External hernia
Introduction
Introduction to abdominal hernia Abdominal hernia is one of the most common diseases in abdominal surgery, and is named after prominent anatomical parts. Among them, the incidence of inguinal hernia is the highest, accounting for more than 90%, followed by femoral hernia, accounting for 5% or so. There are also incisional hernias, umbilical hernias and white lice. In addition, there are rare sputum such as lumbosacral. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Abdominal hernia
(1) Decreased abdominal wall strength: Congenital factors: Some tissues pass through the abdominal wall, such as spermatic cord or uterine round ligament through the inguinal canal, femoral artery and vein through the femoral canal, umbilical blood vessels through the umbilical ring. Congenital hypoplasia The abdominal white line can also become a weak point of the abdominal wall. Acquired factors: poor abdominal incision healing, abdominal wall trauma or infection, abdominal wall nerve injury, old-aged weakness and obesity-induced muscle atrophy, etc., all lead to lower abdominal wall strength.
(2) Increased intra-abdominal pressure: Chronic cough, chronic constipation, difficulty urinating, ascites, pregnancy, weightlifting, frequent crying of the baby, etc. can cause increased intra-abdominal pressure.
Prevention
Abdominal fistula prevention
If the diagnosis of abdominal hernia is complicated or secondary to prostatic hypertrophy, chronic bronchitis, habitual constipation or other diseases with increased intra-abdominal pressure, the primary disease should be properly treated before surgery, especially secondary to cirrhosis. Or intra-abdominal tumors, more should not be treated surgically. If you ignore this, it will lead to treatment failure and keep the stool smooth. prevent getting cold. When the patient coughs, the wound can be gently pressed with the hand.
Complication
Abdominal fistula complications Complication
Complications of abdominal hernia: intestinal narrowing, intestinal perforation.
Patients with intestinal stenosis often have fever, persistent abdominal pain, and a lumps in the abdomen after gastrointestinal decompression. Laboratory tests revealed significant increases in leukocytosis, metabolic acidosis, lactate dehydrogenase, and amylase. X-ray examination is not sensitive, but it will show signs of coffee beans (single gas expansion chamber, separated by a large dense band of edema intestine), pseudo-tumor sign (intestine mixed with liquid, completely closed) or three different A single flat fix for the plane.
Intestinal perforation refers to the process in which intestinal lesions penetrate the intestinal wall and cause intestinal contents to overflow into the peritoneal cavity. It is one of the serious complications of many intestinal diseases, causing severe diffuse peritonitis, mainly characterized by severe abdominal pain, abdominal distension, and peritonitis. Symptoms and signs can cause severe shock and death.
Symptom
Abdominal hernia symptoms Common symptoms Urinary tract stenosis constipation Right abdominal pain Breath sounds weakened bladder stones Chronic cough
Inguinal hernia: refers to the abdominal hernia in the groin area, which can be divided into two types: inguinal hernia and groin.
Inguinal hernia: more common in infants and middle-aged men, more common on the right side. At first, the symptoms are not obvious. The groin area is swollen and mildly painful only when the intra-abdominal pressure is increased, such as standing, walking or severe coughing. Later, there may be renature mass in the groin area or scrotum, and the mass disappears after lying down or pushing by hand. . Incarceration and strangulation can occur.
In the groin area, a mass is seen. When it falls into the scrotum, it is mostly pear-shaped. The upper end is small, the lower end is wide, and the texture is soft. When coughing, it touches the mass and has a sense of impact. When pushing down or pushing up, the mass can be returned, and the inner ring mouth is pressed after the return, so that the patient coughs to increase the abdominal pressure, and the mass does not appear.
Inguinal hernia: more common in the elderly and infirm, especially accompanied by prostatic hypertrophy, chronic bronchitis and habitual constipation, easy to increase abdominal pressure and lead to this disease, manifested as standing groin on the medial side, no pain and other discomfort.
When standing, the semicircular mass of the inguinal can be seen, does not enter the scrotum, and can disappear on its own after lying down, often reaching obvious abdominal wall defects and weakness at the inner ring.
Stocks: more common in middle-aged women, the general symptoms are mild, easy to be ignored, when standing for a long time or coughing to increase the internal pressure, a slight feeling of bulging. In the case of localized severe pain, consider the possibility of incarceration and strangulation.
The sacral mass of the femoral hernia is generally located at the fossa ovalis below the inguinal ligament. It is a hemispherical bulge and has a small volume. Because of the narrow neck of the sac, the cough has no obvious impact. Easy to incarcerate and strand.
Umbilical hernia: Umbilical hernia is more common in children and obese women. Pediatric umbilical hernia is noisy, constipation, hemispherical mass appears in the umbilicus, no other discomfort. Adult umbilical hernia can cause gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. In children, the umbilical hernia is generally less than 2 cm. Most of the umbilical hernia can touch the defect of the abdominal wall. Adult umbilical hernia is not easy to repay, and it can touch the abdominal wall defect of the ankle ring or umbilicus. When the incarceration occurs, the sputum becomes hard, and abdominal pain and intestinal obstruction appear.
Incisional hernia: There is a history of surgery. When standing, walking, coughing, or abdominal force, there is a swelling in the abdominal wall incision, which may be accompanied by discomfort such as indigestion, abdominal distension, and abdominal pain. During the examination, the abdominal incision can be seen at the surgical scar, and it may be a soft mass. It stands obviously, disappears after lying down, and can touch the surrounding abdominal muscles, abdominal wall defects, and sputum contents.
Examine
Examination of abdominal hernia
Transmittance test, chest fluoroscopy, duodenal barium meal, chest radiograph, organ palpation.
Diagnosis
Diagnostic identification of abdominal hernia
Diagnostic criteria
1. History of the disease asked about the onset time, with or without chronic cough, frequent vomiting, constipation, rectal prolapse, urethral stricture, phimosis, bladder stones, dysuria, abdominal surgery, trauma and other medical history, with or without incarcerated history.
2. Physical examination pay attention to whether the abdomen has abnormal bulging or depression, ascites, hepatosplenomegaly, and a prominent mass during standing. Elderly people should check for prostate enlargement. Whether the chest has limited side breathing, reduced breathing sounds, full ribs, and whether you can hear bowel sounds or watery sounds on the chest. Inguinal hernia should pay attention to the shape of the ankle and the size of the ankle ring. Whether the contents fall into the scrotum when standing or coughing, can it be reset. It is important to know if there is a strangulation or incarceration and to determine the type of plutonium. Should be identified with other diseases in the scrotum, suspected scrotal effusion, should be tested for light transmission.
3. Auxiliary examination of the chest to see if there is any lung disease. If you are suspected of being paralyzed, you should take a positive and lateral chest radiograph and check for a meal or a barium enema to determine the diagnosis.
According to the pathological changes and clinical manifestations of the contents of the sputum, the abdominal hernia can be divided into the following types, that is, whether the contents of the sputum can be returned to the refractory sputum, and the refractory sputum; Can be divided into incarcerated , strangulated .
