislation & jurisprudence