Hernia
Learning objectives
? To appreciate that hernias can strangulate ,and then become surgical emergencies
? To know that femoral hernias are especially susceptible to strangulation
? To understand the anatomy of the common hernias
? To know the common surgical approaches to hernias
Definition
It is protrusion of viscus or part of viscus through an abnormal opening in the wall of its containing cavity
Types
External ; inguinal, femoral ,umbilical ,incisional ,epigastric spigelian , obturator ,gluteal,&diverication of recti.
Internal; hiatal hernia
Causes
1-weakness ;smoking ,obesity ,&old age
2-increase intra-abdominal pressure ; cough ,straining ,pregnancy,ascitis &malignancy.
Composition of hernia
a- sac ; usually parietal peritoneum
b- covering ;wall layers covering the sac
c- content; omentum ,small&large bowel ,ovary ,bladder .
classification of hernia
1-reducible ;content can be reduced inside the abdomen
2-irreducible ;content cannot be reduced (but no complication )
3-obstructed ; it is irreducible plus obstruction of bowel
4-strangulated ;obstructed bowel plus obstructed blood supply
5-inflammed ; the content of the sac become inflamed
Other hernias
Epigastric hernia
Incisional
Burst abdomen
Epigastric hernia
Hernial defect in the linea alba from xiphisternum to the umblicus
Felt as swelling
My be associate with pain
Epigastric pain like that of DU
Treatment ;operative repair for painful and big one
Umblical pilonidal sinus
Is sinus contain hair
Disharhing pus
Treatment ;excision
Umblical fistulae
Patent vitelointestinal duct
Patent Urachus
Abdominal wall
Burst abdomen ( abdominal dehiscence ) the viscera extruded to out side due to burst of abdominal wall suturing
Incisional hernia ;partial disruption of deeper layer the skin remain intact
causes
Technique of wound closure
Factors related to incisions
Resons for initial operation
Coughing, vomiting , distension
General condition (obesity ,jaundice ,malignant disease ,hypoprotinemia ,and anemia ,steroid ,pregnancy ,ascitis )
Burst abdomen
Serosanguinous discharge ,the pathognomonic feature
Some time patient fell some thing giveway
Emergency operation
Incisional hernia
Aetiology
Clinical features
Treatment