interabdominal hernia
Introduction
Introduction to the abdominal wall Interparietalhernia is a special form of inguinal hernia. It is characterized by the fact that the abdominal organs do not descend through the abdominal tube, but protrude into the abdominal wall through the intra-abdominal ring. basic knowledge The proportion of illness: 0.052% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction
Cause
Abdominal wall disease
(1) Causes of the disease
The etiology of inguinal hernia sac rupture into the abdominal wall to form the intercondylar wall is still unclear. The comprehensive literature may be related to the following factors.
1. Stenosis or occlusion of normal stenosis : stenosis or occlusion of normal sacral stenosis is more common in patients with testicular hypoplasia, testicular insufficiency is related to abnormal testicular lead, testicular dysplasia and other factors, anatomical abnormalities, mechanical obstruction, fascia Covering the entrance to the scrotum, the scabbard does not enter the inguinal canal, etc. It is also the main factor that causes it to occur. Because the testicular insufficiency is accompanied by the uncinate process and the inguinal hernia, during the progression of the sputum, due to the inguinal canal And the outer ring is narrow and there are obstacles such as hard tissue, etc., the normal channel of the sputum is occluded, the sac block can not be covered by the stenosis or covered by the hard tissue, and can be pushed to the abdominal wall to form the inter-abdominal wall, and some scholars believe that: When the abdominal pressure suddenly increases, the abdominal organs forcefully expand the sacral neck, a large amount of sputum contents are prolapsed, and when the sacral neck retracts, the contents of the sputum cannot be returned, and the sudden increase of sputum content is strongly stimulated and causes the intra-abdominal oblique muscle. , the transverse abdominis muscle and abdominis fascia contraction close the inguinal canal, the contents of the sputum fail to enter the normal channel and enter the peritoneum and muscle, or form a peritoneum Between the abdominal wall hernia.
2. Inappropriate ankle compression : If the ankle strap is not pressed at the inner ring mouth, but is pressed below the inner ring mouth, when the intra-abdominal pressure is increased, the ankle block can protrude but cannot enter the inguinal canal through the normal passage of the ankle. The scrotum, but protruding into the abdominal wall tissue.
3. Improper resetting : When the inguinal hernia is incarcerated and the squeezing method is used, the contents of the sputum are forcibly squeezed through the inner ring due to improper resetting, and the abdominal cavity is not fully retracted at the neck of the sac, forming a peritoneum. The anterior space is paralyzed, and frequent and improper maneuver reduction can cause the tissue around the sac wall and the intra-abdominal ring to be weak and slack, and it is easy to induce inter-abdominal spasm.
(two) pathogenesis
According to the way in which the sac is sneaked in, the abdominal wall sputum is divided into three types:
1. Preperitoneal hernia : The hernia sac is located between the peritoneum and the transverse abdominis muscle. The intestine is invaded at the neck of the sac, where the bulge protrudes into the abdominal cavity, and the peritoneum is separated from the muscle. 20%,
2. Interstitial hernia : The hernia sac is located between the muscles of each layer, between the transverse abdominis muscle and the internal oblique muscle, or between the abdominal oblique muscle and the external oblique muscle aponeurosis, accounting for about 60%.
3 external ablique musculoaponeurotic hernia of abdomen: the hernia sac is located outside the aponeurosis of the external oblique muscle, accounting for about 20%, the position of the intercondylar sac can be between the transverse transverse fascia and the transverse abdominis muscle. Between the transverse abdominis muscle and the intra-abdominal oblique muscle or between the intra-abdominal oblique muscle and the external oblique muscle aponeurosis, a small number of abdominal wall spasm may exist simultaneously with the inguinal hernia (there are two ankle rings or biguanides).
Prevention
Prevention of abdominal wall
1. For the inguinal hernia should be diagnosed early, early treatment.
2. In the treatment of inguinal hernia, inappropriate compression of the ankle and manual reduction should be avoided.
Complication
Complications of abdominal wall hernia Complications, intestinal obstruction
At the time of physical examination, due to the incision or narrowing of the intestine, the symptoms of intestinal obstruction may be manifested, and a localized tender mass may be present.
Symptom
Abdominal wall hernia symptoms Common symptoms Paroxysmal abdominal pain, abdominal distension, abdominal pain, dull pain
Some patients had a history of inguinal hernia. After the incarceration, the doctor or the doctor gave a manual reduction treatment. After the reduction, the block disappeared, but the symptoms of abdominal pain still existed, and the symptoms were progressively increased. The testicular position is elevated, and the mass is touched near the inner ring of the lower abdomen and there is tenderness.
A small number of patients may have paroxysmal abdominal pain, bloating, vomiting, cessation of bowel movements and other symptoms of intestinal obstruction after sudden forced breath or severe cough, but no sputum is released, and there is a painful mass near the inner ring of the lower abdomen.
The clinical manifestations of this disease are not specific, can be asymptomatic or blurred symptoms, such as abdominal dull pain and soreness, usually rarely seen because of symptoms, sometimes the small part of the muscle is not easy to touch the muscle layer, plus the abdominal ring emptiness Very rarely missed by doctors.
Examine
Examination of abdominal wall hernia
1. X-ray examination: X-ray or abdominal film has signs of intestinal obstruction.
2. B-ultrasound: It is suggested that there is abnormal intestinal fluid echo near the inner ring of the lower abdomen.
Diagnosis
Diagnosis and differentiation of abdominal wall
diagnosis
1. History: A history of incarcerated inguinal hernia or inguinal hernia.
2. Clinical manifestations: After the incarceration, the treatment was performed by manual reduction, and the sputum disappeared, but the symptoms of intestinal obstruction still existed.
3. Auxiliary examination: X-ray fluoroscopy or abdominal filming has signs of intestinal obstruction; B-ultrasound shows the intestinal tube echo with abnormal gas liquid near the lower abdomen ring.
Differential diagnosis
The incarcerated mass is large and easily misdiagnosed as a tumor or abscess. Various examinations are needed to identify it.
