Abdominal hernia is a fairly common disease that can occur in any person. It is divided into many types that have different symptoms, location, causes of development and treatment tactics. The disease brings a lot of discomfort to a person’s life, so it is important to know what a hernia of the abdomen is.

A hernia on the abdomen is a disease characterized by the protrusion of the abdominal organs to the surface of the abdomen or by directing them through the hernial orifice into the abdominal cavity. Hernial gates are clearings that have arisen in the wall of the abdomen. This defect is of natural origin or may be formed due to trauma or surgery.

As statistics show, different types hernias in the abdomen suffer about 5% of the population. The vast majority of them (80%) are men, and the remaining 20% ​​are women and children. As a rule, abdominal hernia is diagnosed in preschoolers and people over 50 years old.

Diseases have types, including abdominal hernia. The classification is very extensive and includes a huge number of subspecies. For clarity, let's make a table.

signs	Types of hernias
Location	external hernia of the abdominal wall (goes beyond its limits); internal hernia (organs move within the abdominal cavity).
Localization	umbilical (appear in the navel area); paraumbilical (located near the umbilical ring); inguinal, which are further divided into straight and oblique, depending on the location of the spermatic cord; ventral hernias are hernias of the anterior abdominal wall, formed in the lower section; epigastric hernias, which are located along the midline of the abdomen; lumbar; obturator; hernia of the Spigelian line; hernia of the food opening of the diaphragm; laterallocated behind the sheath of the rectus muscle.
Hernia incarceration	strangulation infringement that occurs when the vessels of the mesentery are squeezed, followed by necrosis of the intestine; obstructive, appears due to the inflection of the intestine and the cessation of the movement of feces through the intestines; marginal is formed when a small part of the intestinal wall is infringed with further necrosis and perforation.
Volume	incomplete hernia (the hernial sac leaves the abdominal cavity, but does not go beyond its borders); complete hernia (the hernial sac is outside the walls of the abdominal cavity).
Special types	congenital hernia of the abdominal cavity; Littre's hernia, in which there is a diverticulum of the jejunum in the hernial sac; wandering hernia in the abdominal cavity.

Internal abdominal hernias are diagnosed in 25% of cases. In all other situations, patients suffer from outward appearances. The ventral hernia also deserves special attention. AT recent times she began to meet more often. Ventral hernia occurs after surgery.

Causes and symptoms

Abdominal hernia does not appear spontaneously. It takes time and several pathological factors to occur. Causes are divided into 2 types: disposing and accomplishing.

The available ones include:

• hereditary factor;
• congenital weak muscles;
• the resulting changes due to injuries, surgical interventions, exhaustion, after which weak points appear on the body.

Accomplishing causes provoke an increase in intra-abdominal pressure and the development of a hernia of the anterior abdominal wall at weak points. Among them are:

• regular heavy physical activity;
• excess weight;
• tumors of organs located in the abdominal cavity;
• persistent cough that occurs with chronic lung diseases;
• disturbed urination;
• persistent constipation;
• pregnancy, difficult childbirth;
• some diseases (tuberculosis, cirrhosis, enlarged prostate, paralysis of the legs, poliomyelitis, etc.).

All of the above causes that cause the appearance of pathology should last for a long time. Only then is a hernia of the anterior abdominal wall formed.

Symptoms of a hernia of the abdomen manifest themselves in different ways.

All types are characterized by a feeling of discomfort, soreness and protrusion, which takes place in a horizontal position. When observing these symptoms, you should see a surgeon. He will conduct the necessary examinations and make the correct diagnosis.

When a hernia forms in the abdomen, the symptoms depend on its location and severity. Signs of a hernia of the abdomen are as follows:

1. A protrusion in the form of a tumor that appears with any physical exertion.
2. Aching and drawing pains in the region of the hernia.
3. Urinary disorders.
4. Various digestive disorders - bloating, diarrhea, constipation, vomiting, nausea, constant belching.

Diagnosis of the disease

If you suspect the pathology of "abdominal hernia", the corresponding symptoms are observed, then you need to contact a specialist for a comprehensive examination of the body.

If the tumor forms in the usual places for hernias (groin, navel and thigh), the disease is easily diagnosed. Ventral hernia is recognized by the "cough push". It is necessary to put a hand on the protrusion and ask the patient to cough, while clear tremors should be felt. Diagnostic methods include palpation of the hernial orifice, palpation and tapping of the tumor.

For some types of hernias of the anterior abdominal wall, additional methods are used:

Methods of treatment

Very rarely, a ventral abdominal hernia disappears with conservative treatment. Surgery is almost always required. If there is an infringement of the internal organs, then the operation is carried out urgently. Below we consider in more detail all the methods of treatment.

conservative methods

Conservative treatment of abdominal hernia is prescribed in order to prevent complications, tumor growth and alleviate symptoms. It is used in relation to patients for whom surgical intervention is contraindicated due to age, pregnancy, serious illness.

Conservative methods include:

Surgical treatment

The only way to cope with the pathology is to remove the hernia of the abdomen through surgery.

Only one type of hernia can disappear on its own - it is umbilical in children under 5 years old. Other types, including ventral hernia, will not disappear on their own, moreover, over time they will increase in size and pose a serious threat to human health.

With the manifestation of the first symptoms, you should immediately consult a surgeon. A timely operation gives more chances for a quick recovery without various complications. Before the operation, the patient must undergo an examination and pass all the necessary tests. An analysis of the patient's health will allow the surgeon to prescribe the appropriate treatment option.

As a rule, a hernia of the abdomen is removed using hernioplasty. In total, there are 3 ways to carry it out:

1. Tension (the hole at the site of the removed hernia is tightened by its own tissues).
2. Without tension (to close the hole, polypropylene mesh implants are used).
3. Combined (use both mesh and own fabrics).

Usually resort to the second method. It does not stretch fabrics, and the polypropylene mesh provides reliable protection that can withstand significant loads.

Also, an operation to remove a hernia can be performed by open, laparoscopic and endoscopic methods:

Postoperative Recovery

Rehabilitation consists in restoring the strength of the patient's body. Recommendations depend on the method of the operation, they must be prescribed by a doctor. After examining the patient, he prescribes a diet, postoperative therapy and determines the intensity of exercise.

10 days the patient must go to the hospital to perform dressings. In addition, assigned drug treatment painkillers and antibiotics. Physiotherapy courses will help speed up the recovery process.

You can't play sports for a few months. You also need to follow proper nutrition. In the first days after the operation, it is necessary to eat liquid food: broths, light soups, kissels. Gradually, cereals, lean meats and fish, eggs, vegetables, fruits, and seafood should be added to the diet. It is necessary to give up salty and spicy foods, smoking, drinking alcoholic beverages.

The stitches are removed after a week. After that, it is recommended to wear a bandage to restore tone to the abdominal muscles. After 3 months, you can do light physical education, while the bandage can not be removed. Breathing exercises and regular massage contribute to a quick recovery.

Abdominal hernia is a serious disease that requires treatment. Otherwise, serious complications may occur in the form of peritonitis, intestinal obstruction, intoxication.

Hernia

A hernia is a pathological protrusion of internal organs into the subcutaneous fat through physiological (congenital) or pathological (acquired) holes or defects in the muscular-aponeurotic layer of the anterior abdominal wall, and visually manifested by the appearance of a tumor protrusion uncharacteristic for this area of ​​the abdomen.

Hernia classification

Hernias can be congenital and acquired, appeared during life, including against the background of constant regular physical exertion or in the area of ​​damage to the layers of the anterior abdominal wall (for example, after previous operations or stab wounds).

According to the localization of the hernia, it can be conditionally divided into "external" and "internal".

Of the hernias of external localization, the most common are inguinal hernias, umbilical hernias, femoral hernias, hernias of the white line of the abdomen and hernias after previous open surgical interventions on the abdominal organs (postoperative hernias - ventral).

Less common is a hernia of the Spiegel line, lumbar hernias (Petit triangle and Greenfelt-Lesgaft gap) and pelvic hernias. Internal hernias include hernias of the esophageal opening of the diaphragm, hernia of the obturator canal. The latter is extremely rare.

Abdominal hernia

Abdominal hernia is the exit from the abdominal cavity of the internal organs along with the peritoneum covering them through natural or acquired defects of the abdominal wall under the skin or into other cavities. Hernias occur in 3-5% of the population. There are external and internal, congenital and acquired, reducible and irreducible hernias of the abdomen. External abdominal hernias are formed in anatomically weak places of the abdominal wall (inguinal canal, femoral canal, umbilical ring, white line of the abdomen, diaphragm), areas of postoperative scars, injuries or inflammatory processes (postoperative hernias).

Hernial gates are congenital or acquired openings in the muscular-aponeurotic layer of the abdominal wall, through which internal organs come out of the abdominal cavity. They are formed in natural places where vessels, nerves, spermatic cord pass through the abdominal wall, or arise as a result of injuries of the abdominal wall, surgical wounds and scars.

A hernia consists of a hernial orifice, a hernial sac and its contents.

The hernial sac is formed by the parietal peritoneum, which came out through the hernial orifice. Sometimes the wall of the hernial sac can be made up of an organ partially covered by the peritoneum (bladder, kidney, caecum, etc.). Such hernias are called sliding.

Hernial contents are called internal organs that go into the hernial sac from the abdominal cavity. Most often it is a large omentum, loops of the small intestine.

Consider the most common types of hernias:

Umbilical hernias form in the umbilical region. In newborns older than 5 years, surgical treatment is necessary. Acquired umbilical hernias are quite common in adults.

Hernias of the white line of the abdomen are located along the midline of the abdomen, more often between the navel and the xiphoid process. Such hernias themselves are not

closed and subject to surgical treatment.

Inguinal hernias are called hernias that form in the groin. They are much more common in men. They can be straight, oblique and inguinal-scrotal. Direct inguinal hernias are spherical and located above the inguinal fold, oblique ones are oval and go along the inguinal fold.

Inguinal-scrotal hernias go into the scrotum.

Femoral hernias occur mainly in women and are much less common than inguinal ones. It is located on the thigh below the inguinal fold.

Diaphragmatic hernias are more often congenital and represent a malformation of the diaphragm. Acquired diaphragmatic hernias occur after trauma or occur in the area of ​​the esophagus. With these hernias, respiratory distress, cardiac activity, and shortness of breath occur, especially after eating. Hernias of the esophageal opening of the diaphragm are characterized by vomiting, abdominal pain, heartburn. An X-ray examination with a contrast agent in the chest area shows bowel loops.

Incisional hernias account for about 15% of hernias. They are formed in the area of ​​the postoperative scar, which is facilitated by tampons and drains passed through the surgical wound, infection and suppuration of the surgical wound, deterioration in tissue regeneration, nerve damage during surgery, and a large load in the postoperative period. The outer hernial membranes are represented by scar tissue tightly adherent to the hernial sac or skin with subcutaneous tissue and a surgical scar in the middle. Hernial orifice and surrounding tissues are also cicatricially changed. Postoperative hernias are often irreducible.

The most dangerous complication of a hernia is strangulation.

Infringement is a compression of the contents of the hernia in the region of the hernial ring. As a result of infringement in the hernial content, blood supply and innervation are stopped, blood stasis and tissue necrosis develop.

The most important symptoms of a strangulated hernia are sudden pains in the area of ​​the hernia, its enlargement, irreducibility, sharp tension and soreness of the hernial protrusion. The symptom of cough shock is negative. After some time, a picture of acute intestinal obstruction develops: cramping abdominal pain, vomiting, stool and gas retention.

With infringements, the greatest changes occur in the region of the strangulation furrow at the site of compression of the hernial contents. As a result of venous stasis, edema of the contents of the hernia develops, exudation into the lumen of the hollow organ and into the lumen of the hernial sac or into the surrounding tissues (with false hernias). The exudate is initially transparent, later hemorrhagic, purulent. The exudate in the hernial sac is called hernial water.

The spread of the inflammatory process to the surrounding tissues leads to inflammation of the hernia, the development of fistulas, peritonitis, and sepsis.

Forced or self-reduction of a strangulated hernia, its reduction during surgery can cause the following complications: damage to the hernial contents with the development of peritonitis and internal bleeding; reduction of necrotically altered hernial contents with the development of peritonitis.

clinical picture. Hernias develop gradually. With heavy physical exertion, the patient feels tingling pains at the site of the emerging hernia. The pains are a little disturbing at first, but gradually increase and begin to interfere with movement. After some time, the patient discovers a protrusion in himself, which increases with physical exertion and disappears at rest. The protrusion gradually increases and acquires a round or oval shape, appears at the slightest physical exertion. If the protrusion disappears on its own at rest, in a horizontal position or with light pressure on it with hands, then such a hernia is called reducible. With a reducible hernia, a positive symptom of a cough shock is noted - a sensation of a push with the palm of your hand applied to the hernial protrusion when coughing. With an irreducible hernia, the hernial protrusion does not change its size and shape or decreases somewhat at rest and with pressure on it. As a rule, such patients complain of constant pain, aggravated by physical exertion, irradiation of pain throughout the abdomen, and dyspeptic disorders.

Tactics. With a strangulated hernia, thermal procedures, anesthesia, antispasmodics, and attempts at manual reduction are contraindicated. Shown emergency hospitalization in a surgical hospital on a stretcher in a position that is comfortable for the patient. In case of spontaneous reduction during transportation, emergency hospitalization is also indicated for the dynamic observation of the patient in the hospital.

Treatment. The main method of treatment of abdominal hernias is operational - hernia repair. Hernias in children under 4 years of age are subject to conservative treatment, if they are reducible and not infringed. With conservative treatment, massage of the abdominal muscles, physiotherapy exercises, games without physical activity are used.

Contraindications to surgical treatment of non-incarcerated hernias are: severe respiratory and cardiovascular failure, active tuberculosis, malignant tumors. A bandage is recommended for such patients, when worn, the pilot closes the hernial orifice and prevents the hernial protrusion from coming out. Wearing a bandage for those who will be operated on is contraindicated, since prolonged wearing contributes to the expansion of the hernial orifice.

Several types of surgical interventions are used - auto-hernioplasty (closing of the hernial ring is carried out using the patient's own tissues) and allohernioplasty (various synthetic grafts are used, usually from polypropylene). Strangulated hernias require emergency surgery.

Before a planned operation, the patient undergoes an outpatient examination. In the hospital on the eve of the operation in the evening and in the morning

cleansing enema. With extensive ventral hernias, before surgery, the stomach is tightly bandaged for 2 weeks to prevent a sharp increase in intra-abdominal pressure, physiotherapy exercises are performed and chest breathing is taught.

With a strangulated hernia, the patient is urgently hospitalized in the surgical department for emergency surgery. The introduction of painkillers and antispasmodics is unacceptable, as self-administration can occur. After surgery (hernia repair), the patient is prescribed bed rest for 2 days. 2 hours after the operation, which took place without complications, they are allowed to drink and take liquid food. On the 2nd day, the patient is transferred to the general table. After getting out of bed, the patient is advised to wear a tight belt around the abdomen for 1 to 2 weeks and limit physical activity for 3 to 4 weeks. Suspensors are used after surgery for an inguinal-scrotal hernia to reduce swelling of the scrotum.

In the last 10 years, a fundamentally new page has been opened in the treatment of hernias. Hernia orifice plasty has been replaced by tension-free methods of surgery, which consist in the implantation of synthetic prostheses (mesh) in weak areas of the abdominal wall through which the internal organs protrude (in case of large or recurrent hernias). Synthetic meshes may have a different shape and size depending on the location of the hernia (see photo).

A synthetic prosthesis for abdominal hernia forms a powerful scar that securely closes the defect (weak spot) of the anterior abdominal wall.

Nursing process in injuries and diseases of the abdominal organs

The 1st stage of the nursing process is the nursing examination of the patient.

When a patient is admitted to a hospital with damage or disease of the abdominal organs, the nurse pays attention to the color of the integument and visible mucous membranes, icterus of the sclera, acrocyanosis, the presence of spider veins, intradermal and subcutaneous hemorrhages. In particular, the expansion of the veins of the anterior abdominal wall suggests liver cirrhosis or cancer. Examination of the patient, examination of the pulse, respiratory rate, measurement of blood pressure, body temperature provide grounds for a preliminary assessment of the severity of the condition. The nurse determines the presence of pain, discomfort and changes in organ function due to the presence of this disease. An allergological history is carefully collected, information about the medications taken, the patient's diet, bad habits, the presence of fear, bad mood, anxiety level. The nurse determines the patient's readiness for surgery. This is the execution and verification of documentation, the availability of clinical and biochemical blood tests, endoscopic, x-ray and ultrasound methods for diagnosing abdominal organs, checking samples for blood compatibility. During this period, the surgical field is necessarily examined and prepared.

The 2nd stage of the nursing process is diagnosing or identifying the patient's problems.

After assessing the state of health and self-care, the nurse makes nursing diagnoses. Prior to surgery, the following nursing diagnoses are possible:

belching, heartburn, vomiting, nausea, abdominal pain, due to a pathological process in the abdominal cavity;

violation of bowel emptying;

increased gas formation in the intestines;

An increase in body temperature due to the development of the inflammatory process;

fear, anxiety, insecurity associated with hospitalization;

strangulated hernia sac

Disturbance of motor activity associated with trauma or pain;

sleep disturbance due to pain, etc. After surgery, typical problems are:

Nausea, vomiting, pain in the area of ​​operation associated with surgery on the digestive organs;

risk of falling due to weakness after surgery;

The risk of bleeding due to the divergence of the sutures in the postoperative wound;

inability to carry out self-care due to weakness, etc.

After all nursing diagnoses have been made, the nurse prioritizes them.

The 3rd stage of the nursing process is the planning of nursing interventions.

The planning of nursing interventions before surgical treatment includes care and observation of the patient, preparing him for additional laboratory and instrumental studies. The purpose of nursing intervention is to improve the patient's condition or reduce the severity of the manifestations of the disease. The nurse should inform the patient about the importance of following the drug therapy regimen, the timing of taking the drugs, the sequence of taking in relation to each other and to food intake, and the dangers of self-medication. She explains the need for surgical intervention, helps to cope with a feeling of fear, teaches behavior in the postoperative period, introduces a set of breathing exercises and physiotherapy exercises. In the postoperative period, the tasks of the nurse are as follows: prevent early postoperative complications, infection of the wound, create comfort for the patient, relieve stress through conversation, teach the patient how to serve himself as much as possible or teach his relatives how to care for the patient, engage in physical therapy with the patient, massage the back muscles and extremities, prevention of bedsores. At this stage, it is necessary to involve the patient in active participation in the treatment process.

The 4th stage of the nursing process is the implementation of the nursing intervention plan.

This stage includes preparing the patient for the upcoming operation. Antiseptic soap is used to reduce the number of microorganisms on the skin surface, and the surgical field is treated. It is mandatory to refrain from eating and drinking 8 hours before surgery to prevent vomiting during surgery. The nurse is required to conduct psychological preparation and support for the patient.

In the postoperative period, the patient's rehabilitation begins immediately to prevent possible complications and help the patient and his relatives to behave correctly in a new difficult life situation for them. The main tasks are the most complete restoration of the functions of the digestive organs, working capacity, etc. prevention of postoperative complications. Timely and tactically correct medical rehabilitation significantly reduces the period of temporary disability, reduces disability, and reduces the number of patients with postoperative pathological syndromes.

Stage 5 of the nursing process - evaluation of nursing interventions.

Through additional examination, it is determined whether the expected results have been achieved. Evaluate the patient's response to nursing care, the quality of care provided, the results obtained. The patient expresses his opinion about the activities carried out. The outcome of the disease often depends on the relationship that has developed between the nurse and the patient, on their mutual understanding.

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External abdominal hernias is a common disease. They are observed in 3-4% of the total population. Along with the limitation of the patient's ability to work, a hernia poses a danger to his life due to the occurrence of such complications as infringement, inflammation of the hernial sac, etc.

Etiopathogenesis of abdominal hernias. For the occurrence of a hernia, both local and general factors are important. Local factors include weak, muscle-free spaces. Weak spots or “hernial points” of the abdominal wall include the inguinal canal in men, the femoral canal (the area of ​​the oval fossa on the thigh), the navel and the white line of the abdomen in women, the Spigsley line area, the Petit triangle area, the Greenfelt-Lesgaft quadrangle area, the area locking hole.

General factors are divided into predisposing and derivative.

Predisposing factors include: heredity, age, gender, physique, degree of fatness, frequent childbirth, trauma to the abdominal wall, postoperative scars, paralysis of the nerves that innervate the abdominal wall. All of these factors lead to a weakening of the abdominal wall.

Among the causes of hernias, an increase in intra-abdominal pressure with a strong cough, heavy physical exertion, constipation, weight lifting, difficult childbirth, and difficulty urinating is important.

Local changes due to the weakness of the tendon elements in the area of ​​potentially expected hernia gates are also contributing factors for the occurrence of hernias.

The occurrence of a hernia is also facilitated by the presence of an unclosed vaginal process of the peritoneum, loss of body weight with a decrease in the volume of adipose tissue. Congenital insufficiency of connective tissue also contributes to the occurrence of a hernia.

The weak areas of the abdominal wall that favor the formation of a hernia, as already noted, include: the zone of the inguinal canal, the oval fossa on the thigh, the navel, the supra-umbilical region, the aponeurosis of the white line of the abdomen (see Figure 1), etc.

Figure 1. Weaknesses in the abdominal wall

The mechanism of hernia occurrence depends on the origin of the hernia (congenital or acquired). The reason for the formation of congenital hernias is the underdevelopment of the abdominal wall in the prenatal period. Such hernias include epigastric-umbilical hernias, hernia of the umbilical cord, non-closure of the vaginal process of the peritoneum.

As a result of an increase in intra-abdominal pressure, a hernia first occurs, and then a hernial sac is formed. In the future, there is a gradual increase in the hernial sac, and due to physical effort, the internal organs penetrate the hernial sac, pushing the layers of the abdominal wall in front of them.

The hernial sac is formed by stretching and progressive protrusion of the parietal peritoneum. The resulting hernia tends to increase over time, sometimes reaching huge size. In elderly and senile age, as a result of age-related involution of the connective tissue, even more favorable conditions arise for increasing hernias. The occurrence of hernias at any age is also favored by congenital anomalies.

Structure and pathological anatomy of hernias. True external hernias consist of the following elements: hernial ring (1); hernial sac formed by a leaf of the parietal peritoneum (2); the contents of the hernial sac, i.e. internal organs protruding into the hernia (3); hernia membranes, consisting of fascia and fiber (4) (Figure 2).

Under the hernial gate understand the weak points in the muscular-aponeurotic wall of the abdomen, through which the internal organs, together with the parietal peritoneum, exit the abdominal cavity. Hernial orifice can occur in any congenitally or acquired weakened area of ​​the abdominal wall. These places include natural fissures and channels passing through the thickness of the abdominal wall or acquired, formed as a result of trauma, surgery.

Congenitally weakened places are located where vessels, nerves or some organs (for example, the spermatic cord, umbilical cord, etc.) pierce the abdominal wall, or where there are gaps between muscles, fascia and aponeuroses.

Figure 2. Elements of a hernia

There is also a traumatic (including postoperative) occurrence of a hernial ring. The muscular aponeurotic tissues that form the edges of the hernial orifice are in a state of atrophy and fibrous degeneration due to the constant pressure of the increasing hernial protrusion. The shape, size of the gate and the degree of atrophy of their muscular aponeurotic edges have great importance for the clinical picture of the disease.

There are hernias with small hernial orifices (from 2 to 4 cm) and hernias with large orifices (whose diameter exceeds 4 cm). Natural canals include: inguinal canal, femoral canal, umbilical canal; to the fissures: the fissures between the aponeurotic, forming the white line of the abdomen, the lunate (spigelian) line, the obturator foramen, the sciatic foramen. Defects in the muscular-aponeurotic layers or a canal, which includes a deep hole, the canal itself and an external or superficial hole, can serve as a hernial ring.

hernial sac is a protrusion of the parietal peritoneum through the hernial ring. Hernial sacs are congenital or acquired. In the hernial sac, the mouth, neck, body and bottom are distinguished. The mouth is called the entrance to the hernial sac from the side of the abdominal cavity. The neck is that narrow part of the hernial sac, which is located in the thickness of the abdominal wall and connects the mouth with the body. The body of the hernial sac is its largest part. The distal part of the hernial sac is called the fundus.

The shapes and sizes of the hernial sac are different. Single-chamber, multi-chamber and double sacs are observed. The hernial sac may have additional pockets, partitions, cystic formations. In the initial stage of hernia formation, the hernial sac has a thin wall, then as it increases and as a result of infringement, injury and inflammation, it thickens, areas of cartilage density and calcification are formed.

In the region of the neck and bottom of the hernial sac, as a result of trauma and inflammation, adhesions and adhesions with the organs containing the hernial sac are often formed. These changes in the hernial sac may contribute to the infringement of the contents of the hernia in one of the cavities of the hernial sac. A complete hernial sac septum with isolation of one segment can lead to the formation of a hernial sac cyst.

The hernial sac is surrounded hernial membranes, the nature of which and the number in different hernias are not the same, preperitoneal fatty tissue, thinned fascia, muscle fibers (for example, m. cremaster), elements of the spermatic cord. The membranes are usually easily separated from the hernial sac in a blunt way, but sometimes, with a long-term existence of a hernia, especially after applying a bandage or after former inflammations, the membranes turn out to be cicatricially fused with each other and with the hernial sac.

The hernial sac may be absent: 1) in embryonic umbilical hernias, in which it is filled with the so-called primitive membrane and amnion; 2) about sliding hernias; 3) in false traumatic hernias.

The contents of the hernia can be almost all the mobile internal organs of the abdominal cavity that have entered the hernial sac. Any organ of the abdominal cavity (except for the pancreas) can be in the hernial sac. Most often, there are moving organs in the hernial sac: loops of the TC, OK, greater omentum. The contents of the bag are usually easily reduced into the abdominal cavity. The inner surface of the hernial sac in response to trauma, other irritations, inflammation or disorders of the blood and lymph circulation easily releases fibrin. The latter causes the occurrence of adhesions inner surface hernial sac with the organs in it or its walls with each other.

With the formation of adhesions between the contents and organs and the hernial sac, its contents become partially or completely irreducible. Due to the formation of adhesions, the hernial sac often turns into a two-, multi-cavity formation or takes the form of an "hourglass"; cysts appear in its wall. Often, single or looped jumpers are observed inside the bag, with which the internal organs turn out to be fused in places. Adhesions of the internal organs with the sac are most often observed at the mouth of the sac neck and in its bottom.

Clinic and diagnosis of uncomplicated hernias. Patients with uncomplicated external hernias, first of all, complain of pain in the area of ​​the hernia, especially felt during its formation, and the presence of a hernial protrusion in one of the hernial zones. In addition to the area of ​​hernial protrusion, pain can also be localized in the epigastrium, lower back. Hernial protrusion appears when straining or in the vertical position of the patient, disappears or decreases in a horizontal position after its manual reduction.

Pain in the area of ​​the hernial protrusion occurs especially during physical exertion, with bloating, long walking, sudden movements, coughing, constipation, changes in barometric pressure, and sometimes in connection with eating. If the hernia reaches a significant size and leaves the abdominal cavity, nausea, belching, sometimes vomiting, flatulence, and constipation may join. There is a violation of urination in cases where the contents of the hernial sac is the bladder, ureter, kidney.

The hernia develops slowly. Initially, in the place of the forming hernia, a tingling pain occurs during physical exertion, walking, running, lifting weights. After some time, a protrusion appears, which disappears in the horizontal position of the patient and reappears during physical exertion. The protrusion gradually increases, acquires a rounded or oval shape. With a sharp increase in intra-abdominal pressure, patients feel severe pain in the area of ​​​​the emerging hernia, observe the sudden appearance of a protrusion of the abdominal wall and hemorrhage into the surrounding tissues.

The main objective signs of an external uncomplicated (reducible) hernia are: swelling in the place of the abdominal wall, which is characteristic for the localization of abdominal hernias; quick and easy variability of the outlines and volume of this swelling; the existence at the site of the protrusion of a defect in the muscular-aponeurotic and fascial layers of the abdominal wall; the presence of the phenomenon of a cough push, felt by a finger inserted along the course of the protrusion of the hernia into the defect of the abdominal wall or into the hernia canal.

With an uncomplicated hernia, the protrusion is easily reduced into the abdominal cavity either without sound (if the contents are the omentum), then with a rumbling (if the intestinal loop is reduced).

After reduction, it is possible to determine the outlines of the hernial orifice, their size, the condition (strength, flabbiness, tone) of the surrounding tissues, the relationship of the hernial orifice with the hernia membranes and the hernial sac, and the displacement of the fusion with the help of palpation. The presence of an intestinal loop in the hernia is recognized by the smooth surface and elastic soft consistency of the protrusion, the appearance of a tympanic sound during percussion.

Palpation determines the consistency of the contents of the hernia. The determination of the elastic consistency at the same time gives reason to think about the intestinal loop, and the lobed structure and soft consistency - about the greater omentum.

After the reduction of the internal organs in the horizontal position of the patient, the hernial orifice is covered with a finger, the patient is asked to strain and the appearance of a hernial protrusion is determined. At the time of reduction of a large hernia, a characteristic rumbling in the intestines can be felt.

In the diagnosis, the symptom of "cough push" is important, which is determined after the reduction of the contents of the hernia. By inserting a finger into the hernial orifice, the patient is offered to cough. When the patient coughs, the examiner's finger feels the tremors of the protruding peritoneum and adjacent organs. Auscultation allows you to determine the nature of the contents of the hernial sac, since the peristalsis of the intestinal loops can be clearly determined.

A hernia can be reducible, partially reducible and irreducible.

Of the instrumental methods of research, fluoroscopy and radiography of the gastrointestinal tract are of the greatest importance, especially for large hernias. These methods are of particular importance in the diagnosis of hernias of the diaphragm and internal hernias. Intestinal contrast, Bladder helps in the diagnosis of sliding hernias. Suspicion of the presence of a bladder wall hernia (sliding hernia), which occurs in the presence of dysuric phenomena, can be confirmed by cystoscopy or, even better, by contrast radiography of the bladder. Difficulties in diagnosis may arise with rare types (obturator, ischial) or internal hernias.

Irreducible hernia. An irreducible hernia is called when its contents cannot be pushed into the abdominal cavity. This condition occurs as a result of fusion of organs with each other, with the walls of the bag, or as a result of narrowing of its neck. With an irreducible hernia, pain in the area of ​​​​the hernia, gastrointestinal disorders, and prolonged constipation are often noted. The development of irreducibility is due to trauma to the organs located in the hernial sac. As a result of aseptic inflammation, fairly dense adhesions occur. Irreducibility can be partial, when part of the contents of the hernia is reduced into the abdominal cavity, and the other part remains irreducible.

With complete irreducibility, the contents of the hernia are not reduced into the abdominal cavity. The development of irreducible hernia contributes to the long-term wearing of the bandage. Irreducible are more often umbilical, femoral and postoperative hernias. Quite often, multi-chamber hernias are irreducible. Due to the development of multiple adhesions and chambers in the hernial sac, an irreducible hernia is more often complicated by the infringement of organs in one of the chambers of the hernial sac or the development of adhesive LE in the hernial sac. With an irreducible hernia, the ability to work is significantly reduced.

An irreducible hernia is rarely asymptomatic. An irreducible hernia is recognized by the fact that for some time now, according to the patient, it has ceased to be amenable to reduction, but at the same time it does not affect either pain or a violation of the general functions of the body. An objective examination reveals a tumor-like formation of various consistency, which does not retract into the abdominal cavity and in the supine position with a relaxed abdominal press. An irreducible hernia is sometimes partially reduced, and when straining, it may increase slightly in size. Hernial ring is not defined. Percussion determines tympanitis or dullness.

Grigoryan R.A.

A hernia is nothing more than a protrusion of internal organs through a pathological defect that forms in the tissues. Most often, patients with pathology in the abdomen become patients of the surgical department. In this case, intestinal loops or parts of other organs exit through the defect. Separately, spinal hernias are distinguished, which have a completely different clinic and the cause of formation. But abdominal hernias have many similar symptoms.

Abdominal hernias are more common than other types of protrusion

Almost all forms proceed for a long time without any complaints. At the same time, under certain conditions, a complication may arise, and the most common is infringement. The condition is an emergency and requires immediate surgery. Otherwise, peritonitis or sepsis, life-threatening conditions, may develop.

In order to determine the pathology in oneself, it is important, first of all, to find out what hernias are and how they manifest themselves. Protrusions differ in localization. Based on this, a symptom complex of one form or another is determined.

The most common are external hernias of the abdomen. Only ¼ is internal.

More common is an external hernia bulge

The main cause of the pathology is an increase in internal pressure. The condition of muscle tissue and connective tissue is also important. In men, an inguinal hernia is most often diagnosed, but in women, an umbilical hernia is common. There are other types of hernia in the groin and abdomen.

Inguinal hernia

As already mentioned, the most common in men are inguinal hernias. They can be acquired, but sometimes congenital forms are also detected. In this case, the defect is formed in the region of the inguinal canal. In some cases, in men, the hernial sac descends lower and reaches the scrotum. If the pathology develops in women, then there is a possibility of spreading to the area of ​​the labia.

There are two types of this pathology:

• Oblique - implies the passage of parts of organs through the anatomical opening, namely the inguinal canal. In this case, the diameter of the defect changes gradually. Accordingly, the initial, canal and inguinal form is distinguished. With progression, an inguinal-scrotal form or a straightened form may develop.

Inguinal hernia can be congenital or acquired

• Direct - in this case, the defect is located along the inguinal canal, that is, it does not pass through it. With this development, the organs do not reach the scrotum.

This pathology often proceeds without any clinic. The only complaint is the presence of a protrusion in the groin area. It will be characteristic that it increases during weight lifting. In children, this form is often congenital and is determined in the first months of life. By the year it can pass on its own. If it doesn't, the scheduled operation is performed. The hernia does not cause any discomfort to the child.

femoral hernia

No less often femoral hernias are diagnosed. But unlike the case described above, this form is more typical for women. In most cases, a bilateral defect is detected, but the presence of a right or left-sided defect is not excluded. The main difference between the form is that in this case the hernia is located in front of the thigh.

Uncomplicated femoral hernia goes unnoticed for a long time

Pathology also causes little discomfort, and only with an increase in size or the development of complications, pain appears.

Umbilical hernia

This form is especially often diagnosed in female patients. At the initial stage of the pathology, in the absence of complications, the protrusion is easily reduced. At the same time, it is possible to palpate the edges of the hernial ring and assess its size. In the presence of a major defect, the following complaints appear:

• soreness in the protrusion area due to circulatory disorders and pinched nerve endings;
• nausea, and sometimes vomiting, due to impaired bowel function due to the fact that its loops penetrate the hernia ring;

An umbilical hernia is easily determined by palpation

• external changes in the form of a visually noticeable protrusion that interferes with the wearing of tight-fitting clothing.

Hernia of the white line of the abdomen

This form is more typical for men. Appears precisely in the area of ​​​​the position of the strip of connective tissue. It has minimal elasticity, and with tissue weakness or increased pressure, defects form first of all here.

Depending on where exactly the defect was formed, the following forms are distinguished:

• supraumbilical;
• paraumbilical;
• subumbilical.

Hernia of the white line of the abdomen to the touch is a soft protrusion

Pathology rarely worries patients. They are mainly treated due to the fact that a protrusion appears on the abdomen that is soft to the touch. With progression, pain, nausea, and stool disorders may join. In the hernial sac with a given location of the hernia, both intestinal loops and fatty tissues can be located. The last option is the safest.

Despite the fact that hernias in this area do not reach large sizes, they are often complicated by infringement.

When treating this form, it is important to note that it especially often occurs in parallel with diseases such as cholecystitis, peptic ulcer, and so on.

A dangerous complication of a hernia can be infringement

Postoperative hernia

Separately allocated postoperative hernia. This pathology can be provoked by violations in the technique of performing the operation, infection of wounds, and so on. Also important is the condition of the muscular layer of the abdomen, compliance with all recommendations after surgery and the presence or absence of concomitant pathologies.

Such a hernia is determined especially easily. There is a scar in the protrusion area from a previous intervention. For certain reasons, it becomes thinner, the inner layers of muscle tissue weaken and internal organs penetrate through the formed defect. Especially often, according to this scenario, hernias develop in overweight patients, with reduced immunity, as well as against the background of pathologies of the digestive and respiratory organs.

Incisional hernias appear in immunocompromised patients

Internal hernia

If all of the listed hernias can be determined visually, then internal ones develop imperceptibly for the patient and are diagnosed only during a complete examination. For this, an X-ray or CT scan is prescribed. Of all the existing diaphragmatic hernias, when parts of the internal organs pass through the anatomical holes in the diaphragm, they are especially often detected. Specialists distinguish the following classification of abdominal hernias with an internal location.

rare forms

But this is not all hernias that can be diagnosed in a patient. Separately allocated muscle. In this case, the protrusion is formed in the area of ​​torn fascia. That is why this pathology is more common in people professionally involved in a particular sport. The reason for the gap may be:

• sharp blows to the muscles;
• excessive loads;
• consequences of surgical procedures;
• hereditary predisposition.

Muscle hernias appear with excessive physical exertion

Very rarely, hernias of the xiphoid process, obturator, perineal or sciatic are detected. They have their own characteristics and are quite difficult to diagnose:

• A hernia of the xiphoid process is formed in the area of ​​the anatomical opening next to the xiphoid process. Through it, the digestive organs can penetrate into the lung cavity.

Pathology is especially difficult in terms of diagnosis, since in its clinic and examination results it has many similarities with tumors.

• Obturator hernias occur in older women. Outwardly, such a pathology may not manifest itself in any way, but there are still some complaints. First of all, it is pain in the region of the obturator nerve. Often, pain radiates to the leg, groin.

Lumbar hernia is visually invisible and is detected only in a certain position of the body

• Lumbar hernia is also rare. Most often localized on the side of the abdomen. It is revealed only if the patient is laid on his side. In the position on the sore side, the defect is invisible.
• Sciatic hernias are more often noted right-sided. In this case, the defect is formed in the region of one of the three holes in the pelvic region. It is noteworthy that the form is found predominantly in men.
• Perineal hernia, on the contrary, is detected more often in women. Outwardly, it can be confused with the sciatic or inguinal. Accurate diagnosis is carried out by vaginal examination.

A vaginal examination is required to diagnose a perineal hernia.

All of these pathologies apply to adult patients, but children also have a hernia, and in this case it has its own characteristics. First of all, it can be congenital and acquired. The first are detected immediately in the delivery room, and sometimes it is possible to diagnose pathology using ultrasound even during gestation. But still, it is the acquired one that is detected in the first months of a baby’s life more often.

The most common are umbilical and inguinal hernias. The first one is formed due to high blood pressure and the weakness of the ring. Detected during the first three months of life. Pathology manifests itself in the form of an increase in protrusion in the navel. This form does not cause the child much discomfort, provided that there is an uncomplicated hernia.

Inguinal are more typical for boys. In this case, there is a non-closure of the natural opening through which the organs penetrate the skin. Diagnosed predominantly oblique inguinal hernia. In the presence of such a disease up to 1-3 years, expectant management is carried out. Further, if the pathology persists, a planned operation is prescribed.

Inguinal hernias are more common in boys

Despite the fact that hernias in children do not cause much discomfort, they should definitely be consulted by doctors. The fact is that there is always the possibility of complications. With any hernia, it is a pinching, dangerous with peritonitis and tissue necrosis. Even the inguinal can have its own characteristics. So, it is often combined with a pathology such as dropsy of the scrotum, which also requires surgical intervention. Its need can only be determined by the surgeon.

The appearance of any changes, for example, an increase in protrusion, pain, redness of the skin, is an indication for an emergency visit to a doctor.

What causes hernias

So, there are many abdominal hernias, each of which differs in position, the likelihood of complications, and so on. But the reasons are often almost the same. Their clarification is an obligatory part of the diagnosis, since only by eliminating the causes it will be possible to completely get rid of the pathology. Even a timely operation can give a relapse of the disease if the causes of its development are not eliminated.

Patients with varicose veins are prone to hernias

There are two reasons for the formation of a hernia:

• tissue defect;
• increase in pressure.

These reasons can be attributed to almost any hernia. The tissue defect can be either congenital or acquired. Hereditary predisposition is especially clearly visible. It can be suspected by the presence of diseases such as varicose veins, hemorrhoids and flat feet. Acquired injuries include injuries, previous operations, illiterately planned workload.

An increase in pressure, as a rule, in the abdominal cavity occurs in the presence of both pathological processes and physiological ones. The first ones are inflammatory processes, diseases of the digestive system, tumors and so on. Physiological can be considered pregnancy, the process of childbirth, straining when emptying the intestines and sneezing.

There is a high risk of hernia during pregnancy

In the presence of tissue weakness, sometimes a prolonged cough is enough to form a defect.

When identifying a hernia, it is especially important to accurately determine the cause of its formation. If it is a chronic cough, then it should be dealt with in the first place, even before surgery. If there is a pathology associated with the failure of the connective tissue, then this problem should also be eliminated. In addition, this fact must be taken into account when drawing up a plan for the operation.

Establishing diagnosis

It is possible to determine a hernia both with the help of an examination and through instrumental research, but, for example, internal ones are detected only after a full examination of the patient. The diagnostic plan includes the following steps:

• questioning the patient for complaints;

Diagnosis of pathology begins with the collection of anamnesis

• assessment of hereditary burden;
• identification of concomitant pathologies;
• examination of the patient;
• palpation of the protrusion in different positions of the body;
• performing ultrasound, CT and x-rays.

Only on the basis of all the data it will be possible to make an accurate diagnosis. In this case, pathologies with similar symptoms should be excluded. First of all, these are tumors, lipomas, abscesses, lymphadenitis, dropsy, cryptorchidism, and so on.

An accurate diagnosis can be made after an ultrasound

Why treat a hernia

Hernia in most cases proceeds without complaints. Sometimes even a large protrusion does not cause discomfort, except for an external defect. But this does not mean that the pathology can not be treated. At any time, with a sharp movement, it may be pinched. As a result, the blood supply to the tissues is disrupted, which subsequently leads to tissue necrosis. This is accompanied by pain, nausea, weakness, and in the absence of timely assistance, symptoms of intoxication join.

A strangulated hernia, regardless of its position, is an absolute indication for surgery.

Treatment of pathology outside the stage of exacerbation or in the absence of complications can be performed in two ways:

• Conservative medicine is used in children under five years of age and in adults with contraindications to the operation. It consists in wearing a bandage, performing massage and exercise therapy. In this case, constant monitoring by a doctor is important.

Conservative treatment of a hernia involves wearing a bandage

• Surgical treatment is used in all forms. Only with its help it is possible to completely eliminate the defect, and with the right choice of technique for performing the intervention, it can also prevent the formation of a relapse. For this reason, the choice of a surgeon for hernia surgery should be especially careful.

Often, hernias are disguised as other pathologies, which greatly complicates the diagnosis. Therefore, if any discomfort or induration occurs, you should consult a doctor, and not wait for the onset of pain and other symptoms.

You will learn more about the types of hernias and the features of their treatment from the video:

Hernia- This is a disease in which the internal organs exit the cavity where they are located through pathologically enlarged openings, which is the result of an injury or developmental defect.

1. Classification of hernias of the anterior abdominal wall.

Hernia classification: I. By origin, hernias can be congenital or acquired. II. By location relative to the abdominal wall: external and internal. III. By localization. External hernias by localization are

1. Inguinal - straight and oblique.
2. femoral;
3. umbilical;
4. White line of the abdomen;
5. Lumbar;
6. perineal;
7. Back hole;
8. Gluteal;
9. Hernia of the xiphoid process;

Internal hernias by localization are divided into:

1. Diaphragmatic;
2. Hernias of the omental opening;
3. Hernia recessus duodenjtjunalis;
4. Hernia recessus sigmoideum;
5. Hernia recessus iliocecalis.

IV. By reducibility into the abdominal cavity: reducible and irreducible. V. In the presence of recurrence: recurrent, recurrent, and separately postoperative. Inguinal hernia is the most common type of hernia and occurs in 87-90%. In men, this type of hernia is 4-5 times more common than in women, due to the greater width of the inguinal canal. Fig.1. Topography of inguinal hernia.1 - a. et v. epigastrica inferior 2 - preperitoneal fatty tissue 3 - fascia transversalis 4 - hernial sac 5 - small intestine, 6 - tunica va-ginalis testis, 7 - fascia spermatica int., 8 - fascia cremasterica et m. cre-master, 9 - fascia spermatica ext., 10 - tunica dartos, 11 - skin, 12 - scrotum, 13 - m. obliquus internus abdominis, 14 - n. ilioinguinalis, 15 - aponeurosis m. obliqui externi abdominis. Inguinal hernias occur within the inguinal triangle, limited by the “perpendicular from above”, lowered from a point on the border of the outer and middle third of the inguinal ligament to the outer edge of the rectus abdominis muscle, laterally by the inguinal ligament, medially by the outer edge of the rectus abdominis muscle. Within the inguinal triangle there is a weak point - the inguinal gap (Geselbach's triangle). Its limits are laterally - the inguinal ligament, medially - the outer edge of the rectus abdominis muscle, from above - the lower edge of the internal oblique and transverse abdominal muscles. Inguinal hernias come out through the inguinal canal. The latter has 2 holes and four walls. The anterior wall is formed by the aponeurosis of the external oblique muscle of the abdomen, the posterior wall is formed by the transverse fascia, the upper wall is the lower edge of the internal oblique and transverse abdominal muscles, the lower one is the pupart ligament. External opening - formed by the legs of the aponeurosis of the external oblique muscle of the abdomen. The internal opening of the inguinal canal is a recess in the transverse fascia and is projected onto the external inguinal fossa. According to the anatomical structure, all inguinal hernias are divided into two groups relative to the place of exit from the abdominal cavity: oblique and straight. Oblique inguinal hernia - exits through the internal opening of the inguinal canal and is located outward from a.epigastrica inf., Repeating the course of the inguinal canal in the membranes of the spermatic cord and descends into the scrotum. According to the degree of development, oblique inguinal hernias are divided into 5 stages:

1. Initial - (penetrates through the inner ring of the inguinal canal)
2. Incomplete (channel) - the hernial sac is located within the inguinal canal
3. Complete - the bag extends beyond the inguinal canal;
4. inguinal-portal hernia descends into the scrotum
5. large hernia.

Direct inguinal hernia accounts for 5-10% of all types of inguinal hernias. Such a hernia exits through the medial inguinal fossa, does not pass through the inguinal canal, is never congenital, is located separately from the funiculus, and is often bilateral. There are many classifications of inguinal hernias, the most commonly used classification of Gilbert's hernias with Rutkov's application. Type 1: An oblique hernia in which there is a slight expansion of the internal inguinal ring. Type 2: An oblique hernia in which the internal inguinal ring is dilated no more than 4 cm. Type 3: Indirect hernia, in which the internal inguinal ring is dilated more than 4 cm and the hernial sac often descends into the scrotum. Type 4: direct hernia. Type 5: direct hernia, in which the hernial sac looks like a small diverticulum and hernial orifice no more than 1-2 cm. Type 6: hernia, which has both an oblique component and a direct one. This is the so-called "pantalon hernia" Type 7: femoral hernia. Differential diagnosis of inguinal hernia is carried out with: - dropsy of the testicular membranes - dropsy of the spermatic cord, - lymphadenitis, - tumors of the testicle, spermatic cord, scrotum, - abscess; - cyst of the round ligament of the uterus.