abdominal incisional hernia

Introduction

Abdominal wall incision Incisional hernia is a hernia that protrudes through the abdominal wall by an intra-abdominal organ or tissue. This kind of cockroach has no real sac. More common in the longitudinal incision area of the abdomen, especially the median incision or the rectus abdominis incision. The incidence rate accounts for about 1.7% of the sputum, and rarely occurs in the first stage of healing incision. After infection in the incision, the incidence of incisional hernia increased significantly, reaching 10% to 30%. The cause of abdominal incisional hernia is related to systemic and local factors in the original surgery. Incision infection is the most important cause of incisional hernia. After infection, the incision healed in the second stage, and there were many scar tissues. The abdominal wall had different degrees of defects, and the abdominal wall strength of the incision site was significantly reduced. According to statistics, the incidence of incisional hernia after incision infection is 5 to 10 times that of the first-stage healing incision. Prevention of wound infection is the most important measure to reduce the incidence of incisional hernia. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal pain

Cause

Abdominal wall incision

The cause is related to systemic and local factors in the original surgery.

Incision infection (30%):

This is the main cause of incisional hernia. After infection, the incision healed in the second stage, the scar tissue was more, the abdominal wall had different degrees of defects, and the abdominal wall strength of the incision site was significantly reduced. According to statistics, the incidence of incisional hernia after incision infection was a first-stage healing incision. 5 to 10 times the prevention of wound infection is the most important measure to reduce the incidence of incisional hernia.

Incision type incisional hernia is more common in straight incisions, muscles in each layer of the abdominal wall (except for the rectus abdominis muscle fibers in the longitudinal direction), the fibers and nerves of the aponeurosis and fascia are transversely oriented, and the straight incision is bound to cut off the above layers of tissue. The straight incision after suturing always bears the tension of lateral traction. If the abdominal wall is weak and the pressure in the abdominal cavity is high, the incision is easy to split. Obviously, the incidence of incisional hernia in the transverse incision is much lower than that in the straight incision. Tension also facilitates the alignment of the transverse incisions.

Other factors (40%):

A weak abdominal wall or a chronic disease with increased intra-abdominal pressure is easy to induce incisional hernia, so it is more common in elderly or obese patients. Other factors related to the original surgery are poor intraoperative anesthesia, and the abdominal wall is forcibly closed or sutured. The organization of each layer is not exactly aligned.

Prevention

Abdominal wall incision prevention

Do daily care. Eat cereals, whole grains, beans and their products, fresh melons and vegetables and garlic, fragrant agar, fungus, onions, fish, etc.; eat more foods rich in vitamins A, B and vitamin C, such as oranges, apples, Tomatoes and other fruits and vegetables; taboo smoke, wine, raw garlic, mustard and other spicy foods; avoid high-salt foods. Avoid the increase of blood pressure due to sodium ion retention in the body; avoid eating acid, too spicy, salty, alcohol and other irritants.

Complication

Abdominal wall incision hernia complications Complications, abdominal pain

Timely treatment will not lead to complications.

Symptom

Abdominal incisional hernia symptoms Common symptoms Pain or bulge in the reclamation area

The main manifestation is that there is a protruding block at the incision when standing. It is more obvious when coughing or exerting force. Usually, the ankle ring is larger. After lying down, the block will disappear by itself. If the block is larger, there are more organs and tissues protruding. There may be abdominal pain, distraction and other discomforts. Because of the wideness of the ankle ring, incarceration or strangulation is rare. The patient is lying flat on the defect of the abdominal wall with his fingers, and then the patient's hernia can clearly lick the edge of the ankle ring. Understand the size of the defect and the strength of the marginal tissue. Intestinal peristalsis can be seen only in the abdominal wall defect.

Examine

Examination of abdominal wall incisional hernia

Routine examination: There is a protruding block at the incision when standing, which is more obvious when coughing or exerting force. Usually, the ankle ring is larger, and the flat block is self-returned and disappears after lying down. If the block is larger, there are more organs and tissues protruding. The patient with the squat is placed in the defect of the abdominal wall with his fingers, and the patient's hernia can be clearly licked to the edge of the ankle ring to understand the size of the defect and the strength of the edge tissue.

Diagnosis

Diagnosis and differentiation of abdominal wall incisional hernia

1. Have a history of abdominal surgery.

2. When standing, the abdominal wall mass is prominent, and it is more obvious when coughing or exerting force. When lying down, the mass disappears on its own. If the block is larger, there are more organs and tissues protruding.

3. The mass of the mass in the scar of the abdominal wall can reach the defect of the subcutaneous abdominal wall. The patient's hernia can clearly lick the ankle ring edge to understand the size of the defect and the strength of the marginal tissue.

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