white line hernia
Introduction
Introduction to the white line The scorpion protruding through the abdominal white line is called the white line , also known as the abdomen. The abdominal white line is formed by intertwining the rectus abdominis sheath on both sides of the abdomen. The white line on the umbilicus is wider, and the white line under the umbilicus is narrow and firm. Therefore, the white line tends to occur on the umbilicus, and the white line of the abdomen is poorly developed or has pores. The sacral ligament deep in the upper part of the abdomen, the round ligament of the liver and the surrounding adipose tissue, first protrude from the defect of the white line (ankle ring), without peritoneal protrusion, so there is no sac, no visceral prolapse, only the extraperitoneal The fat is highlighted by the ankle ring. basic knowledge The proportion of illness: 0.05% to 0.10% Susceptible people: no specific population Mode of infection: non-infectious Complications: functional vomiting
Cause
Cause of white line
Abdominal wall strength is reduced (30%):
The weakening of the abdominal wall is an anatomical cause, which is the basis of the occurrence of sputum, and there are two cases of congenital and acquired. Congenital such as peritoneal sheath rupture, lower abdomen oblique muscle high, wide groin (Hesselbach) triangle, umbilical ring insufficiency, abdominal wall white line defect, etc., some normal anatomical phenomena, such as spermatic cord Or the uterine ligament through the inguinal canal, the femoral artery and vein through the femoral canal area, can also cause the abdominal wall strength to weaken. Acquired causes include surgical incision, poor healing of the drainage port, trauma, inflammation, infection, surgical cutting of the abdominal wall nerve, excessive fat infiltration in obese people, degeneration of muscles in old age, and abnormal metabolism of collagen, resulting in a firm fascia tissue. Anatomical reasons for the loosening of microporous connective tissue layers or fat.
Increased intra-abdominal pressure (33%):
Increased intra-abdominal pressure is a predisposing factor for many reasons, such as chronic cough (such as smokers and bronchitis in the elderly), chronic constipation, late pregnancy, ascites, difficulty urinating (prostatic hypertrophy, phimosis), frequent crying, weightlifting , often vomiting, and intra-abdominal tumors.
Prevention
White line prevention
Long-term physical labor, trauma, pregnancy, obesity, and a large amount of ascites can all be the cause of the occurrence of white mites. When the diaphragm and the upper abdomen are inconsistent and strong at the same time, such as severe coughing or breath holding, the force generated by pulling the diaphragm upward and pulling the sacral cross to the side is the largest at the midpoint between the xiphoid and the umbilicus. Therefore, this is the most common site of white line mites.
Complication
White sputum complications Complications, functional vomiting
The prognosis is good, and there is no special complication. The omentum is easy to adhere to the hernia sac and becomes difficult to relapse, but it is rarely incarcerated. White mites rarely incarcerate or strange, and 10% of patients may still have difficulty re-renaturation, causing discomfort to the patient, and even the risk of strangulation, so the diameter is greater than 0.5cm, symptomatic, larger Patients with white sputum or difficult, incarcerated, and strangulated white sputum should be treated surgically.
Symptom
White line sputum symptoms Common symptoms Abdominal midline lumps upper abdominal pain abdominal pain
(1) Abdominal pain: The most common symptom of patients with white sputum is upper abdominal pain. Most patients only show upper abdominal pain, while a few of them show severe deep pain. The mechanism of abdominal pain is mainly caused by sputum compression. The intercostal nerve fibers of the line cause localized pain. The omentum and the round ligament of the liver cause deep pain. The abdominal pain can be radiated to the lower chest and back. The degree of pain is related to body position, eating and heavy physical labor, and the position changes, especially Pain often relieves or disappears when lying down, and can be aggravated after eating or heavy physical labor. The severity of abdominal pain is not proportional to the size of the sputum, often small and clinical symptoms are very serious.
(2) nausea, vomiting: a small number of patients with white line sputum in addition to abdominal pain, may be accompanied by nausea, vomiting and other gastrointestinal symptoms, the mechanism is:
1 The large omentum and the round ligament pulled out can cause deep pain and cause gastrointestinal symptoms such as reflex nausea and vomiting.
2 large omentum and round ligaments can lead to pyloric sputum, and then nausea, vomiting and other gastrointestinal symptoms.
2. Signs
(1) Abdominal wall mass: The abdominal wall mass is the main sign of the white line sputum. Since most of the white line lice occur between the umbilicus and the xiphoid process, the lumps are mostly located on the white line between the xiphoid and the umbilicus. It can be biased to the midline side. The standing block or the post-meal block is more obvious. The diameter of the block is generally about 2~4cm. Some scholars have reported that the largest piece of the block has a diameter of 15cm. A few patients have a small block, but the skin is soft. Round protrusions are not easy to detect, and obese patients are more difficult to find. When the contents of the sputum are returned, they can touch the edge of the fascial ankle ring at the white line.
(2) Litten sign positive: During the physical examination, put your finger on the suspected sputum, and cough when you are in the standing position. Sometimes, while coughing, the finger can feel the cracking sound, which means the Litten sign is positive.
(3) Inducing pain: pulling the tumor with the thumb and forefinger and pulling it outward, often affecting the abdominal pain of the patient due to the involvement of the round ligament, peritoneum or omentum. Moure et al believe that this is a specific clinical condition of the white sputum. Signs.
Examine
White line inspection
1. History: There are no special symptoms. The patient reports abdominal pain, especially when the force is painful or aggravated, or the history of the abdomen can be re-established. Smaller white mites tend to be painful and easy to incarcerate.
2. Clinical features: mass in the midline of the abdomen, supine and rectus abdominis when the sacral block is retracted and can touch the abdominal white line defect ( ring), Litten sign is positive, and the thumb and index finger are used to clamp the mass and pull outward. Pain and so on. Small and obese patients with prominent abdominal wall should be carefully examined to avoid missed diagnosis.
Diagnosis
White line diagnostic identification
Those with deep abdominal pain and gastrointestinal symptoms such as nausea and vomiting must be differentiated from upper gastrointestinal diseases. Some patients with white-line paralysis have been misdiagnosed as chronic cholecystitis, chronic pancreatitis, chronic gastritis, stomach or duodenal ulcer, and have long been treated in internal medicine. Because this disease is often accompanied by abdominal diseases and other parts of the abdominal hernia, and the pain in the white line is often found in other upper abdominal diseases, so before the diagnosis of white line sputum, it should be thought that there are visceral organs at the same time. Therefore, it is necessary to ask the medical history and comprehensive examination to avoid misdiagnosis or missed diagnosis.
