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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-

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HERNIA

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  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

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