abdominal hernia

Abdominal hernia - a protrusion of abdominal viscera, together with covering their parietal layer of a peritoneum through the "weak" places the abdominal wall under the skin (external hernia) or in various pockets and bags peritoneum (internal hernia). The place of stepping herniation may be the holes and crevices of walls . abdomen, which for various reasons, the size (weight loss, weakening of the ligamentous apparatus) increased or holes caused at the site of tissue defect, thinning postoperative scar, etc. hernia consists of hernial ring - opening through which comes hernial protrusion, hernia sac formed parietal peritoneum, and its contents (it can be any organ of the abdominal cavity).

Depending on the location distinguish inguinal, femoral, umbilical hernia, hernia of white line of the abdomen, etc. By etiological factor of hernia can be divided into congenital and acquired, traumatic, post-operative.; the nature of the flow - to complete and incomplete, and vpravimye nevpravimye, complicated and uncomplicated.

The most characteristic feature is the presence of the hernia swelling, appearing and disappearing straining muscles during relaxation in the supine position or after manual reduction. Swelling is not amenable to reposition, characteristic of irreducible hernia.

In the initial stage of development of a hernia was detected by the introduction of a finger into the hernial canal sensation of stepping on the hernia contents when coughing or straining of the patient. If the hernial sac is intestinal loop, the percussion is determined tympanic sound, and auscultation - rumbling. Often, patients concerned about pain in the hernia bulge, nausea , belching , constipation , bloating, impaired urination.

Inguinal hernia. The anatomical features of the inguinal region contribute to the formation of hernias. There are oblique and direct inguinal hernia. Oblique inguinal hernia through the deep inguinal ring goes into the inguinal canal along the spermatic cord, it penetrates through the superficial inguinal ring and is located under the skin, often descending into the scrotum, and for women - in the labia lips. Direct inguinal hernia comes from the abdominal cavity through the medial inguinal fossa, located opposite the superficial inguinal ring (introduced into it in the direction the finger is straight, as opposed to oblique hernia). Direct inguinal hernia is often bilateral. Content inguinal hernia in most cases - the small intestine and omentum, rarely cecum, appendix, bladder, sigmoid colon, internal female sex organs.

Recognition of an inguinal hernia is usually not difficult, and only in the initial stage of development, when the hernia did not come out even beyond the surface of the ring, there may be a doubt. Then in the course of the inguinal canal is administered finger, and if there is a push of the subject when coughing and straining, it indicates the presence of a hernia.

Femoral hernia takes second place in frequency after groin, is more common in women 40 - 60 years. By the development of femoral hernia predisposes increase in size and the weakness of the femoral ring (area of ​​passage femoral vessels below the inguinal ligament). Femoral hernia usually contains small intestine and omentum, rarely other abdominal organs (uterus, ureter, and others.). Patients complain of pain in the abdomen, groin and thigh, nausea. Femoral hernia is defined below the inguinal ligament, in contrast to inguinal hernia, located above it. Often femoral hernia is bilateral.

Umbilical hernia is more common in women; contribute to its appearance of multiple pregnancies and births , weaken the abdominal wall and umbilical ring. The content of umbilical hernias are more often the small intestine and omentum, but may be the colon and stomach. Umbilical hernia often causes pain, nausea and other complaints.

Hernia white line of the abdomen (epigastrium) occurs through cracks and holes in the white line of the abdomen, in which first passes preperitoneal fat, gradually tightening for a peritoneum. Observed hidden hernia, when the hernial protrusion is in the thick white

pine will not go beyond its limits. Often there are multiple hernias, which are located one above the other. The contents of the hernia are more often the gland, sometimes the small intestine and other organs. Most of these hernias are asymptomatic, but in some cases, patients complain of pain in the pit of the stomach, worse after eating, nausea and even vomiting. Often this is accompanied by a hernia peptic ulcer disease, gastric cancer, cholecystitis, and others.

Postoperative hernia formed in the area of postoperative scar after appendectomy, midline laparotomy, after operations on the biliary tract, and others. Hernial ring in these hernias are slotted or round, sometimes very large. They are formed by the edges of the muscles and fascia. The most common postoperative hernias is associated with surgical wound festering. Symptoms of post-operative hernias - pain, sometimes nausea , vomiting , constipation . Recognition is based on the presence of hernias in postoperative scar bulge that appears when straining, coughing or vertical position of the patient.

Internal abdominal hernias are rare. They are formed as a result of entering the abdominal cavity to various intra-pockets (omental bursa, cecal region and others.). Many patients with internal hernia is not manifested and discovered by chance during any intra-abdominal surgery. In strangulated hernia, symptoms similar to symptoms of bowel obstruction. The diagnosis is usually adjusted during operation.

Complications. Threatening complication of hernia is infringement. Strangulated hernia is associated with a sudden compression of the contents in the hernial ring, usually after heavy lifting, heavy straining, coughing. The reason of infringement may be spasmodic contraction of the tissues surrounding the hernial ring, scar constriction in the hernial sac. Most infringed the small intestine, the site of the compression ring is formed which derogates from strangulation furrow (dramatic thinning of the intestinal wall), and poor circulation occurs in disadvantaged parts of the intestine. Usually first compressed mesenteric venous vessels, resulting in the thickness of the bowel wall and bowel lumen propotevaet plasma. The volume of the strangulated intestine increases blood flow to the gut is disturbed blood, and it undergoes necrosis. Plasma propotevaet and hernial sac to form a "hernia water", which is the penetration of micro-organisms in it becomes cloudy. Necrosis of the bowel may be accompanied by perforation of its wall and peritonitis. Clinical signs infringement intestine are the same as in intestinal obstruction. In the field of hernia usually occur in great pain, but in the elderly it may be blunt. Hernia becomes nevpravimoy, tense, increased in volume and very painful on palpation. Often there is vomiting, beginning with the bile and then kalopodobnaya, stops discharge of feces and gases. Pulse weak and frequent, cold extremities, dry tongue, sometimes comes dizziness.

In the diagnosis of strangulated hernia is very important is well collected history. However, the small size of the hernia patient may not be aware of its existence, so when abdominal pain should always explore all areas of the abdominal wall, where the formation of a hernia. The emergence of severe pain with irreducible hernia - a possible sign of its infringement, especially if they are accompanied by a delay chair and gas, vomiting, abdominal distention. The patient with a strangulated hernia immediately hospitalized in the surgical ward (transportation should be carried out on a stretcher). Trying to reposition of strangulated hernia is inadmissible as well as the appointment and the use of painkillers warmers.

Treatment operative hernias. All patients who have found a hernia, should be directed to the operation. Exceptions are patients with acute infections, dermatitis and eczema in the area of ​​the hernia, pregnant at later stages of pregnancy, patients with severe diseases of the heart, lungs, kidneys, liver. If the operation is not possible due to severe diseases, is shown wearing a bandage.

Surgery produced hernia (hernia repair), is to remove the hernia sac, reposition the viscera into the abdominal cavity and strengthening the weak area of ​​the abdominal wall in the area of ​​plastics hernial ring by local tissues. In strangulated hernia shows emergency surgery, as with every hour increases the risk of developing necrosis strangulated organs.

Hernias in children are usually detected soon after birth. More common inguinal and umbilical hernia.

Inguinal hernia develops in patent processus vaginalis of the peritoneum. When you cry, straining the child in the groin protrusion appears painless, easy to reduce a lying down. Quite often combined inguinal hernia cryptorchidism - undescended testicle with his delay in the abdomen or in the inguinal canal. The differential diagnosis of inguinal hernia carried out hydrocele (see. Hydrocele). Operation with inguinal hernias produce aged 6 months - 1 year. In strangulated hernia occur sudden severe pain in the herniation, his painful tension, while nevpravima hernia. In strangulated hernia of the child is sent to the surgical hospital.

Umbilical hernias in children manifested as swelling in the umbilical ring, which typically occurs when crying, anxiety and child easily reduce a into the abdominal cavity at rest. Infringement of umbilical hernia in children is rare. Treatment of umbilical hernia initially conservative - anterior abdominal wall massage, physiotherapy, nutrition. Typically, the background of this treatment when the child reaches 3 to 5 years old umbilical ring shrinks and closes automatically. If not, the operation is shown.