Strangulated hernia - Causes, Symptoms, Diagnosis and Treatment

Strangulated hernia - the most frequent and serious complication of abdominal hernias. Strangulated hernia is an acute surgical condition requiring immediate intervention, and inferior to the frequency of occurrence of only acute appendicitis, acute cholecystitis and acute pancreatitis. The operative Gastroenterology strangulated hernia is diagnosed in 3-15% of cases.

Strangulated hernia is associated with a sudden compression of the contents of the hernia sac (the gland, small intestine, and others. Bodies) in the hernial ring (defects of the anterior abdominal wall, diaphragm holes, pockets of the abdominal cavity, and so on. D.). Infringement may be subject to any abdominal hernia: inguinal (60%), femoral (25%), umbilical (10%), less often - white line of the abdomen hernia, hiatal, postoperative hernia. Strangulated hernia is associated with risk of necrosis of the compressed bodies, intestinal obstruction, peritonitis.

Meckel diverticulum or the appendix, overlap the body lumen is not observed at all.

According to the development characteristics distinguish antegrade, retrograde, false (alleged) sudden (in the absence of a history of hernia) strangulated hernia.

There are two mechanisms of infringement of hernia: elastic and fecal. Elastic infringement occurs when the simultaneous stepping through the narrow hernial hernia large amount of content. The internal organs are enclosed in a hernial bag can not be entitled to the abdominal cavity of its own. Their denial of the narrow ring of hernia gate leads to the development of ischemia, expressed pain, persistent muscle spasms hernial ring, more weighting strangulated hernia.

Fecal infringement develops the sudden overflow resulting in bowel loops, trapped in the hernia sac, intestinal contents. This discharge intestine flattens and infringed hernial ring with the mesentery. Fecal infringement often develops in long-existing irreducible hernia.

Strangulated hernia can be primary and secondary. The primary denial is less common and occurs against a background of simultaneous extraordinary efforts, which results in the simultaneous formation of previously existing hernia and its compression. Secondary infringement occurs against the previously existing hernia of the abdominal wall.

constipation, cough (bronchitis, pneumonia), difficulty urinating (prostate adenoma), heavy births, tears, etc. Development and strangulated hernia contributes to the weakness of the muscles of the abdominal wall, intestinal atony in the elderly, traumatic abdominal injuries, surgery, weight loss.

When abdominal pressure normalization hernial decrease in size and infringe released beyond them hernial sac. The probability of infringement does not depend on the diameter of the hernial ring and the size of hernia.

tachycardia and hypotension.

Depending on the type of strangulated hernia pain may radiate to the epigastric region, center of the abdomen, groin, thigh. If you have intestinal obstruction pain takes spastic character. Pain, usually expressed for several hours, as long as the restrained body develop necrosis or death of nerve cells occur. When fecal infringement pain and intoxication are less pronounced, slowly developing bowel necrosis.

In strangulated hernia can occur single vomiting, which initially has a reflex mechanism. With the development of intestinal obstruction and becomes a constant vomiting becomes fecal character.

In situations infringement hernia partial obstruction phenomena tend not to occur. In this case, but the pain can disturb tenesmus, gas delay, dizuricheskie disorder (more frequent painful urination, hematuria).

A long-term impairment of a hernia can lead to the formation of cellulitis hernia sac, which is recognized by the characteristic local symptoms: swelling and redness of the skin, pain herniation and fluctuations over him. This condition is accompanied by general symptoms - high fever, increased toxicity.

The outcome of time, not the elimination of infringement of hernia is a diffuse peritonitis, the inflammation caused by the transition to the peritoneum or perforations stretched department strangulated intestine.

plain radiography of the abdominal cavity reveals Kloybera bowl. For the purpose of differential diagnosis is performed ultrasound of the abdomen. Infringement of femoral and inguinal hernia must be distinguished from hydrocele, spermatoceles, orhiepididimita, inguinal lymphadenitis.

hernia repair with local tissues or using synthetic prostheses).

The most crucial moment the operation is to assess the viability of the strangulated bowel loops. The criteria for bowel viability are restoring its tone and physiological color after the release of infringing the ring, smoothness and gloss of the serous membrane, no strangulation furrow, the presence of ripple mesenteric vessels, the safety of peristalsis. In the presence of stated features, gut recognized viable and immersed into the abdominal cavity.

Otherwise, strangulated hernia requires bowel resection with anastomosis site "end to end". superimposed intestinal fistula (enterostomy, colostomy) If unable to perform resection of necrotic bowel.

Conducting plastics primary abdominal wall is contraindicated in case of peritonitis, and cellulitis hernia sac.

Prediction and prevention of infringement of hernia

Mortality in strangulated hernia in elderly patients is 10%. Late referral for medical care and attempts at self infringement hernia lead to diagnostic and tactical mistakes, significantly worsen health outcomes. Complications of surgery for infringement of a hernia may be modified by necrosis of the intestinal loops when incorrect assessment of its viability, the failure of the intestinal anastomosis, peritonitis.

Prevention of infringements is a planned treatment of any identified abdominal hernias, as well as the exclusion of the circumstances that contribute to the development of a hernia.