HERNIA Presenter: Golnaz Malekzadeh
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Transcript of HERNIA Presenter: Golnaz Malekzadeh
HERNIAPresenter: Golnaz Malekzadeh
A hernia is an abnormal weakness or hole in an anatomical structure which allows something inside to protrude through.
It is commonly used to describe a weakness in the abdominal wall.
The signs and symptoms of a hernia can range from noticing a painless lump to the painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen—possibly a strangulated
hernia .
Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated).
If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency.
Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Obesity Heavy lifting Coughing Straining during a bowel movement or urination Chronic lung disease Fluid in the abdominal cavity Hereditary
lordosis Constipation Urine retention Difficulty in breathing Compartment syndrome And ….
1 .External
2 .Internal
3.intermittent
1 .reducible hernia is one in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent.
2 .irreducible hernia is one whose contents or part of contents cannot be returned to the abdomen, without serious symptoms.
hernias are trapped by the narrow neck
incarcerated hernia: is one whose contents cannot be returned to the abdomen, with severe symptoms.strangulated hernia: denotes compromise to the blood supply of the contents of the sac.
incarcerated hernia and strangulated hernia are the two stages of a pathologic courseRichter’s hernia (intestinal wall hernia ) a hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen.Sliding hernia is one in which the wall of a viscus forms a portion of the wall of the hernia sac. It is may be colon ( on the left), caccum (on the right) or bladder (on either side) . Belongs to irreducible hernia Littre hernia: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum).
Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, these hernias are composed usually of fatty tissue and rarely contain intestine.
Men > Women these hernias are often painless and
unable to be pushed back into the abdomen when first discovered.
1- Congenital2- Adault acquired
Common in infants Close spontaneously if <1.5 cm Repair if > 2 cm or if persists at
age 5 years
Repair primarily or with mesh
Women > men Risk factors
Multiple Pregnancies Prolonged labor Ascites Large Abdominal Tumors-CT scan may be indicated
for some patients Activities which result in strenuous physical
activity(occupational or recreational :example weight lifting)
Morbitiy and incarceration rate considered to be high enough to warrant repair. One study showed incarceration twice that of femoral hernia .
Unfortunately, recurrence rates as high as 20 -28 % have been recorded.
patients with ascites ???
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Rare Hernia through subumbilical portion of
semi-lunar line Difficult to diagnose –Abdominal pain or
mass noted in abdominal wall. Frequently tender over area Clinical suspicion (location) CT scan
Repair primarily or with mesh
a protrusion of part of the contents of the abdomen through the inguinal region of the abdominal wall.
indirect inguinal hernia: the internal inguinal ring the inguinal
canal external inguinal ring scrotum
direct inguinal hernia: Hesselbach’s triangle
Pantaloon type
Hereditary Smoking CDH Sedentary life style acquired weakness or defect of
abdominal wall Increased intra abdominal pressure And ….
feature indirect direct
age children, young people aged people
pathway of protrusion coming down the inguinal canal, may enter the scrotum
pass through Hesselbach’s triangle, rarely enter the scrotum
contours of sac elliptic, pear-shaped semispheric, wide base
Relationship of spermatic cord with sac
Posterior to the sac Anterior and lateral to the sac
Relationship of sac neck with inferior epigastric artery
Sac neck is lateral to it Sac neck is medial to it
Incarcerated incidence high low
Palpation of hernia sac on spermatic cord
lymph node lipoma saphenous varicosity mass
RecurrenceNeuralgia
IlioinguinalIliohypogastricGenitofemoralLateral cutaneous
Ischemic orchitisInjury to vas deferenceWound infectionBleeding
All are acquired. Are secondary to an expanded
femoral ring. Probably due to increased intra
abdominal pressure Diagnosis by physical exam.
1. indirect inguinal hernia 2. lipoma 3. groin lymph nodes 4. long saphenous varix 5. iliolumbar tuberculous
abscess
an abnormal protrusion of a viscus through the musculoaponeurotic layers of a surgical scar.
Swelling and mass in the incision Rarely incarcerate
Operative factors: - types of incision: vertical incision, transrectus
incision, midline incision, standard paramedian incision - technique of closure - suture materialPostoperative factors: - increased intra-abdominal pressure - Obesity - Malnutrition - Smoking -Immune dificiency
Bring together fresh fascial edges after trimming sac
Clean off fascial edges at least 1 cm back
Close with interrupted or continuous sutures
Even with careful technique recurrence rates as high as 50% have been reported
1- Trendelenberg position
2-morphin+ diazpam
3-ice bag
Contra indications: Fever Lococytosis Positive abdominal sign Erythema of skin
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