Pincushion

Injury is a condition in which a previously restored hernia suddenly ceases to recover. Allocate an elastic and calico infringement. Elastic pinching occurs, as a rule, at physical stress, at which the hernial gates expand and increase the intra-abdominal pressure, which causes an increase in the volume of contents of the hernial sac. The subsequent reduction in the size of the hernial gates and causes compression of the contents of the hernial sac. Fecal infringement occurs as a result of overflow with the contents of the intestinal loops located in the hernial sac.

Symptoms, course. Sudden sharp pain in the area of ​​hernial protrusion, sometimes the pain is extremely intense, can lead to shock. Hernial protrusion becomes dense, sharply painful, unrecoverable. There may be a vomiting of a reflex character. In the future, with the progression of intestinal obstruction (strangulated hernia-a typical variant of strangulation intestinal obstruction), asymmetry of the abdomen, cramping pain, vomiting with stagnant contents appears. After the development of necrosis of the intestinal wall, the symptomatology of peritonitis progresses.

There are also typical, retrograde and parietal infringement. With retrograde infringement, two loops of the small intestine are located in the hernial sac, however, the bowel loop connecting them in the abdominal cavity is first necrotic. Pristenochnoe (Richter) infringement usually occurs with small hernias - the initial inguinal or femoral. The diagnosis of parietal infringement is often difficult, since there is no characteristic symptomatology of intestinal obstruction. The main sign of this infringement is soreness in the area of ​​the hernia gates and a slight painful formation.

The diagnosis of infringement of a hernia is usually simple. Difficulties arise in the diagnosis of Rechter infringement and infringement in one of the chambers with a multi-chamber hernia (usually umbilical or postoperative). In the latter case, the diagnosis is made on the basis of the formation of a painful compaction in the hernial contents, as well as anamnestic data on the acute onset of the disease. With a survey X-ray study of the abdominal cavity organs, it is possible to detect radiographic signs of acute intestinal obstruction.

Treatment operative. Do not inject, do not inject drugs, antispasmodics! Do not put an enema! In contrast to the planned hernia repair, the hernial sac is initially opened, the hernial contents are fixed, the viability of the intestine is evaluated after the incision of the restraining ring. Signs of viability of the gut are: restoration of color of the intestinal wall, peristalsis, pulsation of vessels directly at the intestinal wall. Changing the color of the wall (cyanosis or pallor) in combination with petechial subserous hemorrhages - signs of impracticability, strangulation furrow - a sign of necrosis. When doubts about the viability of the intestine after the introduction of 80-100 ml of 0.25% solution of novocaine into the mesentery, the loop of the intestine is also immersed in the abdominal cavity. After the end of the isolation of the hernial sac (after 15-20 min), it is re-examined. If doubts about the viability remain, the gut must be resected. When resected from a macroscopically visible area of ​​necrosis, it is necessary to retreat in the oral direction by 40 cm, in the abdominal - by 20 cm. After resection, anastomosis is better to be applied end-to-end by nodal sutures.

With the injured inguinal and femoral hernia, an additional medial laparotomy access is usually used to perform a gut resection. The plastic of the hernia gates is produced, as in the planned hernia repair. Mortality with an injured hernia, accompanied by bowel necrosis, can reach 15-20%. This circumstance dictates the need for planned hernia repair, even in patients of senile age.