Herniated abdominal wall
Last reviewed: 23.04.2024
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Herniated abdominal wall - the exit of contents of the abdominal cavity through acquired or congenital weak points or defects in the abdominal wall. Most hernias are asymptomatic, but in some cases, with the development of infringement or strangulation, there is a strong pain syndrome, which requires urgent surgical treatment. The diagnosis is clinical. Treatment of a hernia of the abdominal wall consists in selective surgical plastic.
Abdominal hernias are extremely common, especially in men, and the number of operations in the US is approximately 700,000 per year.
[Symptoms of a hernia of the abdominal wall
Most patients who have abdominal hernias complain only of visible protrusion, which can induce undefined discomfort or may be asymptomatic. Most hernias, even large ones, can be manually adjusted by gently pressing in the Trendelenburg position. An unrecoverable hernia of the abdominal wall does not have any specific clinical signs. When the hernia is infringed, a persistent, gradually increasing pain syndrome occurs, usually with the appearance of nausea and vomiting. The hernia itself is painful, and peritonitis can develop depending on the localization of the hernia with diffuse pain, tension and peritoneal symptoms.
Herniated abdominal wall: localization and species
Abdominal hernias are classified into hernia of the abdominal wall and hernia of the inguinal region. If infringement develops ischemia of hernial contents due to physical constriction and a violation of blood supply. In this case, gangrene, perforation and peritonitis may develop. Irreversible and strangulated hernias should not be manually adjusted.
Hernias of the abdominal wall include umbilical hernia, epigastric hernia, Spiegel's hernia and postoperative (ventral) hernia. Umbilical hernia (protrusion through the umbilical ring) is mostly congenital, but in some cases it is acquired in adulthood and secondary to obesity, ascites, pregnancy or chronic peritoneal dialysis. Hernias of the epigastric region come out through the white line. Hernia Spigel out through the defect in the transverse abdominal muscle, lateral to the vagina of the rectus, usually below the navel. Postoperative hernias go through abdominal wall defects after previous abdominal operations.
Hernias of the inguinal region include inguinal and femoral hernias. Inguinal hernias are located above the inguinal ligament. The oblique inguinal hernia traverses the inner inguinal ring and passes through the inguinal canal, and the right inguinal hernia is located directly anterior and does not pass through the entire inguinal canal. Femoral hernias are located below the inguinal ligament and pass into the femoral canal.
Approximately 50% of all abdominal hernias are oblique inguinal hernias and 25% are direct inguinal hernias. Postoperative hernia is 10-15%. Femoral and rare forms of hernia constitute the remaining 10-15%.
Diagnosis of abdominal hernia
The diagnosis of "hernia of the abdominal wall" is clinical. Since the hernial protrusion is visualized with increasing abdominal pressure, the patient should be examined in a standing position. If the hernial protrusion is not determined, the patient should cough or perform Valsalva with simultaneous palpation by the abdominal wall doctor. The navel is examined, the groin area (with a finger scan of the inguinal canal in men), the femoral triangle and the areas of all postoperative scars.
The formation of the groin, resembling a hernia, can be the result of adenopathy (infectious or malignant), ectopia of the testicle or lipoma. These formations are dense and do not correct. The formation of the scrotum can be varicocele, edema or testicular tumor. Ultrasound is performed to clarify the diagnosis after a physical examination.
Treatment of a hernia of the abdominal wall
Congenital umbilical hernia is rarely infringed and can not be treated; most of these hernias spontaneously disappear within a few years. Very large defects can be closed after 2 years. Umbilical hernia in adults causes cosmetic problems and can be operated on according to indications; infringement of such hernias are observed not often, but usually their contents is an epiploon, and not an intestine.
Hernias of the inguinal region should be selectively operated because of the risk of infringement, which leads to a higher percentage of complications (and possible mortality in elderly patients). The plastic can be performed by a standard method or laparoscopically.