HERNIA Presenter: Golnaz Malekzadeh HERNIA Presenter: Golnaz Malekzadeh.

HERNIAPresenter:

Golnaz Malekzadeh

A hernia is an abnormal weakness or hole in an anatomical structure which allows something inside to protrude through.

It is commonly used to describe a weakness in the abdominal wall.

The signs and symptoms of a hernia can range from noticing a painless lump to the painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen—possibly a strangulated

hernia .

Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated).

If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency.

Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Obesity Heavy lifting Coughing Straining during a bowel movement or urination Chronic lung disease Fluid in the abdominal cavity Hereditary

lordosis Constipation Urine retention Difficulty in breathing Compartment syndrome And ….

1 .External

2 .Internal

3.intermittent

1 .reducible hernia is one in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent.

2 .irreducible hernia is one whose contents or part of contents cannot be returned to the abdomen, without serious symptoms.

hernias are trapped by the narrow neck

incarcerated hernia: is one whose contents cannot be returned to the abdomen, with severe symptoms.strangulated hernia: denotes compromise to the blood supply of the contents of the sac.

incarcerated hernia and strangulated hernia are the two stages of a pathologic courseRichter’s hernia (intestinal wall hernia ) a hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen.Sliding hernia is one in which the wall of a viscus forms a portion of the wall of the hernia sac. It is may be colon ( on the left), caccum (on the right) or bladder (on either side) . Belongs to irreducible hernia Littre hernia: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum).

Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, these hernias are composed usually of fatty tissue and rarely contain intestine.

Men > Women these hernias are often painless and

unable to be pushed back into the abdomen when first discovered.

1- Congenital2- Adault acquired

Common in infants Close spontaneously if <1.5 cm Repair if > 2 cm or if persists at

age 5 years

Repair primarily or with mesh

Women > men Risk factors

Multiple Pregnancies Prolonged labor Ascites Large Abdominal Tumors-CT scan may be indicated

for some patients Activities which result in strenuous physical

activity(occupational or recreational :example weight lifting)

Morbitiy and incarceration rate considered to be high enough to warrant repair. One study showed incarceration twice that of femoral hernia .

Unfortunately, recurrence rates as high as 20 -28 % have been recorded.

patients with ascites ???

..\ \ \ 5175Desktop ventral hernia herL um6b

Rare Hernia through subumbilical portion of

semi-lunar line Difficult to diagnose –Abdominal pain or

mass noted in abdominal wall. Frequently tender over area Clinical suspicion (location) CT scan

Repair primarily or with mesh

a protrusion of part of the contents of the abdomen through the inguinal region of the abdominal wall.

indirect inguinal hernia: the internal inguinal ring the inguinal

canal external inguinal ring scrotum

direct inguinal hernia: Hesselbach’s triangle

Pantaloon type

Hereditary Smoking CDH Sedentary life style acquired weakness or defect of

abdominal wall Increased intra abdominal pressure And ….

feature indirect direct

age children, young people aged people

pathway of protrusion coming down the inguinal canal, may enter the scrotum

pass through Hesselbach’s triangle, rarely enter the scrotum

contours of sac elliptic, pear-shaped semispheric, wide base

Relationship of spermatic cord with sac

Posterior to the sac Anterior and lateral to the sac

Relationship of sac neck with inferior epigastric artery

Sac neck is lateral to it Sac neck is medial to it

Incarcerated incidence high low

Palpation of hernia sac on spermatic cord

lymph node lipoma saphenous varicosity mass

RecurrenceNeuralgia

IlioinguinalIliohypogastricGenitofemoralLateral cutaneous

Ischemic orchitisInjury to vas deferenceWound infectionBleeding

All are acquired. Are secondary to an expanded

femoral ring. Probably due to increased intra

abdominal pressure Diagnosis by physical exam.

1. indirect inguinal hernia 2. lipoma 3. groin lymph nodes 4. long saphenous varix 5. iliolumbar tuberculous

abscess

an abnormal protrusion of a viscus through the musculoaponeurotic layers of a surgical scar.

Swelling and mass in the incision Rarely incarcerate

Operative factors: - types of incision: vertical incision, transrectus

incision, midline incision, standard paramedian incision - technique of closure - suture materialPostoperative factors: - increased intra-abdominal pressure - Obesity - Malnutrition - Smoking -Immune dificiency

Bring together fresh fascial edges after trimming sac

Clean off fascial edges at least 1 cm back

Close with interrupted or continuous sutures

Even with careful technique recurrence rates as high as 50% have been reported

1- Trendelenberg position

2-morphin+ diazpam

3-ice bag

Contra indications: Fever Lococytosis Positive abdominal sign Erythema of skin

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