The cathedra of the faculty and hospital surgery

The cathedra of the faculty and hospital surgery of the treatment faculty of the Tashkent medical academy Complications of the hernias of the abdomen

Complications of the hernias of the abdomen Unsetting Coprostasis Strangulation Complications at 10 -15% of hernia-carrier Inflammation

Types of the strangulation of the hernias Elastic strangulation Excrement strangulation

Retrograd ctrangulation

Near-wall (Richter’s) strangulation

Clinic of the strangulated hernia • Sharp begining • Pain in the area of hernia • Unsetting of the earlier setting hernia • Sharp painful, compaction, effort of the hernia • The symptom of «cough pushing» is negative

Stages of the operation at the strangulated hernia 1. Tightly section of the tissues to the 2. 3. 4. 5. 6. aponeurosis and stripping of the hernia’s bag Opening of the hernia’s bag, liquidation of the hernia’s water, keeping strangulated organ Section of the strangulative ring Identification of the vitality of the strangulated organs Resection of the not viable organs Plastic of the hernia’s gates

Signs of not viable intestine • Absence of the peristaltic • Absence of the pulsation on the mesenterial vessels • Blue-black color • Absence of the briliance of the peritoneum

Tests to indentify the vitality of the intestine • Novocain test • Mechanical test • Test with the «hot compress»

Separation of the hernia’s bag Opening of the hernia’s gate

Section of the strangulative ring

Resection of not viable department of the intestine

Intraintestinal anastomosis “side-by-side” Nasoenteral probe Intubation of the small intestine

Independent or forcible setting of the strangulated hernia It is impossible to define the state of the strangulated organ Possibility of setting with the strangulative ring Possibility of defeat of the strangulated organ

Complications of the forcible setting of the hernia

Inflammation of the hernia Sources of the infection of the hernia’s bag From the inside • Strangulation of the intestine • Acute appendicitis • Diverticulitis Terminal ileitis • Typhoid fever’s ulcers • Perforation of the small intestine From the outside • Inflammatory processes of skin Defeats of the skin epydedimitis, orchitis lymphadenitis

Unsetting The complication of the hernias, connected with the formation of the soldering among hernia’s bag and hernia’s content as a result of their trauma or aseptic inflammation

Unsetting

Hernia and loose-hanging abdomen

Coprostasis - stasis of the excrements in the intestine The development of the coprostasis promote: • Unsetting of the hernia • Less activity of the life • Rich feeding Coprostasis more frequently occurs: • At fat patients of elder age • At men at the inguinal hernias • At women at umbilical hernias

Treatment of the coprostasis • It is necessary to reach the evacuation of • • • the content of the intestine At setting hernias it is necessary to try to keep the hernia at set state Use small enemas with the hypertonic solution, glycerin The using of the purgatives is contraindicated!

Prevention of the complications of the hernias The surgical treatment of all the patients with the hernias in planned regime