Chapter 2. ABDOMINAL HERNIAS

Definition and statistical data

Abdominal hernias - the entrance or possibility of the entrance of the abdominal cavity inner organs through the natural or acquired openings of the abdominal wall, pelvic fundus, diaphragm (muscular-aponeurotic layer) under the outer body coverings or into the adjacent cavities with parietal peritoneum entity preservation.

They are found in 3-4% cases among the whole population. Among all hernias inguinal ones are 73% cases, femoral - 7%, umbilical - 8%, post-operative - 11%. Other kinds of hernias consist about 1%.

Differentiation of direct and oblique inguinal hernias

(according to indirect clinical and anatomical characteristics)

Characteristic

Direct hernia

Oblique hernia

Age

More often old

Young

Localization

More often bilateral

More often unilateral

Form

Rounded (semispherical)

Oval (elongated)

Direction of the cough tremor

Direct

Oblique

Descending into the scrotum

Does not occur

Occurs

Strangulation

Does not occur

Occurs

Origin

Always acquired

May be congenital

Sliding hernia

Occurs

Does not occur

Location of the spermatic cord

Laterally from the hernial sac

Medially from the hernial sac

Reference of the sac's neck to the epigastric vessels

More medial from the vessels

More lateral from the vessels

Intraoperative detection of the strangulated intestine vitality following the strangulating ring cleaving

Signs

Intestine is vital

Intestine is not vital

Hernial water

serous, transparent

turbid with odor

The color of the intestine

may be cyanotic, but after strangulation liquidation the normal color is quickly restored.

black-green or gray, after the strangulation liquidation the normal color is not restored.

Wall tonus

quickly restored after strangulation liquidation

after strangulation liquidation the intestine remains flabby

Peristalsis

quickly restored

absent

Pulsation of the vessels

preserved

absent

Limits of the resection of the dead intestinal loop: towards the efferent loop - 20 cm, towards the afferent side - 40 cm from the border with the intact intestine due to its overextension and intestinal wall dystrophy.

In the hernial sac phlegmon medial laparotomy is performed.

At the hernial sac phlegmon is performed laparotomy near hernia, resection of intestine, necrectomy.