Hernia - Causes, symptoms and treatment. MF.

Hernia - protrusion of the viscera together with the peritoneal wall of the peritoneum through a defect in the muscular layer of the abdominal wall under the skin. Distinguish the femoral hernia, the hernia of the white line, the hernia of the inguinal, the umbilical hernia, the post-operative hernia, the hernia restrained. Herniated femur is more common in women. Hernial portal serves the femoral canal, the insides emerge internally from the femoral joints.

There are many types of hernias. Almost all show indicate the place of exit of the hernia( for example, inguinal hernia), some - in the name of the scientist who first described them( for example, the hernia of Richter).The most famous types are:

- inguinal hernia, in which the hernial sac is in the inguinal canal;
- femoral - hernia sac is located along the large vessels on the inner side of the thigh at the site of the outcome of these vessels from the abdominal cavity;
- umbilical - the hernial sac emanates either through the umbilical ring or through the outlet of the placental vessels;

- diaphragmatic - the hernial bag exits through the aperture in the diaphragm;
- abdominal - the consequence of a trauma to the abdominal wall, if the muscle layers are not completely reconstructed.

Hernia is occasionally located inside the abdominal cavity, if the hernial sac leaves, for example, through the sciatic hole;these hernias are observed infrequently and do not matter.

Intra-abdominal hernias are caused by the penetration of internal organs into various pockets of the peritoneum: near the blind or sigmoid colon, the omentum bag, near the treetz ligament. Hernias of this kind appear only in the period of complications, with infringement there is a partial or complete intestinal obstruction, which leads the patient to the operating table. During intubation, infringement is found in the internal hernia. The disease is very rare.

Hernia is either congenital or acquired. Congenital appears due to vulnerabilities, or potential herniated gates existing from birth. Some hernias can be corrected, others can not be. A large number of unrecoverable hernias are infringed and cause symptoms similar to those of intestinal obstruction. A small or large intestine, a bladder, a peritoneal fold, or an ovary may appear in the hernial sac.

Signs and flow.

There is a protrusion in the area where the hernia has arisen, when the palpation is indicated by the hernial gates, with a cough - that is, the finger that is inserted into the hernia gates feels the push from the internal organs when coughing. A very frequent complication is infringement. There is also an inflammation of the hernial sac and its phlegmon. With extensive hernias, there may be an obstruction of the intestine in the hernial sac.

The most dangerous complication is the infringement, in which due to pressure in the hernial gates, there is a violation of blood circulation in the organs that have fallen into the hernial sac, with probable necrosis. If such patients do not undergo timely surgery, peritonitis, phlegmon of the hernial sac, acute intestinal obstruction can form.

The cause of the appearance of a hernia is the weakness of the walls of the cavity, from which the hernia penetrates, which leads to the appearance of a wall defect. This is facilitated by factors such as increased intracavitary pressure( for example, intra-abdominal with constant coughing, lifting weights) and congenital defects in the walls of the cavities or not scarring the congenital apertures.

Diagnosis of a hernia

Diagnosis of a hernia is as follows:

Complaints of a patient: these can be complaints about the occurrence of a protrusion in a particular area in the diseased that occurs during physical exertion. In addition, there may be small, blunt temporary pain in the protrusion area. If the pain in the area of ​​protrusion, which does not disappear in the patient, is constant, this indicates that the hernia is irreparable.

Instrumental methods of examination: these include a method such as diaphanoscopy, used to differentiate the scrotal hernia from dropsy. It involves examining the scrotal area with a light element.

Physical examination methods: the doctor, after examining the protrusion, feels it, determines its density, adjusts it to the cavity, and also notes the condition of the natural canals and openings( not widened, for example, by inserting the fingertip into the inguinal canal,he)

One more method of examination is an ultrasound.

Inguinal hernia

Inguinal hernia makes up 80 to 90 percent of other hernias. Among those with inguinal hernia, men range from 90 to 97 percent, and women from 3 to 10 percent. More frequent occurrence of inguinal hernia in men is associated with the developmental features and anatomical structure of the inguinal region in men. Inguinal hernias are both acquired and congenital.

Congenital inguinal hernia.

If the vaginal part of the peritoneum remains completely uninhabited, its cavity communicates without difficulty with the abdominal cavity. In the future, congenital inguinal hernia is formed, in which the vaginal process is a hernial sac. Congenital inguinal hernia constitute the main number of hernias in children. But still, in adults, there are congenital inguinal hernias.

Acquired inguinal hernia.

Distinguish oblique external inguinal hernia and internal inguinal hernia. The inguinal inguinal hernia emerges through the outer inguinal cavity;straight - take medial groin. In the initial stage of development of oblique inguinal hernia, vyapachevanie imperceptibly. When the patient tenses or coughs, the oval form is swollen, rapidly disappearing after the diseased person stops straining, with the channel form the bottom of the hernial sac reaches the outer opening of the inguinal canal. When the cervical form of the hernia passes through the outer opening of the inguinal canal and is located at different heights of the spermatic cord. In the inguinal and scrotal form, the hernia descends into the scrotum, increasing it. Only in the first stages of the disease oblique inguinal hernia has an oblique direction. As the hernia grows, the inner opening of the inguinal canal expands in the medial direction, pushing the epigastrium vessels to the inside.

With long-lasting inguinal and scrotal hernias, the inguinal canal acquires a direct direction, and its upper opening is almost level with the inner orifice, this is the so-called oblique hernia with rectified stroke.
With large hernias, the scrotum grows very much in size, the penis lurks beneath the skin, the contents of the hernia individually do not fit into the peritoneum. When the correction is heard rumbling in the abdomen.

Direct inguinal hernia passes from the abdominal cavity through the medial fossa, protruding the transverse posterior wall of the inguinal canal. Going out through the outer opening of the inguinal canal, it grows at the root of the scrotum above the puarth ligament in the form of a circular formation. Very often, the inguinal hernia is bilateral.

Define a special group of intravenous inguinal hernias. With these hernias, the hernial sac is located between different layers of the abdominal wall.
Separate the preperitoneal hernia, this is when the hernial sac is between the peritoneum and the transverse fascia, the intermuscular hernia, when the hernial sac is between different layers of muscles and aponeurosis;superficial hernia, when the hernial sac is located behind the superficial inguinal ring between the aponeurosis of the external oblique abdominal muscle and the superficial fascia.

Clinic and diagnosis: it is not difficult to identify the inguinal hernia that has formed. A classic symptom is an anamnesis: the sudden appearance of a hernia at the time of physical effort or the gradual development of a hernial protrusion, the appearance of protrusion of the abdominal wall under tension, in the vertical position of the diseased body and the direction of the hernia in the patient's horizontal position. Those who are ill worry about pain in the area of ​​a hernia, in the abdomen, a feeling of discomfort when walking, dyspeptic phenomena, and with sliding blisters of the bladder, dysuric manifestations appear.

Diagnosis of inguinal hernia consists in the following:

Examination of a diseased person in an upright position gives an idea of ​​the asymmetry of inguinal areas. If there is a protrusion of the abdominal wall, you can determine the size and shape of the hernia. When feeling, the surface is determined, the consistency of the hernial protrusion, the rumbling of the intestine, and percussion - the percussion sound. A finger examination of the external opening of the inguinal canal is carried out in the horizontal position of the patient after the contents of the hernial sac have been adjusted. The doctor with the index finger, invaginating the skin of the scrotum, enters the superficial opening of the inguinal canal, which is located inside and slightly higher from the lumbar tubercle. Inspection of inguinal hernia in women is based on examination and palpation, since the introduction of a finger into the external opening of the inguinal canal is impossible.

In women, inguinal hernia is distinguished from the cyst of the round ligament of the uterus, which passes in the inguinal canal.
The cyst of the round ligament of the uterus, unlike the hernia, does not change its dimensions with the patient's horizontal position, the percussion sound above it is always deaf, and the hernia can be tympanic over the hernia.

To distinguish inguinal hernia from the dropsy of the egg and the spermatic cord, inguinal ectopia of the femoral hernia.

Intervertebral hernia

Dystrophic disorders in the lumbosacral spine are most pronounced at the age of twenty to fifty years and are one of the most frequent causes of temporary disability and often disability of the patient. Up to fifty percent of all surgical interventions in hospitals of the neurosurgical profile are carried out regarding the pathology of the discs at the lumbosacral level.

Herniated intervertebral discs are the most common and most severe manifestation of osteochondrosis of the spine. In this case, painful radicular syndrome is formed, which can be accompanied by paresis or paralysis of the muscles of the lower extremities, a violation of sensitivity, a violation of the function of the pelvic organs. Nineteen percent of patients with herniated intervertebral discs need surgical treatment.

Disease occurs as a result of rupture of the intervertebral disc. The resulting hernia, standing back and to the side, presses on the root of the nerve at the site of its exit from the spinal canal and provokes inflammation accompanied by swelling. This explains why pain and loss of sensitivity appear only a day after the onset of the disease. The pinched root of the nerve sends painful impulses to the brain, which are perceived as if they are coming from the foot. The part of the nerve that is outside the hernia pressure place practically ceases to function, which leads to a rapid decrease in sensitivity and the appearance of weakness in the leg.

Almost all patients with the main complaint is a pain syndrome. Very often, pain occurs in adolescence after moderate physical exertion, uncomfortable position in the workplace or in bed. The disease often occurs when tilted with a simultaneous turn to the side, often in conjunction with lifting the severity. Also characteristic is a sudden, not very strong severe pain in the lumbar region. Then within a day, there is pain and weakness in one of the legs, sometimes with loss of sensitivity, pain appears on the inside of the foot and lower leg or on the outside of the foot and the inner side of the shin. When moving, coughing, sneezing or straining, back and leg pains intensify and often become so intense that the ill person needs bed rest.
Some improvement in the condition can be achieved in the prone position by raising your legs or putting them on the pillow.

There are two stages in the development of the disease.

At the first stage, there is pain in the lumbar region, which indicates the onset of a degenerative-dystrophic process. Under the influence of degenerative changes in the vertebral-motor segments, the rather complex structure of the fibrous ring is broken, radial cracks are formed in it, which reduces its strength. The bulpous nucleus is bulging, blood circulation of this zone is disturbed, there is edema of local tissues, adhesive process, hypoxia of the root of the spinal cord. There is a pain syndrome, leading to myofixation of the pathological zone due to the tension of the muscles of the back and, because of this, compensatory curvature of the overlying parts of the spine occurs. In the future, prolonged pathological impulses lead to dystrophic disorders of the joint-ligament apparatus.

At the second stage, the character of the pain syndrome changes. Compression root syndrome arises, which is caused by mechanical compression and tension of the rootlet. In this case, edema of the root occurs, its blood supply is disturbed. With direct contact of the herniated intervertebral disc with the spine, chemical irritation causes a stronger pain syndrome. Often with the appearance of radicular pain, in the lumbosacral region, the pain weakens or disappears. Apparently, this is due to a decrease in internal disk pressure due to rupture of the fibrous ring.

Very often there are vegetative disorders in the form of hypothermia of the skin, their pasty,
is broken, sweating, skin dryness increases.
Quite often, patients take a forced position. Compensatory postures that lower the degree of pressure and tension of the root are manifested by scoliosis, lumbar lordosis consolidation, restriction of flexion and extension of the trunk, tension of the long back muscles. Occasionally, the diseased can not straighten their legs due to pain. Motor changes in the form of paresis or paralysis are rare, they are more common in severe cases. There may be trophic disorders in the form of "weight loss" due to muscle atrophy.

Symptoms of inguinal hernia. Patients complain of pain and the presence of a small tumor in the inguinal fold. When examined, a bulging( with a hazelnut) oval shape is noted. The protrusion does not move to the sides, to the touch - a soft consistency.

A herniated white line appears between the tendon fibers that form the white line of the abdomen.

Symptoms of a hernia of a white line. Patients complain of pain resembling the nature of pain in stomach ulcers and other gastrointestinal diseases. On examination, a small protrusion in the region of the white line is sometimes determined, which appears mainly when straining.

Herniated hernia appears in the inguinal canal. If the hernial protrusion begins in the region of the inner inguinal ring and further spreads along the canal parallel to the spermatic cord, and then exits under the skin through the outer inguinal ring, then this hernia is called a scythe. If the hernial protrusion begins in the posterior wall of the outer inguinal ring, then such a hernia is called a straight line.

Symptoms of inguinal hernia. When the oblique inguinal hernia the sack reaches a large size, the hernia in the form of an oval protrusion descends into the scrotum in men or in the labia of women. With a straight inguinal hernia, the hernial protrusion looks like a half of the ball, and is closer to the left articulation.

An umbilical hernia appears near the umbilical ring. When you feel your finger, you clearly feel the edges of the umbilical ring, and the hernial protrusion;easy to enter the abdominal cavity. Symptoms of an umbilical hernia. Pain, nausea.

Hernia postoperative appears on the site of the divergent edges of the postoperative suture. Symptoms of a hernia after a surgery. Pain, nausea, vomiting, sometimes constipation.

Herniated injury occurs when, under the influence of a strong and rapid contraction of the abdominal muscles and an increase in intra-abdominal pressure, the hernial ring contracting and infringement of the hernial sac - intestinal or omentum loops( the latter in the case of a hernia of the white line).In the place of infringement there is a disturbance of blood circulation in the tissues, which leads to their necrosis and peritonitis.

Symptoms of hernia strangulated. The hernia does not correct, there are strong pains in the area of ​​protrusion and in the lower abdomen. When the intestine is infringed, stool and gas retention occurs, bloating, vomiting. Traditional hernia cure. Treatment operative.

Treatment of hernia

Currently, there is only one type of hernia treatment -operative. An exceptionally effective method is operational. Surgical intervention is best done during the cold season, without waiting for a complication or infringement. Attempts to direct hernial protrusions when infringing are impossible because of the risk to place the organ with altered blood circulation into the abdominal cavity. Wearing special bandages can be advised only if there are contraindications to surgical intervention, since bandages do not guarantee against infringement of a hernia.

There are a lot of methods of surgical operation with a hernia at the present time, although at the present time in general they can be divided into two separate groups: endoscopic operations and open ones. With endoscopic surgery, the surgeon performs the operation through punctures and controls the course of the operation through the TV;When open surgery is required to make a cut over the hernia.

At the present time it is believed that both modes of operation in experienced hands have approximately the same outcomes, and most patients( more than 90%) are satisfied with the outcome of the operation. However, each type of operation has its advantages. Advantages of open surgery:
- Surgery is cheaper than endoscopic( you do not need to purchase a mesh and a fixation tool - herniostepler). - You can make plastic with local tissues.
- Under local anesthesia, that is, does not need anesthesia.

Advantages of endoscopic surgery:
• Slight soreness in the postoperative period
• In surgery for inguinal hernia in men, the endoscopic operation does not affect reproductive function, as the seminal cord is not compressed, which, when open, is usually pressed down when narrowing with sutureshernial gates.
• Probability of examination of all standard weaknesses of the abdominal wall and if an initial hernia is detected, on the other hand The probability of simultaneous closure of the hernial gates on both sides of the
• A good cosmetic effect of
• The earliest recoverability of the patient.

But all the same it is necessary to emphasize once again that at the present time the world surgical community believes that both methods of operation are generally equally effective, and the decision to apply this or that method should be taken individually in each specific case.
In the event that the operation is done endoscopically, it will take an average of 2-3 days to stay in the hospital.

With an open operation, this requires a total of 3-5 days.
Return to normal life probably 1-2 weeks after discharge.
But still you need to take into account that before the full hardening of the tissues in the area of ​​the operation you need at least 6 months, so during this period you should avoid heavy physical exertion( for example, lifting heavy weights - over 10 kg), although it is obvious that this figureis relative, and each patient should be guided by his own state of health.

Surgical treatment of umbilical hernia is recommended for all girls older than 5 years, as well as for boys, if the hernia is noticeable and has indications for surgical treatment. Treatment of umbilical hernia in adults is surgical only. The type of surgery depends on the size of the hernia, as well as some other factors, including age, condition of the abdominal wall.

Small hernias and some small hernias are treated by autoplasty, that is, the reconstruction of the normal abdominal wall due to its own tissues. Usually, the abdominal wall becomes compressed in the hernia, which makes the wall more firm. With medium and large hernias, autoplasty has a high risk of re-emergence of a hernia.

Conservative treatment with hernia does not exist. So-called devices in the form of special belts that have pressure on the hernial gates and do not give a hernia an opportunity to go outside are not treatment, and can not prevent further herniation and possible complications.

No medical hernia treatment. Attempts to strengthen the development of collagen connective tissue in the form of vitamin intake can not cure a hernia. On the other hand, the increased intake of vitamins, the more vitamin C in the postoperative period may be useful for improving the quality of developing scar tissue and the possible prevention of relapse.