Umbilical hernia in adults
Introduction
Adult umbilical hernia Adult umbilical hernia (umbilical herniainadult) is a sputum formed by the increase of intra-abdominal pressure and the bulging of the abdominal organs under the umbilical ring closure. It is acquired umbilical hernia, which is common in middle-aged and elderly women. Secondary to long-term increase in intra-abdominal pressure and excessive stretching of the abdominal wall. Adult umbilical hernia is characterized by inability to self-heal, and is constantly increasing, prone to incarceration or strangulation; followed by sputum content and umbilical scar skin adhesion, usually can not be repaid, surgery. basic knowledge Sickness ratio: 0.05%-0.10% Susceptible people: more common in older women Mode of infection: non-infectious Complications: intestinal obstruction acute peritonitis liver cirrhosis upper gastrointestinal bleeding
Cause
Adult umbilical hernia
Causes
Increased intra-abdominal pressure (45%):
Insufficiency of umbilical ring insufficiency, weak umbilical tissue or atrophy of abdominal fascia muscle is the pathological basis of umbilical hernia. Pregnancy, obesity, excessive omental fat, chronic cough, cirrhosis, ascites, etc. An important incentive.
Umbilical ring scar tissue weakened (38%):
It may be related to the weakening of scar tissue at the umbilical ring, which is the weakest area of the abdomen. In the case of coughing or constipation, or when the abdominal pressure rises due to other chronic diseases, the internal organs are squeezed, and the internal organs such as the small intestine penetrate the weak abdominal wall to form the umbilical hernia.
Pathogenesis
In early childhood, the umbilical ring is closed, and the scar is formed locally, which becomes a weak part of the abdomen. The middle-aged and multiple pregnancy are partially degenerated or degenerative due to partial degeneration or degeneration of the abdominal muscles, and the abdominal wall is more fragile. When excessively stretched, the viscera is removed from the weak part of the umbilical cord. The wall and coating of the umbilical hernia are thinner. The contents of the sputum are like subcutaneous. The contents of the sputum are mostly omentum, followed by the small intestine and colon. There is often adhesion between the contents and the umbilical hernia sac, forming a multi-atrial gap, and sometimes intestinal obstruction. Pregnant women or patients with cirrhosis and ascites, such as umbilical hernia, sometimes have spontaneous or traumatic wear. broken.
Prevention
Adult umbilical hernia prevention
Obese people with weak abdominal wall, middle-aged and elderly women and chronic diseases with increased intra-abdominal pressure should pay attention to the degree of cough and exertion. When umbilical hernia occurs, surgical treatment should be taken as much as possible.
Complication
Adult umbilical hernia complications Complications, intestinal obstruction, acute peritonitis, cirrhosis, upper gastrointestinal bleeding
1. Incarcerated and strangulated adult umbilical hernias are narrow and have a tough scar tissue around them. Therefore, adult umbilical hernias are more incarcerated or strangulated. At this time, severe pain occurs and mechanical properties may occur. Intestinal obstruction, acute peritonitis and symptoms of systemic poisoning.
2. Umbilical hernias worn by pregnant women or patients with cirrhosis and ascites, due to excessive traction of the abdominal muscles, abdominal wall tension is extremely high, sometimes spontaneous or traumatic perforation.
3. Upper gastrointestinal bleeding cirrhosis with umbilical hernia, if surgical repair, may increase the collateral circulation of portal vein blood flow, thereby inducing upper gastrointestinal bleeding.
Symptom
Adult umbilical hernia symptoms Common symptoms Ascites Abdominal discomfort Indigestion Umbilical part of the umbilicus has a globular mass. The umbilical cord is obviously red and swollen. There is a cherry red in the umbilicus.
Clinical symptoms
1. Symptoms: umbilical hernia mass, coughing and sputum block when forced, disappeared when lying down, local pain or abdominal discomfort, may be associated with indigestion, in the presence of incarceration, may have incomplete or complete intestinal obstruction.
2. Physical examination: There are half spherical lumps in the umbilicus, soft and huge umbilical hernia can hang down. If the contents of the sputum are intestines, the peristalsis can be seen; when standing upright, the sacral sacral, when lying down, squatting; there is a coughing impact, back Naco touches the umbilical defect and the round ankle ring.
Examine
Adult umbilical hernia examination
The main clinical manifestation of umbilical hernia is the presence of a spherical or hemispherical reversible mass in the umbilicus. When you do an increase in intra-abdominal pressure (such as crying, standing or exerting force), the mass will increase and become tense. When the umbilical mass is lightly pressed by hand, the contents of the sputum can be incorporated into the abdominal cavity, and the sound of the gas can be smelled, and the umbilical ring or the ankle ring can be touched, and the adult umbilical hernia is larger. There are no symptoms of umbilical hernia. Individuals may have local discomfort or even pain. It may be caused by the peritoneum and fat of the sac sac.
Routine visual inspection and palpation can be diagnosed, and sputum angiography and B-ultrasound examination can be differentiated from other abdominal wall diseases.
Diagnosis
Diagnosis of adult umbilical hernia
diagnosis
1. History: Learn more about the patient's history of multiple pregnancies, history of chronic cough, and ascites of cirrhosis.
2. Clinical features: reversible umbilical hemispherical mass; cough impact can touch the umbilical defect and ankle ring.
3. Auxiliary examination: can exclude other diseases of the abdomen.
Identification
Ultrasound can also be selected clinically for difficult diagnosis. In addition, it should be differentiated from the inguinal hernia, sputum and femoral hernia.
