1 / 39

HERNIA

HERNIA. Begashaw M (MD). Introduction. Common surgical problem A dequate knowledge is important Prevent serious complications. Definition. – Is a protrusion of a viscus through an opening in the wall of the cavity. Component. Sac -Out pouch of the peritoneum-

Gabriel
Download Presentation

HERNIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HERNIA Begashaw M (MD)

  2. Introduction Common surgical problem Adequate knowledge is important Prevent serious complications

  3. Definition – Is a protrusion of a viscus through an opening in the wall of the cavity

  4. Component Sac -Out pouch of the peritoneum- -Four parts-Mouth,Neck,Body&Fundus Content-viscus/organ inside a sac - Small bowel and omentum – the commonest - Large bowel appendix - Bladder

  5. CLASSIFICATION Reducible- viscuscan be returned back Irreducible - contents can’t be returned back Obstructed- intestineisoccluded but no impairment of vascular supply Strangulated- vascularityof viscusis impaired Richter’s- only one side of wall is herniated Sliding - extra peritoneal structure form part of wall of the sac

  6. HERNIAS

  7. Risk factors • Increased intra abdominal pressure - Chronic cough - Straining at urination or defecation - Heavy wt lifting - Abdominal distension • Weakened abdominal wall - Advanced age - Malnutrition - Congenital defect – ppv - Trauma/surgery

  8. Clinical features • History - Lump - Pain, local aching, discomfort - Factors predisposing to increased intra abdominal pressure - Symptoms of int. obstruction/strangulation

  9. Physical examination - Examine Standing & Lying - Lump – reducible, cough impulse with bowel sound - Reduced on lying & increases in size _coughing/ straining - Obstruction – tense, tender, irreducible with absent cough impulse - Strangulation – more tenderness, with warm indurated, and inflamed overlying skin

  10. Examination

  11. Investigation a clinical diagnosis investigation is rarely needed

  12. Complications 1. Irreducibility 2. Obstruction 3. Strangulation is a surgical emergency Risk of obstruction and strangulation is very high in femoral hernia, paraumblical hernia and indirect inguinal hernia with narrow neck

  13. Principles of management 1. Herniotomy- removal of the sac and closure of the neck - in infants and children 2. Herniorrhaphy- Herniotomy and repair of the wall to prevent recurrence

  14. Obstruction • Non operative -Gentle reduction - Put patient in head down position - Sedative is given - Gentle manipulation to reduce the hernia • Urgent Surgery - Failed reduction - All strangulated hernia

  15. Strangulation

  16. Anatomy-inguinal canal • Boundary Anteriorly: External oblique apponeurosis Posteriorly: Fascia transversalis Inferiorly: Inguinal ligament Superiorly: Conjoined tendon and internal oblique M • Runs in antero inferior (InternalExternal ring) _Internal ring -2cm above & 2cm medial to mid inguinal ligament _External ring -just above pubic crest & tubercle

  17. Anatomy

  18. Anatomical site of groin hernia

  19. Contents of inguinal canal • Male • Spermatic vessels • Vas deference • Ileo inguinal nerve • Genito femoral nerve • Female • Round ligament

  20. Anatomy of Femoral canal • Is a narrow rigid space • Boundary - Inguinalligamentsuperiorly • Pectinealposteriorly • LacunarmediallyF • Femoral veinlaterally • prone to obstruction & strangulation

  21. Inguinal hernia - accounts for 80% - commonest is all ages &sexes - 20 x more common is males than women - more common on right side

  22. Classification 1-Indirect_passes through internal inguinal ring along the inguinal canal -May extend down to the scrotum 2 -Direct_Bulges through post wall of inguinal canal

  23. Classification

  24. Hernia

  25. Indirect inguinal hernia • 60% on right • 40% Lt side • 20% bilateral • Due congenital defect patent processes vaginalis - 20 times more common in men

  26. Direct inguinal hernia • due to wear and tear associated • advanced age • increased intra abdominal pressure

  27. Femoral Hernia - acquired downward protrusion of intestinal contents into the femoral canal - 4 times more common in females - rare in children

  28. Clinical features History Physical examination - Small lump on lower groin, lateral and below pubic tubercle - Reducible/irreducibility - Bowel sound/cough impulse – usually absent - Elderly or middle aged woman - lump on anterior and upper thigh - may present with complaints associated with int. obstruction or strangulation

  29. Femoral hernia

  30. Management - surgical repair without delay

  31. Umbilical Hernia Umbilicus is one of the weak sites of the abdomen A hernia can occur at this potential site Risk factors Female sex Multiparity Obesity Ascites Complications Obstruction Strangulation Rupture

  32. Umblical hernia

  33. Treatment Expectant - Spontaneous closure is expected in 80% cases of umbilical hernia in under five children SurgeryBeyondfive years

  34. Incisional Hernia Risk Factors -Wound infection -Poor surgical technique ( -Chronic cough -Straining -Obesity

  35. Clinical features Risk of obstruction and strangulation is very rare Local discomfort Cosmetic problems Difficulties with micturation and bowel movement when very large Treatment Hernioplasty

  36. Incisional hernia

More Related