Complications of abdominal hernias. Presentation on the topic: Strangulated hernia Clinical picture and diagnosis of inguinal hernias

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The presentation on the topic “Abdominal Hernia” can be downloaded absolutely free on our website. Project subject: Medicine. Colorful slides and illustrations will help you engage your classmates or audience. To view the content, use the player, or if you want to download the report, click on the corresponding text under the player. The presentation contains 8 slide(s).

Presentation slides

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Hernial orifices are openings in the muscular aponeurotic layer through which, under the influence of various reasons, protrusion of the parietal peritoneum and internal organs of the abdominal cavity occurs. Hernial sac is part of the parietal peritoneum that has emerged through the hernial orifice. It is distinguished: The mouth is the initial part of the sac The neck is the proximal part of the hernial sac, located in the hernial orifice The body is the widest part located under the skin The bottom is the distal part of the sac Hernial contents are the movable organs of the abdominal cavity: omentum, loops of the small intestine, sigmoid, transverse colon and cecum, appendix, uterine appendages and uterus.

Components of a hernia

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Etiology of hernias

Factors leading to the formation of hernias: 1. Predisposing: local general 2. Producing: long-acting, short-acting

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Local predisposing factors are the anatomical and topographical features of the structure of the anterior abdominal wall with the presence of so-called “weak spots”. General predisposing factors are features of the human constitution that have developed as a result of hereditary and acquired properties, age and gender differences in body structure, weakening of the abdominal wall due to obesity and exhaustion, pregnancy and injury, as well as after heavy physical labor. Generating factors - factors that contribute to an increase in intra-abdominal pressure or its sharp fluctuations: constipation, flatulence, chronic cough, difficulty urinating, pregnancy, prolonged difficult childbirth, heavy physical labor, ascites

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Diagnosis of hernias

The examination allows you to determine the presence of a hernial protrusion, its shape, size, and location. Palpation allows you to determine the consistency of the protrusion, the size of the hernia defect, the reducibility and pain of the hernia. Percussion allows you to determine the contents of the hernial sac by percussion sound. Auscultation allows you to determine the contents by the presence of bowel sounds.

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Hernia treatment

Conservative: use of bandages with pelota for umbilical hernias in children, wearing a bandage if there are contraindications to surgical treatment 2. Surgical treatment

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    • POSTOPERATIVE
    VENTRAL HERNIA

    Definition

    Postoperative hernia (also known as ventral hernia,
    cicatricial hernia) is a condition in which the abdominal organs
    cavities extend beyond the abdominal wall in the area
    scar formed after surgery.
    After all laparotomies, hernias form in 3-5%.

    Causes of postoperative hernia

    Postoperative hernia is a consequence of earlier
    performed surgical intervention.
    The main reason is the divergence of the muscularaponeuratic layers of the anterior abdominal wall in the area
    postoperative scar
    The determining reasons for its development are:
    –
    –
    –
    –
    –
    –
    –
    –
    suppuration and dehiscence of postoperative wounds
    repeated relaparotomies
    laparostomy
    abdominal tamponade
    peritonitis
    incorrect operational access
    errors in surgical technique
    early physical activity

    Predisposing factors for the development of ventral hernias

    Excess body weight
    Elderly and senile age
    Bronchitis, pneumonia after surgery
    Vomit
    Constipation
    Flatulence (bloating)
    Inhibition of protective and regenerative
    body capabilities

    Most often postoperative
    hernias complicate operations,
    carried out in emergency or
    urgently.
    In this case, surgeons usually do not have time to
    carrying out appropriate preoperative
    preparation.
    This leads in the immediate postoperative period to
    intestinal dysfunction (bloating or passage
    intestinal contents), and therefore to an increase
    intra-abdominal pressure, respiratory disorders
    functions, cough, which negatively affects the process
    formation of a postoperative scar.

    Classification of postoperative hernias

    Egiev V.N., 2002:
    – Small (occupies 1 area of ​​the anterior abdominal
    walls)
    – Medium (occupies 2 areas)
    – Large (occupies 3 areas)
    – Giant (occupies more than 3 areas)
    Yatsentyuk M.N., 1978:
    –
    –
    –
    –
    –
    Small – up to 5 cm.
    Medium - from 6 to 15 cm.
    Large - from 16 to 25 cm.
    Huge - from 26 to 40 cm.
    Giant - over 40cm.

    Classification
    ventral
    hernias

    ICD-10 classification

    K43.0
    Hernia of the anterior abdominal wall
    without gangrene: causing
    obstruction, strangulated,
    irreducible, strangulation
    K43.1
    Hernia of the anterior abdominal wall with
    gangrene, gangrenous hernia
    anterior abdominal wall
    K43.9
    Hernia of the anterior abdominal wall
    without obstruction or gangrene

    An example of a hernia with trophic changes

    Trophic changes in tissues in the area
    gigantic postoperative hernia size
    anterior abdominal wall.

    SWR classification

    S (size) - localization of hernia
    M
    Medial location
    L
    Lateral location
    M.L.
    Combined arrangement
    W (windlas) - size of the hernial orifice
    W1
    Up to 5 cm.
    W2
    From 5 to 10 cm.
    W3
    From 10 to 15 cm.
    W4
    More than 15 cm.
    R (relapse) - relapse
    R1
    First relapse
    R2
    Second relapse, etc.
    Example of forming a diagnosis: Gangrenous hernia of the anterior
    abdominal wall with acute intestinal obstruction (2 relapses),
    located medially - K43.1 MW4R2

    A – Patient P. Extensive median postoperative hernia. B – Patient M. Extensive postoperative hernia in the right iliac

    areas.

    A – Patient S. Giant postoperative hernia in the right hypochondrium. B – patient K. Giant median postoperative

    hernia.

    A - Patient I. Extensive right-sided lumbar postoperative hernia. B – Patient U. Extensive left-sided lumbar

    hernia.

    A – Patient D. Medium multiple postoperative hernias of the right hypochondrium and epigastrium. B – Patient Ya. Extensive

    multiple postoperative
    hernias of the right iliac, periumbilical and left
    iliac regions.
    A
    B

    A – Patient N. Giant postoperative hernia. B – Patient Ch. Giant postoperative hernia.

    A - Patient M. Extensive upper-median postoperative hernia. B - Patient O. Extensive median postoperative hernia.

    Symptoms of ventral hernias

    A protrusion in the area is determined
    postoperative scar, increasing with
    straining and standing, decreasing
    in a lying position.
    Sometimes in the presence of large subcutaneous
    pocket, the protrusion may be
    slightly away from the skin scar.

    Complications of postoperative hernias

    The main complications of postoperative
    hernias are:
    –
    –
    –
    –
    –
    Abnormal stool
    Intestinal obstruction
    Strangulated hernia
    Neoplasms of hernia
    Flatulence, etc.
    But even in the absence of the above
    life-threatening complications,
    postoperative hernias lead to a decrease in
    labor and physical activity, violation
    quality of life!!!

    Complications of hernias

    Infringement
    –
    –
    –
    –
    Inguinal – 57.3%
    Thigh – 31%
    Umbilical – 6%
    Hernia of the white line – 3%
    – Postoperative – 2.2%
    – Other localizations – 0.5%
    Inflammation
    Damage
    Neoplasms

    Strangulated Hernia Clinic

    Sharp pain.
    Irreducibility.
    Tension and increase in size.
    Negative symptom of “cough impulse”.
    Symptoms of OKN.
    Leukocytosis, high ESR.
    In the urine - protein, leached red blood cells,
    cylinders (toxic nephritis).
    8. Ultrasound and abdominal X-ray data.
    cavities
    1.
    2.
    3.
    4.
    5.
    6.
    7.

    Treatment methods

    Only surgically!!! (hernioplasty)
    1.Removal of hernia and plastic surgery of the hernial orifice
    own tissues - tension plastic. (practically not
    applies)
    2.Removal of hernia and repair of hernia orifices with mesh
    grafts - tension-free plastic surgery (plasty according to
    Liechtenstein).
    Used in mature, elderly and senile patients
    age. The most reliable method, since relapse is
    According to the literature, it is 0.1-1%.

    Surgical treatment

    Stage 1 Operational access:
    Wide border incisions with complete excision
    postoperative scars, excess skin and pancreas.
    Access selection:
    – Epigastric region - longitudinal approaches
    – Mesogastrium - transverse sections
    – Hypogastric region - transverse or T-shaped (in case of obesity, the subcutaneous tissue is removed
    fat apron).
    Finish with complete isolation of the hernial sac and
    edges of the hernial defect in the muscular aponeurotic
    layer.

    Operational accesses

    Shape and
    direction
    skin incisions
    at
    postoperative
    various hernias
    localization.

    Surgical treatment

    Stage 2 - Opening of the hernial sac and separation
    abdominal organs from its walls.
    Operations for postoperative hernias should be
    produce only intraperitoneally, which
    allows you to examine those soldered to the hernial sac and
    edges of a hernial defect of the abdominal wall of an intestinal loop
    and omentum, separate them or partially resect them,
    thereby reducing the risk of early
    postoperative adhesive obstruction.

    Excision of the hernial sac

    For extensive and giant postoperative
    in hernias the hernial sac is inappropriate
    excise completely, since its parts, in
    combinations with additional plastic
    materials, can be used for plastics
    hernia defect.
    For small and medium hernias, when hernial
    the gates are small and their edges can be brought together
    duplication without noticeable tension, hernial
    the bag is excised completely along the entire circumference.

    Mobilization and excision of the edges of the hernial orifice

    Hernial orifices in postoperative hernias are usually
    have an irregular shape and can be separated
    dense scar tissue into individual cells.
    During the operation, all septa should be cut and
    give the hernial orifice the appearance of an oval.
    It is known that scar tissue heals very poorly or
    does not fuse at all, since it is poor in blood vessels
    vessels.
    The use of scar tissue for plastic surgery is almost
    inevitably leads to recurrence of the hernia, therefore
    scar tissue in the plastic area should be
    opportunities to excise!!!

    Suturing a postoperative wound

    Produced after thorough washing
    antiseptic solution.
    This allows you to remove loose pieces
    fatty tissue and blood clots. Nodal
    sutures match fiber and skin.
    Drainage of the wound is mandatory
    rubber strips for one day or vacuum drainage.

    Abdominal wall plastic surgery

    Autoplasty
    Alloplasty
    Among the autoplastic surgical methods
    treatment of postoperative hernias greatest
    Fascial-aponeurotic and muscular-aponeurotic have become widespread
    plastics, mainly methods:
    1.
    2.
    3.
    4.
    5.
    Martynova
    Napalkova
    Sapezhko
    Mayo
    Sabaneeva–Monakova.

    Autoplasty according to Martynov

    Operation according to N.I. Napalkov for divergence of the rectus abdominis muscles.

    Strangulated ventral hernia. Plastic surgery according to Sapezhko.

    A - U-shaped sutures are applied, while
    the right leaf of the aponeurosis is brought under the left.
    B - a second row of interrupted sutures is applied with
    formation of duplication.

    Plastic surgery of the hernial orifice using the Sapezhko-Dyakonov method. Application of U-shaped seams

    Plastic surgery of the hernial orifice according to the method
    Sapezhko-Dyakonova. Applying shaped sutures
    Create a duplicate from
    white aponeurosis flaps
    vertical abdominal lines
    direction by
    overlays at first 2-4
    U-shaped seams, like
    how this is done with
    Mayo method, with
    subsequent hemming
    interrupted edge seams
    free flap
    aponeurosis to the anterior wall
    rectus sheath
    belly.

    Method of hernial orifice plastic surgery for hernias of the anterior abdominal wall according to the Voronin-Smirnov method

    Alloplastic methods of operations

    Using transplants
    For postoperative ventral hernias in
    in each specific case provide
    maximum possible use
    the patient's own tissues (muscles,
    aponeuroses, fascia, scar tissue, parts
    hernial sac).
    There are several
    methods of application
    transplants.

    Method 1 (“Onlay technique”)

    The hernial orifice is strengthened by suturing
    graft over autoplasty. The edges of the hernial
    the defect is sutured with interrupted sutures until tightly
    contact or duplication.
    Then the anterior surface of the muscular aponeurotic
    layer is separated from the subcutaneous tissue for 8–10
    cm from the suture line in both directions and the graft is sutured,
    strengthening this suture line and weak points of the abdominal wall

    Transplant
    located
    anterior to the musculoaponeurotic
    layer
    1 - skin and
    subcutaneous
    cellulose
    2 - muscularaponeurotic
    layer
    3 - peritoneum
    4 – transplant.

    Alloplasty of the abdominal wall for ventral hernias. (“Onlay-technique”).

    Method 2 (“Inlay technique”)

    With the help of a graft, the wide
    area of ​​the abdominal wall from the inside, between
    peritoneum and muscle layer.
    After removal of the hernial sac and excision of scars
    the peritoneum is peeled off from the muscular aponeurotic layer
    for 6–8 cm. The edges are sewn together. Then over
    a graft is placed in the peritoneum, one edge of which
    it is fixed with U-shaped sutures to the muscularaponeurotic layer from the inside.
    Then the second edge is hemmed so that
    after bringing the edges of the hernia defect over
    the plastic tissue remained taut with the graft,
    “didn’t sail.”

    Alloplasty of the abdominal wall for ventral hernias. "Inlay technique"

    The graft is located behind
    muscular aponeurotic layer
    1 – skin and subcutaneous
    cellulose
    2 – muscularaponeurotic layer
    3 – peritoneum
    4 – graft

    Method 3 (“Sublay technique”)

    This method is used in cases where the seams are used to bring together
    the edges of the hernial orifice are impossible or dangerous. From the walls
    two opposite flaps are cut out of the hernial sac
    6–8 cm wide and equal to the length or diameter
    hernial orifice.
    Using one of the flaps, tightly hemming it
    edges to the opposite edge of the hernial orifice, close
    abdominal cavity. Then to the edges of the hernia defect throughout
    its circumference in the form of a patch is sewn onto the graft,
    on top of which a second hernial flap is fixed
    bag.

    Alloplasty of the anterior abdominal wall “Sublay-technique”

    The graft is located between the leaves
    hernial sac:
    1 - skin and pancreas
    2 - muscularaponeurotic
    layer
    3 - peritoneum
    4 - graft

    Complications of the postoperative period

    Early postoperative period:
    Wound suppuration
    Pneumonia
    Accumulation of serous fluid
    Thrombophlebitis of the lower extremities
    Late postoperative period:
    Relapse of the disease
    Hernias of other localization

    Clinical examples of hernioplasty

    Patient N. Giant postoperative hernia
    belly. A – before surgery; B – 3 years after
    operations.

    Giant postoperative abdominal hernia. A – before surgery; B – 6 years after surgery.

    Patient R. Giant postoperative abdominal hernia. A – before surgery; B – 2 years after surgery.

    Giant postoperative abdominal hernia. A – before surgery; B – 1.5 years after surgery.

    Extensive postoperative abdominal hernia. A – before surgery; B – 3 years after surgery.

    Methods of plastic surgery for giant hernias with abdominal wall defects larger than 300–400 cm2

    Method V.N. Yanova:
    a – the dotted line shows the first
    option of the middle and
    pararectal incisions;
    b – the dotted line shows the second
    option of the middle and
    pararectal incisions;
    c – continuous lacing
    autodermal stripe of edges
    aponeurosis of the white line of the abdomen;
    d – median laparotomy
    wound sutured, pararectal
    laparotomy wounds are closed
    double autodermal
    transplants.

    Method V.N. Yanova
    Autodermal strip
    pass through the muscularaponeurotic edges
    hernia defect on
    at a distance of 3-5 cm from the edge
    hernial orifice by
    intertwining with hernia
    gate in the form of a seam with
    subsequent
    straightening and
    stitching together individual
    strip stitches
    adapting seams with
    frame formation
    from autodermal
    stripes in the form of a lattice.

    Method V.N. Yanova
    Distinguished by
    that autodermal
    the strip is woven into
    edges of the hernial orifice
    by type of lacing,
    with holding
    stripes from the inside
    outward.

    Laparoscopic hernioplasty

    The method of laparoscopic treatment of hernias is
    performing an operation using a small access
    (in the form of a puncture with a diameter of about 2 cm).
    The operation is performed using laparoscopic
    technology.
    This method has the advantage of not only being used
    smaller incision, but also to a lesser extent
    traumatization of patient tissues and less frequency
    complications during and after operations. Disadvantage
    method is to perform laparoscopic surgery
    under general anesthesia.

    Prevention

    Wearing a bandage after abdominal surgery
    cavities
    Proper nutrition
    Weight normalization
    Limitation of physical
    loads after surgery

    is a protrusion of an organ, part or internal
    body tissues through natural channels or
    through pathologically formed (abnormal)
    holes. Protruding tissues change their
    normal position, going beyond that
    cavity in which they should be located. These fabrics
    covered with one or more membranes and not
    have direct contact with the environment
    environment.

    Hernial sac (HM) - area of ​​the parietal
    peritoneum, exiting through the hernial orifice. IN
    It distinguishes between the neck, body and apex.
    Hernial orifice (HV) - defect (weak spot)
    in the wall of the abdominal cavity, through which
    occurs due to various reasons
    protrusion (protrusion) of the hernial sac with
    content.
    Hernial contents (HS) - what is contained
    in the hernial sac. They are usually
    movable organs of the abdominal cavity: omentum,
    loops of the small intestine, sigmoid, transverse colon and cecum, vermiform
    appendage, uterine appendages, etc. Contents
    diaphragmatic hernia may be the stomach,
    spleen, liver.

    sudden or gradual compression of an organ
    abdominal cavity in the hernial orifice, leading to
    disruption of its blood supply and necrosis.
    one of the most common and dangerous complications. They relate
    to acute surgical diseases of the abdominal organs
    cavities and occupy fourth place among them after acute
    appendicitis, acute cholecystitis and acute pancreatitis.

    By pathogenesis:
    1. Elastic
    2. Feces
    3. Mixed
    According to the clinical course:
    1. Spicy
    2. Chronic
    By forms of infringement:
    1. Retrograde
    2. Parietal

    Spastic condition of the tissues surrounding the hernia
    hole
    Narrowness of the hernial opening
    Density and inflexibility of the edges of the hernial opening
    Inflammatory changes in the area of ​​hernial contents
    and the possibility of its infringement
    Various physical changes in the
    displaced organ

    Elastic entrapment
    Fecal impaction.
    Fecal and elastic strangulation.
    Retrograde entrapment
    Parietal entrapment (Richters)

    Elastic infringement means
    sudden release of large quantities
    abdominal viscera through narrow hernial
    gate at the moment of sharp rise
    intra-abdominal pressure under the influence
    strong physical stress.

    Also known in the literature as
    Richter's hernia. With this type of infringement
    the intestine is not compressed to its full extent
    lumen, but only partially, usually in the area
    opposite the mesenteric edge of the intestine.

    Fecal impaction means
    compression of the hernial contents, which
    occurs as a result of sudden overfilling
    afferent section of the intestinal loop,
    located in the hernial sac. Abductor
    the section of this loop sharply flattens and
    is compressed in the hernial orifice along with
    adjacent mesentery.

    It is characterized by the peculiarity that when
    there are smaller ones in the hernial sac
    at least two intestinal loops in relatively
    good condition, and the greatest
    the third, intermediate, undergoes changes
    a loop that is located in the abdominal cavity.

    Strangulation of Meckel's diverticulum in the inguinal
    hernia. This pathology can be equated to
    usual parietal infringement with that
    the only difference is that due to worse conditions
    blood supply to the diverticulum faster
    undergoes necrosis than a normal wall
    intestines.

    sudden sharp pain at the moment of pinching;
    irreducible hernia;
    tension and pain of the hernia
    protrusions;
    signs of OKN (added later):
    (vomiting, bloating, non-passage of stool and
    gases)

    The process of diagnosing a strangulated hernia is mainly
    clinical and based on complaints and anamnestic data
    patient, results of an objective examination of patients (GPP). The most important
    a condition for effective diagnosis is a thorough history taking
    identifying the duration and dynamics of clinical manifestations.
    Leading technologies for special (instrumental) diagnostics in
    The current stage is ultrasound and x-ray methods
    examination of the groin area, scrotum, abdominal cavity, including the pelvis,
    allow to identify tissues and organs with a high degree of reliability
    as part of a hernial protrusion, assess the parameters of organ blood flow,
    identify echographic signs of impaired passage of intestinal contents.
    Indications for plain radiography of the abdominal cavity occur when
    presence of clinical signs of acute intestinal obstruction.

    Irreversible hernia;
    Coprostasis;
    False infringement;

    Pre-hospital stage:
    1. Abdominal pain requires a targeted examination
    patient for the presence of a hernia.
    2. If the hernia is strangulated or is suspected, even in
    in case of spontaneous reduction, the patient is subject to
    emergency hospitalization in a surgical hospital.
    3. Attempts at forcible removal are dangerous and unacceptable.
    strangulated hernias.
    4. Use of painkillers, baths, heat or cold
    Contraindicated for patients with strangulated hernias.
    5. The patient is taken to the hospital on a stretcher in a lying position
    on the back.

    Stationary stage:

    1. The basis for the diagnosis of a strangulated hernia are:
    a) the presence of a tense, painful and non-reducible
    hernial protrusion with a negative cough impulse;
    b) clinical signs of acute intestinal obstruction or peritonitis in
    patient with a hernia.
    2. Determine: body temperature and skin temperature in the hernial area
    protrusions. If signs of local inflammation are detected, carry out
    differential diagnosis between phlegmon of the hernial sac and others
    diseases (inguinal adenophlegmon, acute thrombophlebitis
    aneurysmally dilated mouth of the great saphenous vein).
    3. Laboratory tests: complete blood count, blood sugar, general analysis
    urine and others according to indications.
    4. Instrumental studies: chest x-ray, ECG, survey
    X-ray of the abdominal cavity, if indicated - ultrasound of the abdominal cavity and
    hernial protrusion.
    5. Consultations with a therapist and anesthesiologist, and, if necessary, with an endocrinologist.

    The diagnosis of a strangulated hernia is an indication for emergency surgery. In case of a strangulated hernia, the tactics are active and expectant:

    Peculiarities:
    1. Urgent surgery
    2. Absolute contraindications to surgery
    there is currently no intervention for infringement
    3. It is unacceptable:
    baths, heat, cold on the area of ​​the hernial protrusion,
    forced manual reduction
    Do not reduce strangulated hernias!

    1) elimination of infringement;
    2) audit of injured organs and, if necessary,
    appropriate interventions on them;
    3) hernia repair

    3. flabby wall
    intestines,
    4. absence
    vascular pulsations
    mesentery,
    5. absence
    peristalsis
    intestines.
    Signs
    viability
    and guts
    1.recovery
    normal
    Pink colour
    intestines,
    2.lack
    strangulation
    furrows and
    subserous
    hematomas,
    3. saving
    small pulsations
    vessels
    mesentery and
    peristaltically
    x abbreviations
    intestines.

    Sixth stage:
    Resection of non-viable
    intestines (at least 30-40 cm
    adducting segment of the intestine and 15-20 cm of efferent segment).
    (S.V. Lobachev, O.V. Vinogradova,
    A.I.Shabanov)
    resection of strangulated omentum
    separate areas without
    education of a large general
    stumps

    Seventh stage
    Aponeurotic plastic surgery
    Champion method
    Hernia orifice plastic surgery
    A. V. Martynov’s method
    Henrich's method
    Brenner method
    Operations for oblique inguinal
    hernias
    N.Z. Monakov’s method
    Girard method
    N. I. Napalkov’s method
    Method S.I.
    Spasokukotsky
    Musculoaponeurotic plastic surgery
    A. V. Martynov’s method
    Method M.A.
    Kimbarovsky
    Operations for direct inguinal
    hernias
    Bassini method
    Method N. I. Kukudzhanov
    I. F. Sabaneev’s method
    modified by N.Z. Monakov
    A. V. Gabai’s method
    Other types of plastic surgery
    Alloplasty

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    Treatment Treatment of inguinal hernia is only surgical. The operation is recommended from the age of 6 months. As a rule, surgery for inguinal hernia is performed both in the “classic” open form with a linear incision in the groin area, and laparoscopically. The advantage of the laparoscopic method is the ability, during one surgical intervention, to identify and eliminate an inguinal hernia on the opposite side, which until now has not manifested itself in any way, but could appear in the future.

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    Duhamel II Technique of surgery for inguinal hernia in children with Duhamel II. It is performed at the age of 5-6 years, when the inguinal canal enlarges and it is not possible to isolate the neck of the sac behind the inguinal canal. The skin is cut layer by layer to the aponeurosis of the external oblique muscle, which is exposed along with the external opening of the inguinal canal. Stepping 1.5 cm distally from it, cut the aponeurosis (1.5 - 2 cm long) and make a window in the anterior wall of the inguinal canal. From this window, among the tissues filling the inguinal canal, the neck of the hernial sac is found and separated from the elements of the cord. In the case of congenital hernias, the vas deferens is located medial to the hernial sac, the elements of the cord are “spread out” on it. The isolated hernial sac is cut, its contents are examined, and the internal organs are inserted into the abdomen. The hernial sac is pulled until its neck appears. The bag is sutured proximal to the neck, tied in both directions, the distal part is not cut off. The operation is completed by suturing the window in the anterior wall of the inguinal canal end to end, and layer-by-layer sutures are applied to the wound.

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    Features of the white line of the abdomen in children: Relative width
    Small thickness
    The presence of crevice-like defects between
    bundles of aponeurotic fibers

    Through defects in the aponeurosis penetrate:

    Small areas of preperitoneal
    fiber
    Adjacent parietal peritoneum
    Stuffing box
    Loop or wall of the small intestine

    Located in the midline
    abdomen between the xiphoid process
    and navel.
    There are:
    Paraumbilical
    Epigastric

    Clinic:

    The midline of the abdomen is determined
    bulging:
    Rounded
    Gladkoe
    Elastic
    Slightly painful
    When pressed it decreases, but
    cannot be completely reduced

    Differential diagnosis:

    With an umbilical hernia;
    Diastasis of the abdominal muscles;
    Gastroduodenitis;
    Cholecystopathy;
    Mesadenitis.

    Treatment

    Operative, to establish a diagnosis.
    Skin incision over the protrusion
    Release the aponeurosis
    The hernial sac is isolated, opened,
    are being examined.
    Stitched at the neck, cut off
    The wound is sutured layer by layer

    Infringement is extremely rare

    Presenter - pain syndrome
    Dysphagia

    Umbilical hernia

    characterized by non-closure of the aponeurosis
    umbilical ring, through which
    the peritoneum protrudes, forming a hernial
    a bag whose contents are
    usually, omentum, loops of the small intestine.

    Clinic

    Round protrusion in the umbilical area
    rings
    May be absent at rest
    lying state or position
    Sometimes there is thinning of the skin over
    protrusion
    Defect of aponeurosis in the navel area
    various diameters
    Anxiety in rare cases

    Treatment

    Operational as planned
    Oval access under the navel
    The aponeurosis and the hernial sac are distinguished
    The hernial sac is opened, the contents are examined
    immersed in the abdominal cavity
    The pouch at the neck is stitched, bandaged and removed
    The aponeurosis is sutured. A second row of stitches can be applied
    Excess skin in the navel area is excised and modeled
    navel, sutured to the aponeurosis
    The wound is sutured layer by layer
    Cosmetic stitches can be applied to the skin

    Surgical treatment of umbilical hernia

    Infringement is rare

    Indications for earlier surgery:
    Anxiety attacks due to going out
    large hernia
    The hernia does not go away on its own

    Inguinal hernia

    There are:
    Inguinal hernia
    Inguinal-scrotal (testicular)
    Inguinal-scrotal (cord)

    Conditions for occurrence

    Increased intra-abdominal pressure
    Narrowing of the abdomen to the bottom in children
    Large angle of inclination of the ligament
    Relatively wide inguinal ring

    Contents of the hernial sac:

    For boys:
    Most often a loop of intestine or omentum
    For girls:
    Ovary, sometimes together with tube

    Clinic

    Bulging in the groin area
    Descends along the spermatic cord into
    boys' scrotum
    In girls it is more often located at
    external inguinal ring

    Soft elastic consistency
    Easily reducible into the abdominal cavity
    May disappear on its own
    After reduction it is well defined
    dilated inguinal ring
    Positive “push” symptom with
    straining

    Differential diagnosis

    With communicating dropsy of the spermatozoa
    funiculus and testicle:
    Increase in size and stress
    evening
    Tight elastic consistency
    Positive diaphanoscopy

    Surgical treatment with plastic surgery of the anterior wall of the inguinal canal according to Martynov

    Hernia repair according to Ru-Krasnobaev

    Strangulated inguinal hernia

    In case of strangulation, the contents of the hernial
    the sac is compressed in the aponeurotic
    ring (hernial orifice) and not
    is reduced into the abdominal cavity

    Reasons for infringement:

    Increased intra-abdominal pressure
    Bowel dysfunction
    Flatulence, etc.
    The main threat is violation
    blood circulation in the injured organs and
    their necrosis.

    Clinic

    Anxiety, crying
    Complaints of sharp pain in the groin area
    Hernial protrusion is sharply painful
    Does not fit into the abdominal cavity
    Join at a later date
    obstruction symptoms
    Peritoneal symptoms

    Differential diagnosis

    Acute cyst of elements
    spermatic cord: pain is not expressed,
    palpation is less painful, good
    moves, the inguinal ring is free.
    Inguinal lymphadenitis: mild pain,
    signs of inflammation

    Features of inguinal hernia strangulation in children

    Relatively lower pressure
    pinching ring
    Better blood circulation of intestinal loops
    Greater elasticity of blood vessels
    In periods up to 12 hours there are no sudden
    circulatory disorders in the wall
    strangulated intestine

    Conservative activities

    Atropine, promedol
    Warm bath
    Raising the pelvis
    Light massage of the groin area

    Diaphragmatic hernia

    This condition is understood as
    movement of abdominal organs into
    breast through natural or
    pathological hole in the diaphragm

    Are divided into:

    False - when there is a through
    hole in the diaphragm
    True – there is a hernial sac –
    thinned area of ​​the diaphragm:
    partial bulge
    full protrusion (relaxation)

    The clinic depends on:

    Hernia size
    Degrees of lung collapse
    Mediastinal shifts

    Main symptoms:

    Attacks of cyanosis and shortness of breath (“asphyxia”
    infringement)
    "Scaphoid" belly
    Chest asymmetry
    Percussion-tympanitis
    Displacement of the borders of the heart
    Decreased breathing upon auscultation
    Listening to peristalsis
    Variability of physical data

    When a limited area of ​​the diaphragm protrudes:

    Complaints of incoming pain
    Weakness
    Fatigue on exertion

    Characteristic features of hiatal hernias:

    Complaints of abdominal pain, vomiting
    Hemorrhagic syndrome:
    – Anemia
    – Vomiting with blood
    – Melena or occult blood in the stool

    Diagnosis of hernias of the diaphragm itself

    On the affected side there are ring-shaped
    clearing oval or spherical
    forms
    To clarify the diagnosis, use
    contrast study

    Diagnosis for limited protrusions and relaxation

    Violation of the correctness of the contour
    aperture
    Higher diaphragm dome position
    Lack of movement when breathing

    Diagnosis of hiatal hernia

    Gas bubble of the stomach in the abdominal
    cavities are reduced or absent
    Contrasting
    Fibroesophagogastroscopy

    Differential diagnosis

    Pneumothorax
    Cysts of the lung, mediastinum, tumors
    Inflammatory lung diseases and
    pleura
    Pyloric stenosis

    Spina bifida

    Congenital spinal cleft with
    malformation of the spinal cord and its
    shells

    Anatomical forms

    Meningocele
    Myelomeningocele

    Rachishisis
    Myelocystocele
    Spina bifida occulta

    Clinic

    Located in the midline of the spine
    Tumor-like formation
    Covered with thinned or scarred skin
    May be see-through
    Wide base
    Vascular patch or hair growth at the base
    Unfused vertebral arches can be palpated
    Dysfunction of the pelvic organs and lower
    limbs
    Development of hydrocephalus (in most children)
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