Abdominal outpouching syndrome Causes n n n Hernia

Abdominal «outpouching» syndrome

Causes n n n Hernia; Muscle diastasis; Eventration; Groin lymphadenitis; lipoma, atheroma, neurofibroma; adenophlegmon; Lymph nodes tuberculosis; metastasis; Cold abscess; Varicose diseases; Abdominal wall haematoma.

Hernia is outpouching of interiors through natural or pathological apertures from an abdominal cavity under covers of a body or in other cavity. Distinguish external and internal hernias of an abdominal wall.

Currency n n n 3 -4% of population suffered. On 20% marked strangulation. Higher postoperative mortality, especially on strangulated hernias. Upgrowthed operative interventions nowadays. Related with geriatrics.

Frequency: n n n Inguinal hernias – 75%; Femoral – 8%; Umbilical – 4%; postoperational -12%; Another kinds - 1%.

Differential diagnostics n n n n n Testicle dropsy; Testicle or testicular tubule tumours; varicocele; Inguinal lymphadenitis; Congestive(migrating) abscess; Metastasis lipomatosis; Urachus; lymphogranulamatosis; Varix of orifice large hypodermic vein and etc

Aetilogy: (local factors) n n n At the men the presence of the inguinal channel, through which passes testicle funicle; The presence of a femoral ring, through which passes femoral vessels; The presence of umbilical area and linia alba, where is absent of a muscle layer.

Aetiology: (common factors) n n n n n Predisposing factors: hereditary factors; Age; sex; The constitution of a body; Numerous deliveries; Traumas of an abdominal wall; Postoperative scars; Palsy;

Aetiology: (common factors) n n n making factors (increasing intrabdominal pressure): Heavy physical loading; Hardly proceeding deliveries; Complicated urination; constipation; Long cough.

Indirect inguinal hernia Outpouching from fossa inguinalis lateralis. Testicle funicle is located medially next to hernial sac

Direct inguinal hernia outpouching from fossa inguinalis medialis.

Inherent и acquired hernias n n Inherent hernia arise owing to nonclosure processus vaginalis peritonaei, thus testicle is together by sac contents. At acquired hernia testicle is separately from sac contents.

Umbilical hernias Umbilical hernia is outpouching organs of an abdominal cavity through abdominal wall defects in umbilical area. Women affected by umbilical hernia twice more often, than men, that is connected to a stretching of an umbilical ring during pregnancy.

Richter^s(parietal) hernia Thus content is the part of a intestinal wall

Sliding hernia Hernial content is mesoperitoneal organ

Femoral hernias outpouch below Poupart^s ligament, located along the leading surface of huckle.

Combined inguinal hernias occur seldom, however they deserve the special attention that during operation one of them can be seen, hence, herniotomy will not be made considerably.

Characteristics Inguinal indirect Inguinal direct Femoral Дифференциальная диагностика грыж в паховой области frequency Very high low Very low Patients age Often on children, sometimes on adult On men elder than 40 y, rarely on women Frequently on women than on men localisation Projection is internal inguinal ring External inguinal ring Below the inguinal arch, laterally Often sticks out to scrotum Sticks out foward Never sticks out Direction Check cough reflex

Complications: strangulation; n coprostasis; n malreduction; n inflammation. n

Pre-clinical stage n n n At survey of the patients with abdominal pains purposefully have to search hernia; Even at suspicion on it hospitalize in to surgical department; Alignment not allowed; Avoid of cold procedures and pain killers; The patients should be delivered in laying on a back position, on gurney;

Strangulation types: Ø Elastic;

Strangulation types: Ø Stercoral strangulation;

Strangulation types: Reactionary strangulation n

Strangulation types: Ø Parietal strangulation.

Treatment: Merely operative intervention. n Strangulation is absolute statement to operative introduction. Contradictory is patients agonal condition. n

Coprostasis n n Coprostasis is observed more often at the corpulent patients of senile age, at the men at inguinal hernias, at the women at umbilical hernias. Symptoms: persistent constipations, pain in a stomach, the nausea, is rare vomit. Outpouching is slowly increased in process of filling thick intestine by himus, it is almost painless, is poorly intense, pasty consistence, a cough symptom is defines.

Inflammation of hernia n n Avoid of inguinal plasty on inflammated inguinal hernias! On inflammated umbilical hernias – Grekov^s operation

Brock^s false strangulation n On acute diseases of an abdominal cavity (appendicitis, cholecystitis, ulcer, intestinal impassability) exudate getting in not restrained hernial sac causes an inflammation in it. Hernial outpouching is increased in sizes, becomes painful and intense. These attributes correspond to attributes of strangulation.

Differential diagnostics

urachus

Testicle dropsy

Herpes Zoster

lymphogranulematosis

lipomatosis

Thank you for attention!!!