Abdominal hernia description. Abdominal hernias (abdominal hernias)

(lat. hernia) - protrusion of organs from the cavity, through a pathologically formed or naturally existing hole. At the same time, the shells retain their integrity. The formation can extend into the intermuscular space, under the skin, or into internal cavities and pockets. Eventration (prolapse of internal organs through a defect in its wall) and prolapse (exit of an organ through a natural opening during prolapse) are not hernias.

Types/classification of the disease

Highlight uncomplicated And complicated(inflammation, rupture and phlegmon of the hernial sac, strangulation) of the hernia.

The disease happens along the way:

primary;
recurrent(re-formation of a hernia in the same place);
postoperative(ventral).

By origin of hernia can be acquired, developing as a result of illness or injury or congenital(for example, central Schmorl's hernia), which are developmental defects and have their own characteristics.

According to reducibility they are distinguished:

Reducible- a protruding hernial sac is reduced independently or can be easily reduced through the hernial orifice;
Irreversible– usually due to the formation of adhesions, strangulation or adhesions, a hernia that was previously reduced cannot be returned to its place.

Anatomically, hernias can be external(internal organs fall out under the skin, and the hernia looks like an oval or rounded protrusion), they make up 75%, these are the femoral, epigastric, inguinal, umbilical, sciatic, white line of the abdomen, xiphoid process.

Internal a hernia occurs in 25% of all such pathologies, has no clear external symptoms, organs protrude into crevices, pockets or anatomical cavities or defects. They are divided into intra-abdominal and diaphragmatic.

Symptoms and signs

A protrusion is observed at the site of the hernia formation; when palpated, a hernial orifice is felt. Saccular swelling can vary in size.

Intervertebral hernia

Dystrophic changes in the lumbosacral spine most often appear in adults aged 20 to 50 years. Pathology often becomes the basis for temporary loss of ability to work and even disability. Osteochondrosis in almost all cases provokes the development of a back hernia. In this case, a pain syndrome appears, which can be accompanied by sensory disturbances, paralysis and paresis of the leg muscles, and dysfunction of the pelvic organs. 18% of patients with intervertebral hernias require surgical intervention.

The pathology develops as a result of a disc rupture, the hernia goes back, puts pressure on the nerve root, causing swelling and inflammation. The clinical picture begins to appear one day after the onset of the disease. In almost all patients, the main complaint is pain. Most often it appears in adolescence after a long stay in an uncomfortable position, physical activity or in bed. The disease develops when turning to the side occurs in parallel with bending, sometimes the person also lifts weights.

Lumbar and sacral hernia(sequestrated) begins with a dystrophic process, then changes occur in the spinal motion segments, the strength of the fibrous ring decreases, the microcirculation of this area is disrupted, an adhesive process develops, and swelling of local tissues develops. The symptoms are caused by myofixation as a result of tension in the back muscles, which provokes compensatory curvature of other parts of the spinal column. The long course of the disease leads to dysfunction of the joint-ligamentous apparatus, accompanied by severe pain.

If the intervertebral disc falls into the lumen of the spinal canal, it develops dorsal hernia, which, like other types of pathologies of the lumbosacral region, can manifest itself as autonomic disorders, such as redness, dryness and swelling of the skin, and impaired sweating.

Often, patients take a forced position, with its help the pressure on the spine is reduced, that is, scoliosis is smoothed out, flexion and extension of the body is facilitated, and tension in the long back muscles is eliminated. Occasionally, patients cannot straighten their leg due to pain. Due to atrophy, the muscles “deflate”. Motor disorders (paresis, paralysis) occur only in severe cases.

When coughing and moving, the pain intensifies and often becomes very severe; the patient needs bed rest.

Cervical and thoracic hernia are very rare and have similar symptoms:

Headache;
acute pain radiating to the arms, shoulder blades, shoulders;
unsteadiness of gait;
numbness of fingers;
restriction of movement;
hypertension or hypotension;
dizziness;
weakness in the limbs, decreased reflexes;
sleep disturbance;
chronic fatigue;
memory impairment.

Inguinal hernia- protrusion of the peritoneum into the cavity of the inguinal canal. It is 10 times more likely to occur in men than in women. The main signs of the disorder are a feeling of discomfort and pain in the groin area, intensifying while walking, dysfunction of urination and digestion. A lump forms in the groin and grows when coughing and straining. In men with inguinal hernias of significant size, the affected side of the scrotum enlarges, because of this the penis moves to the opposite side, and with large volumes of formation, the penis can be completely hidden under the skin.

Brief interesting data
- It was Claudius Galen (born around 130 AD) who first introduced the term “hernia.”
- There is a term “giant hernia”, it is used to refer to hernias larger than 40 cm.
- Most often, namely in 80-90%, inguinal hernias occur.
- Statistics indicate that multiple hernias are much more common than single ones.

The linea alba is formed by tendon fibers. When a hernia forms, the patient experiences pain, as with a stomach ulcer and other gastrointestinal ailments. On the line itself there is a protrusion, which occurs mainly when straining in the epigastric region. The pain intensifies after eating, with physical activity and sudden movements. Dyspeptic disorders are often observed: belching, nausea, constipation and heartburn.

Strangulated hernia of the white line cannot be reduced and is manifested by unbearable pain, blood in the stool, nausea and vomiting, retention of gases and bowel movements.

Hiatal hernia usually has no external manifestations. With this pathology, the stomach contents backflow into the esophagus, which causes hiccups, indigestion, heartburn, belching and chest pain.

Umbilical hernia- The abdominal organs extend into the navel area. Most often found in infants. This is due to the fact that the abdominal wall has a defect in which the umbilical ring, which usually closes before birth, remains uncovered. Pathology sometimes appears in children even after they begin to walk early. A hernia of less than a centimeter in a child may disappear on its own by the age of two. If a hernia was diagnosed in a newborn in time, then it can be cured simply with the help of gymnastics, massage and proper placement on the tummy. If necessary, surgery is performed no earlier than 5 years of age.

The acquired form of the disease proceeds a little more favorably. The child most often does not have any symptoms; the pathology manifests itself as a cosmetic defect. The dimensions of the bulge, as a rule, do not exceed 5 cm in diameter. Very rarely, adults experience aching or nagging pain, especially during physical activity, and constipation.

Not only in children, but also in dogs, namely puppies, an umbilical hernia often forms. The animal may refuse food and be depressed.

Complications

Intervertebral hernias cause some discomfort, but when complications occur, rather unpleasant symptoms develop: acute pain, migraine, numbness of the limbs, even paralysis. With disorders in the spinal region, the following develop: lumbodynia, lumbago, lumboischialgia or cauda equina syndrome. If the cervical vertebrae are affected, cervicalgia and cervicobrachialgia may appear, and the thoracic vertebrae - thoracalgia, intercostal neuralgia.

Abdominal hernias are often complicated by strangulation; this is an acute condition that requires urgent help. This disrupts blood circulation, the functioning of the pinched organ, and even tissue necrosis is possible. Severe pain develops, and when the intestinal loops are compressed, digestion is disrupted, up to intestinal obstruction. Internal organs and the hernial sac can become inflamed, which leads to the formation of an abscess, phlegmon, and peritonitis.

Causes of the disease

Abdominal hernias develop as a result of defects in muscle and tendon fibers. An elastic human corset helps maintain the desired position of organs in various body positions and counteract intra-abdominal pressure.

Causes of hernia formation:

Loss of elasticity in muscle tissue due to exhaustion or aging;
increased intra-abdominal pressure in combination with other negative factors;
congenital hole in the abdominal wall;
degenerative disorders at the site of injury or wound;
congenital abnormalities of connective tissue development;
various suppurations affecting the anterior abdominal wall.

Predisposing factors include: family history, individual differences in body structure, heavy physical labor, malnutrition, pregnancy, sharp fluctuations in intra-abdominal pressure (ascites, constant screaming, crying, difficulty urinating, coughing, prostate adenoma and constipation), intestinal dyskinesia.

A spinal hernia is usually the consequence of carrying heavy objects, sedentary work, prolonged vibration or incorrect posture. It develops as a result of pinched nerve trunks and narrowing of the spinal canal.

Diagnostics

First of all, the doctor will conduct an examination, since many hernias are visible to the naked eye. To confirm the diagnosis and early prediction of complications, instrumental diagnostics are performed. For different localizations, the information content of the examination differs. Often, during the study of a disease, such as osteochondrosis, a herniated disc is accidentally discovered.

Diagnostic methods that are most often used:

Ultrasound (ultrasound examination);
MRI;
X-rays are sometimes used when a contrast agent is injected;
CT (computed tomography).

Differential diagnosis is carried out with:

Hematoma, endometriosis, cyst;
dysplasia, osteochondrosis, arthrosis;
varicocele, hydrocele, lymphadenitis;
general diseases of organs and systems (pancreatitis, gastric ulcer);
neurofibroma and lipoma.

Treatment

The main treatment for hernias and their complications is surgery. During surgery, a special mesh is applied to prevent the hernia from coming out, or the damaged area is sutured. Currently, operations are performed endoscopically or using autoplasty (recovery is carried out using one’s own tissues). In order for the patient to return to normal life, a recovery period and intensive rehabilitation are necessary.

Removal of a spinal hernia is performed as a last resort; if there are no complications, traction is recommended. After the end of the acute period or during the recovery period, it is recommended to carry out massage, perform physiotherapeutic procedures (electrophoresis, diadynamic currents, hirudotherapy, acupuncture), exercises to strengthen the muscular-ligamentous frame of the back, and therapeutic exercises also contribute to this. For pain syndrome, NSAIDs (Voltaren, Ketorol, Diclofenac), glucocorticoid ointments (Lorindene, Deperzolon) are prescribed. For almost all types of hernias, to prevent complications, it is recommended to wear an orthopedic bandage.

Treatment of a hernia can be carried out in a sanatorium, where specialists will help carry out a set of measures for treatment and rehabilitation after surgery.

Prevention

To prevent this disease it is recommended:

Do not sleep on soft mattresses;
do not overeat and control weight;
stop smoking and take care of your liver;
avoid excessive loads and sudden movements;
keep your back and head straight when walking;
increase immunity and eliminate stress;
move more, play sports (swimming, yoga);
treat constipation, urological diseases, cough in a timely manner.

Traditional methods of treatment

Any home remedy can only be used with the permission of a doctor. If you are scheduled for surgery, then traditional treatment is unlikely to be effective.

Umbilical hernia treatment is carried out using a cake made of red clay, which is placed on top of the bandage for 24 hours. You can secure it using dressing material and cling film. The cake must be changed every day for 14 days. You can replace it with a copper coin, which must be applied for 3 days. Fix with a sticky bandage and repeat several times. You can also put cut garlic cloves on the hernia for up to 12 hours, but this procedure can cause a burn.

For vertebral hernia, red clay is also used or horse fat is used in the form of a compress of horse fat, which is applied to polyethylene in a thick layer for a day. It is good if the lower back is constantly wrapped in a belt made of dog hair.

Hernia is a disease in which internal organs emerge from the cavity where they are located through pathologically enlarged openings, which is a consequence of injury or developmental defect.

1. Classification of hernias of the anterior abdominal wall.

Classification of hernias: 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 are classified according to location

1. The inguinal muscles are straight and oblique.
2. Femoral;
3. Umbilical;
4. Linea alba;
5. Lumbar;
6. Perineal;
7. Back hole;
8. Gluteal;
9. Hernia of the xiphoid process;

Internal hernias according to localization are divided into:

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

IV. According to reducibility into the abdominal cavity: reducible and irreducible. V. In the presence of relapse: 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, which is due to the greater width of the inguinal canal. Fig.1. Topography of the inguinal hernia.1 - a. et v. epigastrica inferior 2 - preperitoneal fatty tissue 3 - fascia transversalis 4 - hernial sac 5 - small intestine, 6 - tunica vaginalis 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.

1. Inguinal hernias occur within the inguinal triangle, limited by the “perpendicular from above”, lowered from the 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 (Heselbach's triangle). Its limits are laterally the inguinal ligament, medially the outer edge of the rectus abdominis muscle, and above the lower edge of the internal oblique and transverse abdominal muscles. Inguinal hernias exit through the inguinal canal. The latter has 2 holes and four walls. The anterior wall is formed by the aponeurosis of the external oblique abdominal muscle, the posterior wall is formed by the transverse fascia, the upper wall is formed by the lower edge of the internal oblique and transverse abdominal muscles, the lower wall is formed by the Poupart 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 depression in the transverse fascia and projects onto the external inguinal fossa. According to the anatomical structure, all inguinal hernias relative to the place of exit from the abdominal cavity are divided into two groups: oblique and direct. Indirect inguinal hernia - exits through the internal opening of the inguinal canal and is located outside the 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, indirect inguinal hernias are divided into 5 stages:
2. Initial - (penetrates through the internal ring of the inguinal canal)
3. Incomplete (canal) - the hernial sac is located within the inguinal canal
4. Full - the sac extends beyond the inguinal canal;
5. inguinoportal hernia descends into the scrotum

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 cord and is often bilateral. There are many classifications of inguinal hernias, the most commonly used is the Gilbert classification of hernias with the Rutkov application. Type 1: indirect hernia, in which there is a slight expansion of the internal inguinal ring. Type 2: indirect hernia, in which the internal inguinal ring is widened by no more than 4 cm. Type 3: indirect hernia, in which the internal inguinal ring is widened by 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 the hernial orifice is no more than 1-2 cm. Type 6: hernia, which has both an oblique and a direct component. This is a so-called pantaloon hernia. Type 7: femoral hernia. Differential diagnosis of inguinal hernia is carried out with: - hydrocele of the testicular membranes - hydrocele of the spermatic cord, - lymphadenitis, - tumors of the testicle, spermatic cord, scrotum, - abscess; - round ligament cyst of the uterus.

Abdominal hernia (hcrniac abdominalis) - protrusion under the skin of the abdominal organs, covered with the parietal layer of the peritoneum, through various openings of the abdominal wall or pelvis.

If, as a result of an injury, the muscles of the anterior abdominal wall and parietal peritoneum are torn, and any organ of the abdominal cavity falls out through the resulting defect, then they speak of prolapse (prolapsus).

Subcutaneous eventration(evcntratio) - dehiscence of sutures on the peritoneum, aponeurosis and muscles, with a non-dehiscent wound of the skin (after surgical interventions).

There are external and internal hernias.

External hernias(herniae abdominalis externae) - protrusions that emerge through openings in the abdominal wall. These holes are most often normal anatomical formations, usually filled with fatty tissue, but they can occur as a result of various traumatic injuries or diseases.

By origin, external abdominal hernias can be congenital (congenita) or acquired (acquisita).

Internal hernias(berniae abdominalis internae) - entry of abdominal organs into abdominal pouches or diverticula (bursa omentalis, foramen Winslowi, recessus duodenoje-junalis, etc.). Diaphragmatic hernias are also classified as internal.

Internal hernias often cause a picture of intestinal obstruction and are inaccessible for examination without opening the abdominal cavity.

The components of external hernias are the hernial orifice, the hernial sac and its contents.

Hernial orifice - natural cracks and canals passing through the thickness of the abdominal wall (inguinal, femoral canals, etc.), as well as acquired as a result of injuries or after surgical interventions.

Hernial sac - part of the parietal peritoneum that exits through the hernial orifice. Hernial sacs vary in shape and size. They distinguish between the mouth, neck, body and bottom.

Contents the hernial sac can be any of the organs of the abdominal cavity: most often the small intestine as the most mobile organ, then the omentum, the colon (large) intestine, especially its mobile parts - the cecum with the vermiform appendix, the transverse colon and the sigmoid.

Classification of hernias by location: inguinal, femoral, umbilical, white line of the abdomen, xiphoid process, lateral abdomen, lumbar Greenfelt-Lesgaft triangle, sciatic, obturator, perineal.

According to their course, hernias are divided into uncomplicated (reducible), complicated (irreducible, strangulated, with symptoms of coprostasis and inflammation).

Uncomplicated hernias

Subjective signs of uncomplicated hernias (hernia libera, s. reponibilis) include pain localized at the site of the hernia, in the abdomen, and lumbar region. The appearance of pain usually coincides with the entry of the hernial contents into the hernial sac or with the reduction of the hernia. Various disorders may be observed in the gastrointestinal tract: nausea, sometimes vomiting, belching, constipation, bloating.

One of the objective symptoms characteristic of a reducible hernia is a tumor-like formation that appears and disappears in the area of ​​the hernial orifice. Hernial protrusion is usually associated with abdominal tension, and in the patient’s lying position it goes into the abdominal cavity on its own or with the help of manual reduction.

When hernias begin, the protrusion is determined only by a finger inserted into the hernial canal, which feels it as a push when coughing or straining.

Hernias are classified according to the degree of development:

1) beginning (incipiens);

2) incomplete, or intracanal (incompleta, intracanalicularis);

3) complete (completa);

4) scrotals (scrotales), which can reach enormous sizes (hernia permagna).

In some cases, to decide the presence or absence of a hernia, the patient must be examined repeatedly in different positions, resorting to additional examination techniques (long walking, lifting small weights, etc.), since with a narrow hernial orifice the insides enter the hernial sac only under significant physical stress. With large and medium hernias, the hernial opening is relatively easy to determine.

In addition to inspection and palpation, when examining a patient with a hernia, it is necessary to use percussion and auscultation. Thus, the presence of a hollow organ (intestine) in the hernial sac gives a tympanic sound upon percussion, and a rumbling sensation upon auscultation. If there is a dense organ (for example, an omentum) in the hernial sac, then percussion produces a dull sound. If there is a suspicion of the presence of a bladder in the hernial sac, an X-ray examination is performed with the injection of a contrast agent into the bladder.

Treatment of hernias in the absence of contraindications should only be surgical. During surgical treatment of uncomplicated hernias, absolute and relative contraindications are possible. Absolute contraindications include acute infectious diseases or their consequences, decompensated heart disease, malignant neoplasms; relative - early childhood, old age in the presence of chronic diseases, late pregnancy.

Radical surgery consists of removing the hernial sac after ligating it at the neck and narrowing the hernial canal using plastic techniques to strengthen the muscles and aponeurosis of the abdominal wall, depending on the location of the hernia.

Most hernia repairs are performed under local anesthesia (can be combined with neuroleptanalgesia), some under anesthesia, which is used mainly for children.

These patients do not require special preoperative preparation. On the eve of the operation, they take a hygienic bath, have the hair on their abdomen, pubic area and scrotum shaved, and have a bowel movement with an enema. Before being taken to the operating room, the patient's bladder must be emptied.

Management of the patient in the postoperative period depends on the type of hernia, the nature of the surgical intervention, the presence of complications, etc. It is necessary to take all measures to prevent postoperative complications, especially in the elderly.

After the operation and discharge of the patient home (with primary wound healing), persons engaged in mental work are issued a sick leave certificate for up to three weeks, then they begin to work. However, they are not recommended to engage in heavy physical labor for 2-3 months.

For persons with heavy physical labor, sick leave may be extended for a month. Then, by decision of the VKK, the patient can be transferred to lighter physical labor for the period provided for by the regulations on the VKK. If patients with postoperative relapses and other complications are unable to perform their professional work, then they are sent to VTEC to establish a disability group.

Despite its significant prevalence in the working population, hernias are rarely a direct cause of disability. In the practice of medical labor examination, disability due to hernias is established for elderly people in the presence of age-related changes in other organs. In young and middle-aged people, the causes of disability are persistent relapses or other postoperative complications.

Conservative methods of treating hernias are currently used extremely rarely: only if there are contraindications to surgery and the patient categorically refuses it. Such patients are prescribed to wear a bandage. However, a bandage in the area of ​​a hernia injures organs and tissues and does not protect against strangulation of the hernia.

Prevention of hernias should be aimed at eliminating the causes of their formation. A.P. Krymov notes two groups of such reasons:

I. Increasing intra-abdominal pressure:

1) disorder of defecation (constipation, diarrhea);

2) cough;

4) difficulty urinating (urinary canal strictures, prostate adenoma, phimosis);

5) playing wind instruments;

6) tight tightening of the abdomen;

7) difficult childbirth;

9) heavy physical work (lifting weights, carrying loads, working in a bent or other uncomfortable position, etc.).

II. Weakening the abdominal wall:

1) pregnancy, which stretches and thins the abdominal wall, especially repeated pregnancy;

2) diseases that cause weight loss and weakening of body muscles;

3) all kinds of injuries to the abdominal wall.

Physical therapy is a preventative measure to prevent the formation of hernias. Sports exercises, carried out under the supervision of a doctor, strengthen the muscles of the anterior abdominal wall.

To prevent hernias in childhood, proper child care is important. Moments that increase intra-abdominal pressure should be avoided: tightly swaddling infants, throwing them up when crying and screaming.

INGUINAL HERNIA

Inguinal hernias (herniae inguinales) are formed within the inguinal triangle, the lower side of which (hypotenuse) is the Poupartian ligament, the upper (superior leg) is a horizontal line drawn from the point located on the border between the outer and middle thirds of the Poupartian ligament to the intersection with the straight line abdominal muscle. The third side of the triangle will be a perpendicular running from the pubic tubercle to the intersection with the above horizontal line, which corresponds to the outer edge of the rectus abdominis muscle.

The inguinal canal is located obliquely - from top to bottom and to the middle. It has four walls and two holes. The anterior wall is formed by the aponeurosis of the external oblique abdominal muscle, the posterior wall is formed by the transverse abdominal fascia, the upper wall is formed by the edges of the internal oblique and transverse abdominal muscles, and the lower wall is formed by Poupart’s ligament.

External (subcutaneous) inguinal opening formed by the legs of the aponeurosis of the external oblique abdominal muscle, which are attached to the pubic tubercle. Between the legs of the aponeurosis there are transverse tendon fibers that limit the upper (lateral) side of the external inguinal ring.

Internal (abdominal) opening The inguinal canal is an opening in the transverse fascia of the abdomen and is located corresponding to the external inguinal fossa (fovea inguinalis externa). In men, the spermatic cord passes through the inguinal canal, consisting of the vas deferens, spermatic artery, vein, nerve and lymphatic vessels; in women, only the round ligament of the uterus.

Inguinal hernias are divided into oblique and direct. Oblique (external) inguinal hernia(hernia inguinalis obliqua) exits through the external inguinal fossa and is located outward from the art. epiga-strica inferior. The course of an oblique inguinal hernia strictly corresponds to the course and direction of the spermatic cord, i.e. the path taken by the testicle as it descends into the scrotum. With oblique inguinal hernias, the internal opening of the inguinal canal, located in the external inguinal fossa, does not coincide with its external opening, but lies 4-5 cm to the side of it. To exit through the opening of the inguinal canal, the hernial sac must pass this oblique path 4-5 cm long. 5 cm, which is why such hernias are called oblique.

Indirect inguinal hernias can be acquired or congenital. In congenital hernias, the abdominal organs enter the ungrown vaginal process of the peritoneum with the testicle lying at its bottom.

With congenital inguinal hernias, it is necessary to pay attention to the location of the testicle in the hernial sac. The testicle, in the process of its descent into the scrotum, does not enter the hernial sac (open abdominal-inguinal process), but only approaches the wall of the peritoneal-inguinal process and is covered with peritoneum.

Direct (internal) inguinal hernia(hernia inguinalis interna, medialis, directa) exits through the internal inguinal fossa (fovea inguinalis media), which is a permanent anatomical formation and is located between the lateral vesico-umbilical ligament and fold a. epigastrica inferior (plica epigastrica).

An internal inguinal hernia has a direct direction due to the fact that the internal fossa (internal hernial ring) is located opposite the external opening of the inguinal canal. The hernial sac goes in a straight, sagittal direction, and for this reason such hernias are called direct inguinal.

In direct hernias, the hernial sac lies medially in relation to the elements of the spermatic cord, which is why they are called internal. In oblique hernias, the hernial sac is located outward, lateral to the elements of the spermatic cord.

According to their etiology, direct inguinal hernias are always acquired and are observed mainly in elderly people.

Sometimes, with sliding hernias, the internal organs, partially covered by the peritoneum (cecum, bladder), form part of the wall of the hernial sac. The sliding of these organs passes through the retroperitoneal tissue, through the hernial orifice.

Sliding inguinal hernia most often irreducible, their hernial orifices are larger than usual. Patients with sliding inguinal hernias experience constipation, bloating, abdominal pain in the area of ​​the hernial protrusion during defecation, frequent urge to urinate, as well as pain radiating to the lumbar region.

For preoperative diagnosis of sliding inguinal hernias, X-ray examination is of great importance. In women, a bimanual examination helps make a diagnosis before surgery. However, an accurate diagnosis of sliding inguinal hernias is most often made during surgery.

During the operation, instead of the hernial sac, you can open a hollow organ, which should always be remembered.

Oblique inguinal hernias descending into the scrotum must be differentiated from hydrocele of the testicle, as well as from hydrocele of the spermatic cord.

Hydrocele of the testicle(hydrocaele) develops slowly, without causing any pain. The fluid produced by the serous membrane of the testicle accumulates in the cavity formed by the testicle and its own membrane. As fluid accumulates, the hydrocele cavity stretches more and more, becomes tense and does not fit into the abdominal cavity, the testicle and epididymis are not palpable. When feeling the spermatic cord at the external opening of the inguinal canal with hydrocaele, you can freely close your fingers at its upper pole, feeling the vas deferens between them, whereas with an inguinal-scrotal hernia you cannot close your fingers.

Differential diagnosis is also carried out using the diaphanoscopy method. In a dark room, a brightly glowing cystoscope bulb is placed under the scrotum. With hydrocele of the testicle, the half of the scrotum, stretched from the accumulation of serous fluid, turns into a glowing bright pink lantern, at the bottom of which the shadow of the testicle, which does not transmit light, is clearly visible.

Clinical Distinction hydrocele of the spermatic cord(hydrocaele communicans) from hydrocele of the testicle is the phenomenon of emptying the hydrocele cavity at night, when the patient is in a lying position, and filling the sac again during the day when walking. In this case, diaphanoscopy also helps to carry out differential diagnosis.

In addition, inguinal hernias must be differentiated from dilatation of the veins of the spermatic cord(varicocaele), which occurs predominantly on the left, where the spermatic vein flows at a right angle into the renal vein. Upon examination, you can see nodes of intertwined varicose veins running along the spermatic cord, which extend high into the inguinal canal. In such cases, patients complain of pain along the spermatic cord, radiating to the lower back, and a feeling of heaviness in the lower abdomen.

To decide on surgical intervention for inguinal hernias, it is necessary to carefully examine the patient, establishing indications and contraindications for surgical treatment.

According to A.P. Krymov, inguinal hernias account for 73.4% of all hernias. Over a hundred methods of surgical interventions for inguinal hernias have been proposed, but few of them have found wide application in surgical practice.

The goal of surgical intervention for inguinal hernias is to eliminate the hernial sac and close the hernial orifice.

Operations for indirect inguinal hernias. Anesthesia is most often carried out with a local 0.25% solution of novocaine; in excitable persons it can be combined with neuroleptanalyesia; in children - only general.

The surgical intervention consists of the following stages: an incision of the skin, subcutaneous tissue and superficial fascia 8-12 cm long, 2 cm above the inguinal ligament; dissection of the aponeurosis of the external oblique abdominal muscle; separation of the hernial sac from the external flap of the aponeurosis of the external oblique abdominal muscle and from the elements of the spermatic cord; opening the hernial sac and repositioning the contents into the abdominal cavity; suturing the neck of the hernial sac and cutting off its peripheral part. Plastic surgery of the inguinal canal is performed according to one of the methods.

In plastic surgery of the inguinal canal, the methods of Girard, S. I. Spasokukotsky, A. V. Martynov, M. A. Kimbarovsky, as well as other methods of operations that the surgeon is well versed in are more often used.

Girard's method(Girard) consists of strengthening the anterior wall of the inguinal canal over the spermatic cord. First, the edges of the internal oblique and transverse muscles are sutured with interrupted silk sutures to the inguinal fold over the spermatic cord, and then, along the entire length of the incision, the internal flap of the aponeurosis is sutured to the edge of the inguinal ligament. The outer flap of the aponeurosis is laid on top of the inner one (like the flaps of a double-breasted coat) and sutured to the latter with interrupted silk sutures. Catgut sutures are placed on the subcutaneous tissue and silk sutures on the skin. Aseptic bandage on the skin, suspensor.

According to Spasokukotsky's method The internal flap of the aponeurosis of the external oblique abdominal muscle, together with the edges of the internal oblique and transverse abdominal muscles, is sutured to the Pupart ligament with one row of interrupted silk sutures, and the external flap of the aponeurosis is placed on top of the internal one. Many surgeons use the mixed Girard-Spasokukotsky method.

Martynov's method comes down to the formation of a duplicate from the leaves of the dissected aponeurosis: the internal flap of the aponeurosis of the external oblique abdominal muscle is sutured to the Pupart ligament, the external one is laid on top of the internal one and sutured to the latter.

According to Kimbarovsky's method the internal flap of the dissected aponeurosis of the external oblique abdominal muscle and the underlying muscles are stitched from the outside to the inside, retreating 1 cm from the edge of the incision: the needle is passed again only through the edge of the internal flap of the aponeurosis, going from the inside to the outside, then the edge of the Poupart ligament is stitched with the same thread; The outer flap of the aponeurosis is sutured over the inner flap.

Operations for direct inguinal hernias. In direct inguinal hernias, the hernial sac usually has a wide base, so the neck of the sac is sutured with an internal purse-string suture, and the sac is excised below the steel ligature.

Plastic surgery of the inguinal canal is performed using the Bassini method or the N.I. Kukudzhanov method.

Bassini method(Bassini) is as follows:

1) the spermatic cord is retracted upward and outward;

2) using interrupted silk sutures, the edge of the internal oblique and transverse muscles along with the underlying transverse fascia is sutured to the inguinal ligament;

3) in the area of ​​the pubic tubercle, the edge of the sheath of the rectus abdominis muscle is sutured with 1-2 sutures to the Pupart ligament and periosteum of the pubic bone;

4) having tied all the sutures one by one, the spermatic cord is placed on the created muscle bed;

5) over the spermatic cord, the edges of the aponeurosis of the external oblique abdominal muscle are sutured with a series of interrupted sutures.

At the core Kukudzhanov's method lies the principle of strengthening the posterior and anterior walls of the inguinal canal; in the area of ​​the internal hernial orifice, the preperitoneal fatty tissue is sutured with several sutures, the spermatic cord is retracted anteriorly, the transverse fascia is sutured with two mattress sutures, capturing the iliopubic and inguinal ligaments in the sutures, the sheath of the rectus muscle and the aponeurotic fibers of the internal oblique and transverse muscles are sutured to the medial iliac section - pubic and inguinal ligaments. The spermatic cord is placed in place and sutured over it to duplicate the edge of the dissected aponeurosis of the external oblique abdominal muscle.

Operations for congenital inguinal hernias. For congenital inguinal hernias, two methods of surgical intervention are mainly used - without opening the inguinal canal (according to Roux-Oppel) and with opening the inguinal canal.

According to the Roux-Oppel method after dissecting the skin and subcutaneous tissue, the hernial sac is isolated and opened, the hernial contents are inserted into the abdominal cavity. The hernial sac brought into the wound is bandaged at the neck, cut off, and the stump is immersed in the preperitoneal tissue. The external opening of the inguinal canal is sutured with two or three silk ligatures. Interrupted sutures are placed on the anterior wall of the inguinal canal, capturing the aponeurosis of the external oblique abdominal muscle and the underlying muscles slightly above the inguinal canal in the suture on one side, and the inguinal ligament on the other. This method is used for small initial hernias, both congenital and acquired.

At method with opening the inguinal canal access to the hernial sac is the same as for acquired indirect inguinal hernias. Along the spermatic cord, the fascia cremasterica is dissected along with the fibers of the m. cremaster and fascia spermatica interna, isolate the anterior wall of the hernial sac and open it at the neck. The hernial contents are reduced into the abdominal cavity, the posterior wall of the hernial sac at the neck is separated from the elements of the spermatic cord, and then dissected in the transverse direction. The neck of the isolated part of the hernial sac is sutured with a silk ligature, bandaged and cut off, and the testicle is removed into the wound along with the rest of the hernial sac. The latter is excised and twisted around the testicle and spermatic cord, sewing it together with rare interrupted sutures. If the hernial sac is larger, then it is excised over a large area, leaving the peritoneum only on the spermatic cord and testicle. Plastic surgery of the inguinal canal using one of the methods.

– this is the migration of internal organs, surrounded by the outer (parietal) layer of the peritoneum, under the skin or into various parts of the abdominal cavity through defects in the muscular aponeurotic layer. Abdominal hernias form at weak points in the abdominal wall. Uncomplicated pathology is manifested by a painless protrusion under the skin, which is freely reduced. A complicated hernia becomes painful and cannot be reduced. The diagnosis is made on the basis of a clinical examination, ultrasound of the abdominal organs, and herniography. Treatment is exclusively surgical; wearing a bandage is indicated only if there are contraindications to surgery.

General information

Abdominal hernia is a protrusion of the abdominal organs along with the outer layer of the serous membrane through the anterior wall of the abdomen; sometimes - movement of organs and intestinal loops into the openings of the mesentery or diaphragm within the abdominal cavity. Every 5 people per 10 thousand of the population suffer from various hernias; of these, at least 80% are men, the remaining 20% ​​are women and children. About 30% of all surgical interventions in pediatric surgery are performed for this pathology. In adults, inguinal and femoral hernias are more often diagnosed, in children – umbilical hernias. Hernias are most common in preschool age and after 45 years.

In terms of frequency, all ventral hernias are distributed as follows: inguinal hernias occur in 8 cases out of 10, postoperative and umbilical hernias are diagnosed in equal proportions - 8% each, femoral hernias - in 3% of cases, and diaphragmatic hernias - in less than 1% of patients. Today, new surgical techniques (tension-free) are being developed in abdominal surgery, which ensure a low relapse rate.

Causes of hernias

Abdominal wall hernias do not occur spontaneously; their appearance requires a combination of a number of pathological factors and time. All causes of abdominal hernias are divided into those that predispose to the formation of protrusion and those that cause them. Predisposing factors include:

• congenital weakness of tendons and muscles
• acquired changes (as a result of operations, injuries, exhaustion), as a result of which weak points of the body corset are formed (in the area of ​​the femoral and inguinal canals, the umbilical ring, the white line of the abdomen, etc.).

The underlying causative factors stimulate an increase in intra-abdominal pressure and the formation of a hernia at such a weak point. These include:

• hard physical labor
• abdominal tumors
• hacking cough in chronic pulmonary pathology
• flatulence
• urinary disorders
• constipation
• pregnancy, etc.

It should be noted that the listed mechanisms of disease development must operate for a long time.

Classification

Based on location, all abdominal hernias are divided into external (extend beyond the boundaries of the abdominal wall under the skin) and internal (organs move into enlarged openings of the intestinal mesentery or diaphragm within the abdominal cavity). In terms of volume, the hernia can be complete or incomplete.

1. A complete hernia is characterized by the fact that the hernial sac together with its contents is located outside the abdominal wall.
2. With an incomplete hernia, the hernial sac leaves the abdominal cavity, but not the borders of the abdominal wall (for example, with an indirect inguinal hernia, the contents may be located in the inguinal canal).

Abdominal hernias can be reducible or unreducible. Initially, all formed hernial protrusions are reducible - with a little effort, the entire contents of the hernial sac are quite easily moved into the abdominal cavity. In the absence of proper observation and treatment, the volume of the hernia increases significantly, it ceases to be reduced, that is, it becomes unreducible.

Over time, the risk of a severe hernia complication—strangulation—increases. A strangulated hernia is said to occur when organs (contents) are compressed in the hernial orifice and necrosis occurs. There are different types of infringement:

• obstructive (fecal) occurs when the intestine is bent and the passage of feces through the intestines is stopped;
• strangulation (elastic) - when squeezing the vessels of the mesentery with further necrosis of the intestine;
• marginal (Richter's hernia) - when not the entire loop is pinched, but only a small section of the intestinal wall with necrosis and perforation in this place.

A separate group includes special types of abdominal hernia: congenital (caused by developmental anomalies), sliding (contains organs not covered by the peritoneum - the cecum (cecum), bladder), Littre hernia (contains a jejunal diverticulum in the hernial sac).

Symptoms of an abdominal hernia

Inguinal hernia

The manifestations of ventral hernias depend on their location; the main sign is the presence of a hernia formation in a certain area. An inguinal hernia can be oblique or straight. An indirect inguinal hernia is a congenital defect when the processus vaginalis of the peritoneum does not heal, thereby maintaining communication between the abdominal cavity and the scrotum through the inguinal canal. With an indirect inguinal hernia, the intestinal loops pass through the internal aperture of the inguinal canal, the canal itself and exit through the external aperture into the scrotum. The hernial sac passes next to the spermatic cord. Usually such a hernia is right-sided (in 7 cases out of 10).

Direct inguinal hernia is an acquired pathology in which weakness of the external inguinal ring is formed, and the intestine, together with the parietal peritoneum, follows from the abdominal cavity directly through the external inguinal ring, it does not pass next to the spermatic cord. Often develops on both sides. A direct inguinal hernia is strangulated much less frequently than an oblique hernia, but more often recurs after surgery. Inguinal hernias account for 90% of all abdominal hernias. A combined inguinal hernia is quite rare - it involves several hernial protrusions, unrelated to each other, at the level of the inner and outer rings, the inguinal canal itself.

Femoral hernia

Hernia of the white line of the abdomen

A hernia of the linea alba is formed when the rectus muscles diverge in the area of ​​the aponeurosis along the midline and the intestinal loops, stomach, left lobe of the liver, and omentum exit through this opening. A hernial protrusion can form in the supra-umbilical, peri-umbilical or sub-umbilical area. Often, hernias of the white line are multiple.

The rarest hernia of the anterior abdominal wall is located in the area of ​​the semilunar line (it runs almost parallel to the midline, on both sides of it, at the junction of the transverse abdominal muscle with the fascia).

Postoperative hernias

Formed during a complicated course of the postoperative period (wound infection, hematoma formation, ascites, development of intestinal obstruction, in obese patients). The peculiarity of such a hernia is that the hernial sac and hernial orifice are located in the area of ​​the postoperative scar. Surgical treatment of a postoperative hernia is carried out only after the effect of the triggering factor has been eliminated.

Diagnostics

Consultation with a surgeon is necessary for differential diagnosis of abdominal hernia with other pathologies. To establish an accurate diagnosis, a simple examination is usually sufficient, but in order to determine the tactics of surgical treatment, a number of additional examinations are required that will reveal which organs are the contents of the hernial sac, as well as assess their condition. For this purpose the following may be prescribed:

• X-ray of barium passage through the small intestine.
• In difficult situations, consultation with an endoscopist surgeon and diagnostic laparoscopy is required.

Treatment of abdominal hernias

Numerous studies in the field of abdominal surgery have shown that conservative treatment of hernias is completely ineffective. If a patient is found to have an uncomplicated abdominal hernia, a planned hernia repair is indicated; if the hernia is strangulated, emergency surgery is required. All over the world, more than 20 million surgical interventions for abdominal hernia are performed annually, of which about 300 thousand are performed in Russia. In developed countries, for every 9 planned interventions there is 1 operation for a strangulated hernia; in domestic clinics the indicators are slightly worse - for every 5 planned hernia repairs there is 1 urgent operation. Modern methods of diagnosis and surgical treatment of abdominal hernia are aimed at early detection of this pathology and prevention of complications.

Conservative treatment (wearing a bandage) is indicated only in cases where surgery is impossible: in elderly and malnourished patients, pregnant women, and in the presence of oncological pathology. Wearing a bandage for a long time helps to relax the muscle corset and provokes an increase in the size of the hernia, so it is usually not recommended.

Planned hernia repair

In previous years, classical methods of hernia repair prevailed, which consisted of suturing the hernial orifice and closing it with one’s own tissue. Currently, more and more surgeons are using tension-free hernioplasty techniques, which use special synthetic meshes. Such operations are more effective; after their use, recurrences of abdominal hernia practically do not occur.

When a hiatal hernia is detected in a patient, various operations are used (endoscopic fundoplication, gastrocardiopexy, Belsey operation) to reduce the hernial orifice and prevent the movement of abdominal organs into the pleural cavity.

Surgeries to eliminate external abdominal hernias can be performed under local anesthesia, including using endoscopic techniques. For any type of hernia repair, the hernial sac is first opened and the internal organs (the contents of the hernia) are examined. If the intestinal loops and other organs trapped in the hernial sac are viable, they are reduced into the abdominal cavity and a hernial orifice repair is performed. For each type of hernia, its own surgical technique has been developed, and the scope of surgical intervention in each case is developed individually.

Emergency hernia repair

If emergency hernioplasty of a strangulated hernia is performed, examination of the intestinal loops may reveal necrosis, perforation with incipient peritonitis. In this case, surgeons switch to an extended laparotomy, during which the abdominal organs are inspected and necrotic parts of the intestine and omentum are removed. After any operation for hernia repair, wearing a bandage, dosed physical activity only with the permission of the attending physician, and following a special diet are recommended.

Prognosis and prevention

The prognosis for an uncomplicated abdominal hernia is conditionally favorable: with timely surgical treatment, the ability to work is fully restored. Relapses after hernia repair are observed only in 3-5% of cases. In case of strangulation, the prognosis depends on the condition of the organs in the hernial sac and the timeliness of the operation. If a patient with a strangulated abdominal hernia does not seek medical help for a long time, irreversible changes occur in the internal organs, and the patient’s life cannot always be saved.

Prevention of the formation of abdominal hernias - moderate physical activity to strengthen the muscle corset and prevent weakening of the anterior abdominal wall. Accomplishing factors should be avoided: for this you need to eat right (include a sufficient amount of fiber and water in your diet), and monitor regular bowel movements.

A hernia is nothing more than a protrusion of internal organs through a pathological defect that forms in the tissues. The most common patients in the surgical department are patients with pathologies in the abdominal area. In this case, intestinal loops or parts of other organs come out through the defect. Spinal hernias are distinguished separately, having a completely different clinical picture and 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 may develop - life-threatening conditions.

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

The most common are external abdominal hernias. Only ¼ is internal.

More common is external protrusion of the hernia

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

There are two types of this pathology:

• Oblique - implies the passage of parts of organs through an anatomical opening, namely the inguinal canal. In this case, the diameter of the defect changes gradually. Accordingly, the initial, canal and inguinal forms are distinguished. As it progresses, an inguinal-scrotal form or a straight form may develop.

An 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 occurs without any clinical symptoms. The only complaint is the presence of a protrusion in the groin area. It is characteristic that it increases during weight lifting. In children, this form is often congenital and is determined in the first months of life. It may go away on its own by a year. If this does not happen, elective surgery is performed. The hernia does not cause any discomfort to the child.

Femoral hernia

Femoral hernias are no less often 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 side is possible. The main difference in the form is that in this case the hernia is located in front of the thigh.

An uncomplicated femoral hernia goes undetected for a long time

The pathology also causes little discomfort and only when the size increases or complications develop does pain appear.

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. In this case, by palpation it is possible to palpate the edges of the hernial ring and evaluate its size. If there is a major defect, the following complaints appear:

• pain in the area of ​​protrusion due to poor circulation and pinched nerve endings;
• nausea and sometimes vomiting, which is explained by dysfunction of the intestines due to the fact that its loops penetrate into 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 clothes.

Hernia of the white line of the abdomen

This form is more typical for men. It appears precisely in the area where the band of connective tissue is located. It has minimal elasticity and when the tissues are weak or there is increased pressure, defects are formed primarily here.

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

• supra-umbilical;
• periumbilical;
• subumbilical.

A hernia of the white line of the abdomen feels like a soft protrusion

Pathology rarely bothers patients. They mainly come to you because a protrusion appears on the abdomen, soft to the touch. As it progresses, pain, nausea, and bowel movements may occur. The hernial sac at this location of the hernia may contain both intestinal loops and adipose tissue. The last option is the safest.

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

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

A dangerous complication of a hernia can be strangulation

Postoperative hernias

Postoperative hernias are distinguished separately. 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 abdominal muscle layer, compliance with all recommendations after surgery and the presence or absence of concomitant pathologies.

Such a hernia is especially easy to detect. In the area of ​​the protrusion there is a scar from a previous intervention. For certain reasons, it becomes thinner, the inner layers of muscle tissue weaken and internal organs penetrate through the resulting 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.

Postoperative hernias appear in patients with reduced immunity

Internal hernias

If all of the listed hernias can be determined visually, then the internal ones develop unnoticed by the patient and are diagnosed only during a full examination. For this purpose, radiography or CT is prescribed. Of all the existing ones, diaphragmatic hernias are especially often detected when parts of the internal organs pass through the anatomical openings in the diaphragm. Experts distinguish the following classification of abdominal hernias with internal location.

Rare forms

But this is not all the hernias that can be diagnosed in a patient. Muscle muscles are distinguished separately. In this case, a protrusion forms in the area of ​​torn fascia. That is why this pathology is more common in people who professionally engage in one or another sport. The cause of the rupture may be:

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

Muscle hernias appear with excessive physical exertion

It is extremely rare to detect hernias of the xiphoid process, obturator, perineal or sciatic. They have their own characteristics and are quite difficult to diagnose:

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

The pathology is especially difficult in terms of diagnosis, since its clinical picture and examination results have 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 obturator nerve area. Often pain radiates to the leg and groin.

A lumbar hernia is visually invisible and is detected only in a certain body position

• Lumbar hernia is also a rare condition. Most often localized on the side of the abdomen. It is detected only if the patient is placed on his side. When positioned on the affected side, the defect is invisible.
• Sciatic hernias are more often observed on the right side. In this case, the defect is formed in the area of ​​one of the three holes in the pelvic region. It is noteworthy that the form occurs predominantly in men.
• Perineal hernia, on the contrary, is detected more often in women. Externally it can be confused with the ischial or inguinal. Accurate diagnosis is carried out by vaginal examination.

To diagnose a perineal hernia, a vaginal examination is required

All of the listed 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 ones are detected immediately in the delivery room, and sometimes it is possible to diagnose the pathology using ultrasound examination even during pregnancy. But still, more often it is acquired, detected in the first months of the baby’s life.

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

Inguinal ones are more typical for boys. In this case, there is a non-closure of the natural opening through which the organs penetrate the skin. Mostly indirect inguinal hernia is diagnosed. In the presence of such a disease, wait-and-see tactics are used for up to 1-3 years. Further, if the pathology persists, a planned operation is prescribed.

Inguinal hernias occur more often in boys

Despite the fact that hernias in children do not cause much discomfort, you should definitely consult a doctor about them. The fact is that there is always the possibility of complications. With any hernia, this is a pinching, dangerous for peritonitis and tissue necrosis. Even the groin can have its own characteristics. Thus, it is often combined with a pathology such as scrotal hydrocele, which also requires surgical intervention. Only a surgeon can determine its necessity.

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

What Causes Hernias

So, there are many abdominal hernias, each of which differs in position, likelihood of complications, and so on. But the reasons are often practically the same. Clarifying them is an obligatory part of the diagnosis, since only by eliminating the causes will it be possible to completely get rid of the pathology. Even a timely operation can cause a recurrence 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. Tissue defects 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, and poorly planned loads.

An increase in pressure, as a rule, in the abdominal cavity occurs in the presence of both pathological and physiological processes. The first include inflammatory processes, diseases of the digestive system, tumors, and so on. Pregnancy, the process of childbirth, straining during bowel movements and sneezing can be considered physiological.

There is a high risk of a hernia during pregnancy

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

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

Establishing diagnosis

A hernia can be determined both through examination and through instrumental examination, but, for example, internal hernias are detected only after a full examination of the patient. The diagnostic plan includes the following steps:

• interviewing the patient for complaints;

Diagnosis of pathology begins with collecting anamnesis

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

Only based on all the data will it 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 scan

Why treat a hernia

In most cases, the hernia proceeds without complaints. Sometimes even a large protrusion does not cause discomfort, other than an external defect. But this does not mean that the pathology cannot be treated. At any moment, with a sudden movement, it can become pinched. As a result, the blood supply to the tissue 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 are added.

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

Treatment of pathology outside the acute stage 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 if there are contraindications to surgery. It consists of 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 for all forms. Only with its help can the defect be completely eliminated, and with the right choice of intervention technique, it can also prevent the formation of a relapse. For this reason, you should be especially careful when choosing a surgeon for hernia surgery.

Often, hernias are disguised as other pathologies, which significantly complicates diagnosis. Therefore, if any discomfort or thickening occurs, you should consult a doctor, and not wait for pain and other symptoms to occur.

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