Diseases

A person can live with an umbilical hernia for a long time without experiencing any negative symptoms. Often this ailment does not interfere with ordinary life at all and does not remind of itself in any way. The danger is infringement of the umbilical hernia, which occurs in both children and adults. This ailment is becoming a serious problem that can cause concern for the patient's life. After infringement, it is possible to develop necrosis, intoxication of the body, lag in the development of some organs. Therefore, if you have an umbilical, you need to monitor its condition, and in case of growth, immediately consult a doctor.

Signs

Injured umbilical hernias in most cases have slow onset symptoms. Therefore, many doctors note the fact that patients seek help at a later stage of the disease. At this time, the signs of the disease are already manifesting themselves clearly, and it is rather difficult not to notice them. They are more pronounced when pinching the intestinal loop. If there is an omentum in the hernial sac, then the negative sensations can be very weak. The main symptoms of the disease are:

• The appearance of acute pain in the umbilical region.
• Inability to correct the hernia.
• Nausea, vomiting.
• General deterioration in health.
• Indigestion, constipation, intestinal obstruction.

If the patient has suffered from an umbilical hernia for a long time, then with a high degree of probability he will miss the moment when it became uncontrollable. Therefore, hospitalization of patients often occurs when severe pain appears in the later stages of the development of the disease.

The disease in most cases occurs due to an increase in intra-abdominal pressure. In this case, it is not necessary to experience physical activity. For example, in children, the illness can occur when crying or screaming. A strangulated umbilical hernia in adults can be triggered by:

• improper diet;
• physical stress;
• cough;
• difficult childbirth;
• constipation.

This disease is characterized by rapid development. Already after 2-3 hours, the death of organs in the hernial sac may begin. Therefore, at the first symptoms, an urgent need to consult a doctor. You will need:

A strangulated umbilical hernia is fairly easy to diagnose. It is enough for the doctor to palpate. The main questions arise when clarifying contraindications for surgery. Therefore, at the appointment, the doctor will try to determine or exclude the reasons why surgery may be dangerous. To do this, he asks the patient:

1. How long ago did the infringement occur?
2. What reasons could cause it?
3. Does the patient have chronic diseases?
4. What medications are allergic reactions possible?
5. What steps have been taken to try to correct the hernia?
6. What negative sensations does the patient experience?

Particularly important is the question of attempts to reposition a hernia. It is impossible to do this, but in severe cases, patients, making significant efforts, can unconsciously deform the organs trapped in the hernial sac. The consequence is peritonitis, which requires urgent surgical intervention.

What if not treated?

Unfortunately, the consequences of this disease are very serious. If the umbilical hernia itself does not cause great inconvenience in patients, then its infringement can have lethal consequences. This is due to such pathologies:

• Organs trapped in the hernial sac begin to lack blood supply. This leads to a decrease in their normal functions.
• If the loop of the intestine is squeezed, problems with bowel movements begin. In many cases, complete obstruction is observed.
• Lack of nutrition of tissues trapped in the hernial sac leads to necrosis and intoxication of the whole organism.
• In severe pathologies, the intestinal loop ruptures and its contents enter the abdominal cavity. Peritonitis occurs, which threatens the patient's life.

To exclude possible complications that carry a serious danger, it is necessary to timely detect the symptoms of an umbilical hernia, the infringement of which requires mandatory treatment. Only in this case it will be possible to avoid negative consequences.

A restrained umbilical hernia is formed as a result of protrusion and pinching of the internal organs of the abdominal cavity under the skin of the abdomen in the umbilical ring. Basically, a similar pathology is observed in children. With the correct course of treatment, the hernia is eliminated without any negative consequences. Infringement of an umbilical hernia is much more dangerous for adults and the elderly, therefore, at the first signs of a pinched umbilical hernia, you should immediately consult a doctor.

Types of organ entrapment

The emergence of pathological infringement (squeezing) of organs in the hernial orifice occurs in different ways:

1. Elastic infringement of a hernia of the abdomen occurs when a section of the intestine enters the hernial gate, from where the loop cannot return to its place after the hernial gate returns to its original position. In the case of elastic (or elastic) infringement during sudden physical exertion, the internal organs are forced through the narrow opening of the umbilical hernial orifice and are pinched. You cannot correct them yourself. Due to the compression of the hernial ring, ischemia begins (impaired circulation of the protruding organs). This causes a lot of pain. Spasms resulting from pain syndrome provoke increased compression of the hernial ring, which causes necrosis - the death of tissues contained in the hernial sac. With elastic infringement, necrosis of the intestinal loop begins in a few hours from the mucous membrane. Then necrosis affects the submucosa, muscle and serous membranes. This must be taken into account when prescribing treatment.
2. Fecal infringement is a consequence of the fact that decreased intestinal peristalsis interferes with the movement of feces and they accumulate in the hernial sac. During fecal infringement of an umbilical hernia, the pressure of the contents of the hernia increases due to the overflow of the prolapsed section of the intestine with feces. This becomes possible in the presence of wide hernia orifices. The resulting compression and flattening of the discharge section of the intestine causes disruption of blood supply and gradual necrosis (death of organs and tissues). Due to fecal infringement, necrosis of the intestinal loop occurs after several tens of hours. The cause of fecal infringement is not physical activity, but disturbances in intestinal motility and peristalsis, curvature or twisting of the section of the intestine, pinched in the hernial ring. Fecal entrapment is, as a rule, a complication of chronic uncontrolled hernia, therefore, it is diagnosed mainly in elderly and senile patients.
3. Mixed entrapment occurs when the intestinal loops filled with fecal masses are entrapped by the hernial orifice.

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Why is a restrained umbilical hernia dangerous?

Pinching the contents of the hernial sac can pose a danger to certain areas of the small intestine, the omentum, and less often the sections of the large intestine are affected. Much less often the bladder, cecum or uterine appendages are pinched. Compression, flattening or twisting of the intestinal sections in the hernial sac contributes to the development of intestinal obstruction, general intoxication of the body, the development of pain syndrome and tissue necrosis. Therefore, it is a great danger to the human body.

A restrained umbilical hernia, as a rule, causes a disruption in the normal blood supply to the prolapsed section of the intestine. Intestinal congestion causes necrosis, sequentially affecting the inner part of the intestine, the mucous membrane and submucosal layers of the intestine, the muscle tissue of the intestine and the serous membrane.

When an umbilical hernia is pinched, fluid (hernial water) accumulates in the hernial sac. Hernia water is colorless at first, but gradually turns pink and then reddish-brown. The intestinal wall affected by necrosis is not an obstacle to the emergence of microbial flora from it, therefore, hernial water becomes purulent with a special colibacillary odor.

In addition to other complications caused by a strangulated hernia, phlegmon of the hernial sac may occur. Phlegmon appears, as a rule, a few days after the hernia is pinched. During this period, the tissues and organs trapped in the hernial sac gradually die off. A hollow organ trapped in the hernial sac is deprived of normal lymph and blood circulation. The fluid accumulated in the intestine - hernial water - becomes toxic. Purulent inflammation begins, destroying the wall of the abdominal cavity. Phlegmon of the hernial sac is a consequence of elastic, fecal or mixed infringement of the hernia.

The main symptoms of phlegmon:

1. Acute pain at the site of a pinched hernia, gradually subsiding.
2. Fever, bloating, fecal-smelling vomiting, depressed consciousness.
3. Swelling, redness, soreness, and fever of the skin around the hernia.

Phlegmon of the hernial sac is a consequence of elastic, fecal or mixed infringement of the hernia and poses a serious danger to the body.

For the treatment of phlegmon, the hernial sac is opened to the patient during the operation to remove the hernial water, and the affected organs are washed with disinfecting drugs.

After the operation, a course of antibiotic treatment is carried out.

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Hernia of the abdomen: symptoms of infringement

An umbilical hernia may not bother a person for a long time, causing him only some inconvenience. However, in case of infringement, it becomes dangerous to health. Among the main signs of infringement of a hernia in children and adults, it should be noted:

• sharp pains in the umbilical region;
• indigestion;
• nausea and vomiting;
• constipation and intestinal obstruction;
• the presence of blood in the stool;
• irreducible hernia;
• general weakness, impaired consciousness.

Even if the patient was able to correct the umbilical hernia on his own, you need to consult a doctor to avoid mistakes and unpleasant consequences. But it is still better to refuse self-medication.

The main thing is to remember that when an umbilical hernia is infringed, it is categorically contraindicated to take antispasmodic and analgesic drugs. You must also refuse to take a warm shower or bath.

The most severe complication of an umbilical hernia is the pinching of organs in the hernial sac. With an umbilical protrusion, part of the intestine enters the hernial sac, therefore the accompanying symptoms of a strangulated umbilical hernia are expressed in intestinal obstruction, pain and dyspeptic symptoms. This complication is considered severe because of the risk of termination of the functioning of the pinched organ, during which blood circulation is disturbed, the tissues begin to gradually die off. The organs in the hernial sac are susceptible to infringement in the event of increased physical activity, with heavy lifting and strong emotional experience.

An umbilical hernia is not a pleasant phenomenon. What could be worse? Pinching her!

There are several types of infringement of a navel hernia, on which the symptoms and methods of correcting the pathological process depend. Prolonged cough, constipation, pregnancy - all this can provoke a complication of umbilical protrusion.

Types of infringement of an umbilical hernia

Based on the classification, the incarceration of the umbilical hernia is divided into primary and secondary. In the case of a primary lesion, the cause is physical activity or strong stress. Secondary protrusion of an umbilical hernia develops in response to an already existing pathology during the progression of the disease. The second version of the classification divides the infringement into elastic and fecal.

1. Elastic infringement is associated with an increase in intrauterine pressure, when organs that have gone beyond the abdominal wall cannot return to their place on their own. The ring of hernial orifices with strong squeezing interferes with normal blood circulation and ischemic syndrome develops. Any structure of the abdominal cavity can fall into the "trap" when pinched, but in the case of an umbilical hernia, part of the intestine. Elastically restrained umbilical hernia is accompanied by symptoms of severe pain, discomfort in the area of ​​the defect, and the appearance of brain disorders. The patient complains of aching or sharp pain when moving, a full stomach causes heaviness, dizziness, and general malaise appear. Muscle spasm, which often accompanies gastrointestinal diseases, can complicate the course of elastic pinching of the umbilical protrusion.
2. Fecal infringement occurs when fecal masses accumulate in a part of the intestine, localized in the hernial sac. This complication occurs abruptly, but with a prolonged course of the disease. Symptoms of fecal infringement are similar to elastic, but intestinal obstruction is attached, requiring further surgical operation.

A pinched umbilical hernia can be asymptomatic for a long time. It is important to diagnose it on time and start treatment!

In the area of ​​the abdominal cavity, it can lead to a necrotic process, then pancreatitis develops, intoxication of the body, and the patient requires urgent surgical treatment.

Clinical manifestations

Slow blood circulation in the area of ​​the pathological site leads to venous stasis, swelling of the intestinal wall joins. This is accompanied by the penetration of plasma into the intestinal lumen and its walls, which also requires appropriate treatment.

The symptomatic complex with an umbilical hernia develops relatively slowly, which is associated with the covering of the restrained intestine with an omentum. This complicates the timely diagnosis of the deviation, and leads to the accumulation of purulent or serous exudate in the affected area.

Signs indicating a pinched abdominal hernia:

• pain syndrome can be caused by ischemia or irritation of the nerve endings of the intestinal mucosa, in addition, pain can be caused by frequent spasms;
• during physical activity, the patient may feel movement in the affected area, and severe pain also appears, which subsides only after taking painkillers and providing the patient with peace (rest does not always bring relief);
• irritability, nervousness appears, the patient gets tired quickly, anxiety syndrome appears;
• pallor of the skin, decreased appetite, apathy;
• the protrusion becomes denser over time and does not fit into place.

Pain is one symptom of pinching, but not the only one.

With a complicated hernia, intoxication of the body joins, inflammation of the abdominal organs, hypochloremia appears. In advanced cases, heart failure develops, breathing problems appear, and blood pressure rises. Against the background of severe pain, painful shock develops, heart rate increases and fainting may occur.

It is very important, when a characteristic symptomatic complex appears, to carry out an adequate diagnosis of the main and concomitant diseases, to determine the affected area and the main danger for the restrained organ. The listed symptoms can be the reason for the appearance of false protrusion and pinching of organs, which does not pose a danger to the patient, therefore, differential diagnosis with this and other deviations is necessarily carried out. A restrained umbilical hernia is differentiated from acute pancreatitis, perforation of a stomach ulcer, cholecystitis, ectopic pregnancy.

Diagnostic methods

The main diagnostic measures are prescribed when the hernia is compacted, the appearance of sharp pain in the abdominal region, the absence of a reaction of the hernial sac to the cough. Diagnosis of a secondary lesion is not difficult, the patient, knowing about his pathology, informs the attending physician about the appearance of new symptoms, this is a sharp pain, the hernia cannot be repaired, a digestive disorder. With a primary lesion, a comprehensive diagnosis is required, including instrumental and laboratory methods.

1. An X-ray analysis of the abdominal organs is performed to assess the anatomical structure of the internal organs.
2. Ultrasound examination allows you to see the stretched bowel loops with the formation of gas above them.
3. A laboratory blood test helps a specialist determine the presence of an inflammatory process or infection as a complication of the underlying disease.
4. By the method of visual examination, the doctor sees the compaction of the pathological area, with palpation, the navel does not return to its place, which already indicates an infringement.

First aid

The only correct treatment for a strangulated hernia is surgical repositioning of the organs. After diagnosis, the patient is immediately hospitalized in the surgery department, where the surgeon performs laparoscopy. Urgency in action is necessary to prevent tissue death, since blood circulation is sharply impaired, anemia occurs, and soon a necrotic lesion of a part of the pinched intestine may appear.

Urgent surgery to cut the hernial ring to release part of the strangulated intestine may be life-saving

1. An emergency operation is performed to dissect a strangulated ring that is compressing vital organs. During the operation, the hernial ring is cut open and the bowel loop is released.
2. Untimely performance of the operation leads to necrosis, and this outcome also requires an operation to get rid of purulent contents.

Important! Self-medication in case of infringement is prohibited, you cannot set the organ with your hands, the only measure is to call a doctor for further hospitalization in the surgical department. It is also not recommended to take medicated pain relievers that hide symptoms important for diagnosis.

Complications of a restrained navel hernia

Patients who ignore the long course of a hernia of the navel are faced with an exacerbation and the appearance of pinching. If measures are not taken even when an organ is pinched, there is a risk of death due to intoxication of the body.

Why is self-medication for bulging in the navel area dangerous?

1. A multicameral hernia can result in the transfer of organs from one chamber to an adjacent and deeper one.
2. Intestinal loops in the sac can rupture with vigorous physical exertion, resulting in peritonitis.
3. The transition of the hernial sac into the subperitoneal tissue or peritoneum.

Self-medication can end with the subsidence of the symptomatic complex, which will mislead the patient, but the disease itself is only aggravated by this.

The only way out for pinching an umbilical hernia is a timely operation.

Operative treatment

The main indication for surgical treatment is prolonged pinching of organs along with intestinal obstruction. An acute period, accompanied by less than two hours, indicates a false infringement, therefore the operation is postponed and a second diagnosis is carried out, during which the patient is hospitalized.

The subsiding of the symptoms of pain and self-reduction of the organ is not a reason to cancel the operation. Reduction of an organ can occur at any time: after calling an ambulance, on the way to the hospital, or directly on the surgical table.

The operation itself involves the creation of access to the hernia sac, after which the organ is removed and set to its anatomical place. During laparoscopy, it is important to assess the degree of pathological changes in the organ, the presence of purulent exudate, ischemia or internal bleeding, and only after that the operation is considered successful.

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Infringement of the hernia is a dangerous complication that develops as a result of squeezing the contents of the hernial sac by the hernial gate. Such a type of pathology as a strangulated umbilical hernia is considered very common. ICD code K42.0. In case of infringement of a hernia, emergency surgical treatment is indicated.

What happens when infringed

In the restrained area of ​​the hernia, there is a violation of blood circulation and tissue death.

Most often, with an umbilical hernia, the area of ​​the greater omentum, the intestinal loop, is affected. Parts of the organ are impaired in the hernial orifice, an inflammatory process develops, turning into gangrene. The complication is typical for large hernias, small formations have a lesser ability to restrain, since they freely pass through the hernial opening back and forth.

Clinical manifestations

Compression of the organ leads to impaired blood circulation, which causes venous stasis, oxygen starvation of tissues, and suppuration. The first signs of the disease are sharp pain and the inability to reposition the hernia, redness, swelling of the tissues in the umbilical ring. The clinical manifestations of complications depend on which organ has undergone compression.

Pinching of an umbilical hernia with falling into the hernial gate of the intestinal loop is accompanied by symptoms characteristic of intestinal obstruction, the presence of which is determined by the following signs:

• sharp pain;
• lack of gas discharge;
• nausea, repeated vomiting;
• belching, heartburn;
• lack of intestinal motility;
• prolonged constipation.

When the omentum is squeezed, the pain is less intense, vomiting may be absent or occur once.

Common signs of complications include a deterioration in the general well-being of the patient, irritability, weakness, and lack of appetite.

Outwardly, the area of ​​infringement turns red, the protrusion becomes hard, and local edema appears. A characteristic feature is that during physical exertion, the formation does not increase in size, since its contents are clamped by the hernial orifice. There is no symptom of a cough jolt - when you press the protrusion with your finger, there is no synchronous movement during coughing.

Life-threatening symptoms of the patient:

1. Poisoning the body with decay products.
2. Inflammation of the peritoneal organs - peritonitis.
3. Blood pressure surges.
4. Increased heart rate, fainting.
5. Breathing disorder.
6. The development of heart failure.

If such signs develop, immediate surgery is required. With every minute, irreversible changes occur in the human body, which can cost him his life.

Views

To classify infringement of umbilical hernias, concepts such as primary and secondary compression are used. The first type is characterized by the primary development of infringement of an internal organ due to physical exertion. Secondary ones arise against the background of an already existing pathology due to the progression of the disease. In turn, the secondary infringement is divided into elastic and fecal.

Elastic

The intestinal loop is compressed. Most often, this process occurs when parts of organs are squeezed out through the umbilical ring due to physical exertion.

The pain that occurs when infringement provokes muscle spasm, which further exacerbates the course of the disease. It is not possible to correct the hernia on its own, circulatory disorders of the compressed tissues develop, and there is a risk of necrosis.

Kalovoe

The causes of fecal infringement is a decrease in intestinal peristalsis, which provokes the accumulation of fecal masses in the intestine. This type of complication is diagnosed less often, occurs mainly in adult patients suffering from constipation and other disorders of the digestive system.

It is impossible to diagnose pathology on your own. To preserve life and health, you should seek qualified medical help.

Necessary measures for the development of infringement

The appearance of symptoms characteristic of the compression of hernial contents should not be ignored. There are recommendations, the observance of which will help to avoid the deterioration of the patient's condition:

1. In no case should you try to correct the hernia yourself.
2. If alarming symptoms appear, an ambulance team should be called or the patient should be delivered to the hospital on their own.
3. While waiting for the arrival of an ambulance, the patient should lie down and calm down. Breathing should be even and deep.
4. In case of infringement, you cannot eat and drink a lot, this will only aggravate the situation.
5. It is very important to remember the time of the first symptoms and inform your doctor about it.

After the arrival of an ambulance, the doctors should be informed about the time of the onset of each symptom, this will help to correctly diagnose the pathology.

What absolutely must not be done

When an umbilical hernia is infringed, it is strictly prohibited:

1. Take warming baths.
2. Apply a warm compress.
3. Drink a pain reliever, laxative. Taking medication will make it difficult to diagnose.

An attempt to correct the protrusion on your own can lead to such consequences as damage to blood vessels, hemorrhage into the surrounding tissues, rupture of the hernial membrane, and ingress of dead tissue into the abdominal cavity.

Methods for diagnosing pathology

The characteristic signs for the development of complications are:

1. The pain is intense.
2. Consolidation of hernial contents.
3. With tension in the press, there is no reaction of the hernia.

To clarify the diagnosis, plain X-ray is used - signs of intestinal obstruction are determined - Kloyber's bowls.

What to do with spontaneous reduction

In some cases, there is a spontaneous reduction of the hernial contents to their anatomical place. Despite this, the patient needs to undergo a complete medical examination to exclude relapse and possible complications.

If the infringement lasted more than 2 hours, was accompanied by such signs, symptoms of intestinal obstruction, then this condition of the patient is an indication for surgical intervention, despite the independent reduction of the hernia.

With an infringement lasting less than 2 hours, the patient is recommended to go to the hospital and be under the close supervision of doctors. In this case, the operation to remove the hernia can be carried out as planned, after the necessary examination and testing.

Normalization of the patient's condition and the abatement of symptoms should not be a reason for refusing medical care. The infringement can be repeated at any time.

The essence of surgical treatment

The volume of surgery for a restrained hernia depends on the state of the internal organs in the infringement zone. While maintaining the viability, the bowel loop or part of the omentum is returned to the abdominal cavity.

With the development of necrosis, the doctor performs a resection of a dead segment of the intestine, which can be much longer than that which has fallen into the hernial sac. After which the intestine is stitched end to end. Then the plastic of the hernial orifice is performed.

The goals of restrained hernia surgery are:

1. Dissection of the hernial orifice in order to release the affected organ.
2. Assessment of the condition of the affected area, making a decision on the need for its elimination.
3. Removal of dead tissue.
4. Plasty of the hernia orifice to prevent recurrence.

The types of operations include open surgery and laparoscopy.

Open operation

An incision is made in the navel area, which allows the hernial contents to be adjusted, and, if necessary, to remove parts of the organs. After that, the plastic of the hernial orifice is performed using the tension method (stitching the tissues, by imposing the aponeurosis of the rectus abdominis muscle) or with the help of an implant that covers the hernial opening.

Laparoscopy

Surgery with small punctures is a safer and more effective method of treating hernias. During the operation, the surgeon makes several small punctures in the area of ​​the affected area, through which the laparoscope and microscopic equipment are inserted. With the help of microinstruments, the doctor performs the necessary manipulations to remove the hernia and release the restrained organ.

After the operation, the patient must be in the hospital under the supervision of a doctor. The duration of the rehabilitation period depends on the severity of the course of the disease and the individual characteristics of the organism.

Surgical intervention for infringement of an umbilical hernia is always carried out on an emergency basis, regardless of the general health of the patient.

Patient prognosis and prevention

With timely treatment for medical care, the prognosis for recovery is quite favorable. With the help of the operation, it is possible to cope with the complication and prevent further deterioration of the patient's condition.

Prevention of infringement is a planned operation. If there are contraindications to surgical treatment, the patient is recommended to take the following measures:

• decrease in physical activity;
• correct weight lifting (using the back muscles);
• wearing a bandage.

Such a serious pathology as compression of an umbilical hernia requires immediate treatment. Refusal of medical care and untimely admission to the hospital can lead to complications that threaten life.

Version: MedElement Disease Handbook

Umbilical hernia with obstruction, without gangrene (K42.0)

Gastroenterology

general information

Short description

Umbilical called hernias, in which a hernial protrusion forms in the navel. At different age periods, these hernias have serious differences among themselves in origin, anatomical and clinical signs, course and methods of treatment.

Paraumbilical hernialocalized in the navel (usually above it). According to some authors, the perumbilical hernia is one of the varieties of hernias of the white line of the abdomen, which, in addition to it, also includes the epigastric and hypogastric hernia of the white line of the abdomen (see.... According to other authors, the umbilical hernia is an oblique umbilical hernia.

Strangulated hernia- a hernia that is unable to return to its original position as a result of compression by muscle layers.

Note

Umbilical hernia in children;
- umbilical hernia in adults;

Peri-umbilical hernia.

Classification

There are several types of hernia infringement:
- elastic;
- feces;
- parietal;
- retrograde.

Etiology and pathogenesis

Elastic (strangulation) restraint a hernia occurs as follows: during a sudden increase in intra-abdominal pressure (lifting weights, an act of defecation, coughing, sneezing, difficulty urinating), the hernial orifice is overstretched; the insides under great pressure penetrate into the hernial sac. Then, due to the elasticity of the tissues, the hernial gates from the state of overstretching return to their normal state, narrow, but the contents of the hernial sac do not have time to return to the free abdominal cavity.

At fecal infringement there is an overflow of the intestinal loop located in the hernial sac with solid / liquid feces or only gases. Because of this, the loop of the intestine is stretched, peristalsis is hampered, and there is no evacuation of the contents of the intestine from the hernial sac. Mesentery The mesentery is the fold of the peritoneum, through which the intraperitoneal organs are attached to the walls of the abdominal cavity.
the intestine, due to stretching of the bowel loop, is compressed between the adducting segment, and thus a situation similar to elastic infringement arises.

Retrograde infringement characterized by the fact that not that part of the intestinal loop, which is in the hernial sac, but that which is located in the free abdominal cavity is subjected to infringement. At the same time, circulatory disorders are more pronounced in the loop located in the abdominal cavity, and less in the loop located in the hernial sac itself. Due to this feature, the clinical picture of infringement usually develops rapidly.

During parietal infringement not the entire loop of the intestine penetrates into the narrow restraining ring and squeezes there, but only a part of the wall located along the free, antimesenteric edge.

Epidemiology

Sex ratio (m / f): 0.5

Umbilical hernias in children are impaired in 5-7%.
Large umbilical and peri-umbilical hernias in adults are impaired in 15-30%.

Factors and risk groups

- elderly age;
- large size of hernias;
- exercise stress;
- a tendency to constipation;
- cough;
- other causes of increased intra-abdominal pressure.

Clinical picture

Clinical diagnostic criteria

Nausea, vomiting, stool and gas retention, bloating, persistent abdominal pain, hernia pain, irreducible hernia

Symptoms, course

Classic Clinical signs infringement of a hernia:

Sudden pain in the abdomen or at the site of a hernial protrusion;

A rapid increase in the volume of the hernial protrusion, which has become tense;

The sudden disappearance of the possibility of repositioning the hernia;

Deserve special attention the following signs:

In cases of long-standing irreducible hernias, the disappearance of the possibility of repositioning the hernia does not play an important role;

The restrained intestine can suddenly move from the restraining ring into the free abdominal cavity, however, sometimes the non-viable bowel loop is reduced;

With persistent attempts to reposition the restrained hernia, a displacement in depth (sometimes with a detachment of the aponeurotic ring - the gate) of the entire hernial protrusion can occur with continuing squeezing of the contents in the unrepaired restraining ring. Such a "false" reduction is extremely dangerous because the necrosis of the contents of the hernia progresses, possibly the development of vascular thrombosis or peritonitis.

Clinic of infringement with intestinal obstruction develops in terms of 1-2 to 8-12 hours and depends on many factors (the type and nature of the infringement, the size of the hernial ring, the patient's age, and others). With parietal infringement, as well as in elderly patients, the clinic may be worn out.

Symptoms:

The pain intensifies, becomes constant, cramping, or takes on the character of colic, gradually spreading throughout the abdomen;

Hiccups, nausea, vomiting, at first sour (gastric discharge), then with an admixture of bile, then with an unpleasant fecal odor;

Gas and stool retention, bloating;

Enhanced intestinal motility, determined by auscultation and palpation;

Tachycardia, oliguria Oliguria - a decrease in the amount of urine excreted by the kidneys. It can be physiological (with limited drinking regime, loss of fluid in hot weather with sweat) and pathological (with prolonged vomiting and diarrhea, high fever, bleeding, acute glomerulonephritis, edema formation, during pregnancy)
, signs of intoxication.

Diagnostics

The diagnosis is made mainly clinically, taking into account the history.

1. Abdominal X-ray

The Kloyber bowls are revealed Kloyber symptom (syn. Kloyber bowls) - the presence of shadows on the radiograph of the abdomen (with the patient's vertical position), reminiscent of bowls with liquid; a sign of the accumulation of liquid and gas in the intestine with its obstruction
, Kerkring folds Circular folds (syn. Kerkring folds) - masonry of the mucous membrane of the small intestine, located circularly, increasing the working surface and helping with the absorption and movement of the chyme
(the folds of the small intestine are clearly visible in the form of a stretched spiral). Kloyber's bowls appear within 1-2 hours after the onset of the disease.
With obstruction of the small intestine, the Kloyber bowls are larger, their width of the horizontal liquid level is greater than the height of the gas column above them. With obstruction of the large intestine, the Kloyber bowls are smaller and the height of the bowls prevails over the height.

Normally, there should be no gas in the small intestine, except in the following cases:

The initial part of the duodenum;

Terminal part of the ileum;

In children under 2 years of age.

2. Ultrasound: distended intestinal loops, filled with gas, with horizontal fluid levels.

3. CT scan - the most informative and also allows for differential diagnostics. Expansion of intestinal loops is noted, with fluid levels, fecal contents, accumulation of contrast (when used). The swollen intestines can be traced to the place of infringement. Distal to strangulation Strangulation - restraining, blocking by squeezing an opening, such as the airway, blood vessel, or part of the gastrointestinal tract
the intestine is characterized as collapsed.

4. Can also be carried out irrigoscopy Irrigoscopy - X-ray examination of the colon with retrograde filling of it with a contrast suspension
and other additional research.

Laboratory diagnostics

1. General blood analysis:
- hemoconcentration Hemoconcentration - a decrease in the water content in the blood relative to the number of corpuscular elements
;
- leukocytosis with a shift to the left;
- increased ESR.

2. General urine analysis:
- increased specific gravity, color;
- decrease in the rate of diuresis;
- a moderate increase in the indican level is possible (rare).

3. Biochemistry:
- electrolyte disturbances (hypochloremia, hypokalemia) and hypoproteinemia can be partially masked by hemoconcentration;
- slight hyperazotemia is possible (rare);
- an increase in the level of C-reactive protein;
- an increase in the level of lactic acid (hyperlactatemia, lactic acidosis) indicates ischemia of the intestinal wall, while a decrease in the level of lactate over time (including after surgery) does not mean the absence of ischemia of the intestinal wall.

3.KSC Acid-base balance - acid-base state - the balance of acids and bases, i.e. the ratio of hydrogen and hydroxyl ions in the biological media of the body (blood, intercellular and cerebrospinal fluids, etc.)
: first changes towards alkalosis Alkalosis is a form of violation of acid-base balance in the body, characterized by a shift in the ratio between acid anions and blood base cations towards an increase in cations
, then - towards acidosis Acidosis is a form of violation of acid-base balance in the body, characterized by a shift in the ratio between acid anions and base cations towards an increase in anions
... The detected metabolic acidosis has a different degree of compensation and is combined with the so-called "anion gap" (failure) - anion gap.

Despite the absence of laboratory tests directly confirming the diagnosis, laboratory research must be carried out:
- in order to determine the amount of preoperative preparation (replenishment of the BCC BCC - the volume of circulating blood
, correction of electrolyte and metabolic disorders);
- for differential diagnosis and detection of concomitant pathology;
- as a stage of preparation for anesthetic treatment (comprehensive examination and risk assessment of anesthesia);
- as a stage of prognostic assessment of the patient's condition (status assessment scale).

Differential diagnosis

1. Sometimes in small hernias it is not the intestine that is infringed, but the omentum or other organs. In this case, the clinic of intestinal obstruction is practically absent, and immediately develops necrosis oil seal with a clinical picture of "acute abdomen".

2. Coprostasis("Other types of closure of the intestinal lumen" - K56.4) - is detected mainly in irreducible hernias in elderly patients who have a physiological slowdown of peristalsis and a tendency to constipation. This causes stagnation of the contents in the loop of the intestine, located in the hernial sac, but, unlike fecal infringement, with coprostasis, the mesentery of the intestine is never compressed.
Manifestations of coprostasis increase gradually, without prior physical stress, pain syndrome develops slowly. The pain is not intense, the retention of gases and stool comes to the fore, the tension of the hernial protrusion is not pronounced, the symptom of a cough impulse is positive. To eliminate coprostasis, a conventional siphon enema is used; surgical treatment is not required. However, unrepaired coprostasis can lead to fecal infringement of the hernia.

3. False infringement is a pathological condition in patients with external abdominal hernia. It manifests itself in symptoms that resemble a picture of infringement, but are caused by another acute disease of the abdominal organs. This situation can lead to an erroneous diagnosis of hernia incarceration and incorrect surgical tactics. Most often, errors in diagnosis occur with intestinal obstruction, peritonitis of various nature, pancreatic necrosis, ascites, hepatic and renal colic.

When examining a patient, special attention should be paid to pain outside the hernia and the symptom of a cough shock should be carefully checked.

4. Adhesive intestinal obstruction - occurs with large irreducible hernias as a result of trauma to the intestinal loops in the hernial sac. Differentiation is difficult due to the great similarity of the clinical picture of adhesive obstruction with hernia infringement.

Complications

Postoperative complications:
- seroma Seroma is an accumulation of serous fluid. It arises in connection with the intersection of lymphatic capillaries, the lymph of which is collected in the cavity between the subcutaneous fatty tissue and the aponeurosis, which is especially pronounced in obese people in the presence of large cavities between these tissues
;
- hematoma;
- divergence of the edges of the wound;
- leakage of the anastomosis Anastomosis - 1) an operationally created communication between hollow organs, blood vessels or body cavities; 2) the natural connection of two hollow organs, for example, vessels.
;
- incisional hernia;
- infection of the surgical site.

Treatment

When the umbilical hernia is infringed, it is shown emergency surgery.

The operation is usually performed by the Mayo or Sapezhko method. Expanding the operation to eliminate diastasis of the rectus abdominis muscles or concomitant epigastric hernias in this case is impossible.
The hernial sac is not opened in the area of ​​the bottom, but in the area of ​​the body. The dissection of the restraining ring is performed both horizontally and vertically. After that, the restrained organs should be examined.

With phlegmon of the hernial sac, it is rational to use Grekov's method - a bordering skin incision is made, gradually narrowing the wound up to the aponeurosis; then, stepping back 4-5 cm from the restraining ring, the aponeurosis and peritoneum are cut again with oval incisions.

Immediately after surgery, patients with umbilical hernia should use a sheet or cloth tape as a belly band.

Clinical surgery: national guidelines, in 3 volumes / ed. Savelyeva B.C., Kirienko A.I., Moscow: GEOTAR-Media, 2009

General and emergency surgery. Manual / ed. Paterson-Brown S., trans. from English ed. Gostishcheva V.K., M: GEOTAR-Media, 2010

Rafteri E. Surgery. Handbook / edited by O.I. Lutsevich, D.Yu. Pushkar, Medpress-inform, 2006

http://medicalplanet.su/xirurgia/177.html

http://meduniver.com/Medical/Xirurgia/887.html

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