Hemorrhage is called the most common and dangerous complication, with the development of which the formation of a hernial sac occurs, the localization of which can be of any kind. The development of this pathology does not depend on the age indicator of a person. The main factor that leads to infringement of the hernia is increased intra-abdominal pressure or sudden movements when lifting weights. In addition, there are a number of other sources of a pathological or physiological nature that contribute to the occurrence of pinching of the hernial sac.
According to the classification, the following clinical types of infringement are distinguished:
- Parietal infringement (Richter).
- Infringements of Meckel's diverticulum.
- Retrograde infringements.
- Imaginary (false) infringement.
- Sudden infringement of hernias that were not previously detected.
What is parietal infringement?
Parietal, or Richter, infringement of a hernia is one of the types of infringements that cause a lot of worries in the diagnostic process. Such a pathology can occur only on small hernias, since they have narrow hernial gates.
Richter infringement is a pathology in which not the entire intestine is pinched, but only its wall, which is located on the opposite side of the mesenteric edge.
Among surgeons, this infringement is often called insidious, since due to the fact that the lumen of the intestine is preserved, it is impossible to distinguish a clear clinical picture of a hernia with an infringement. This is often the cause of diagnostic errors.
The so-called Richter hernia (prone to such infringement) can rarely cause intestinal obstruction. However, even in the case of spontaneous reduction, perforation of the ischemic area (affected) can occur, resulting in gangrene.
This infringement most often occurs in the small intestine, but there are known cases of pinching that occurs in the stomach, colon, etc.
The Richter abuses include the following kind:
- Postoperative ventral hernia.
- Umbilical hernia.
- Inguinal hernia.
- Bladder.
- Hernias of the white line of the abdomen, etc.
Possible causes
Infringement can occur on any kind of pathological protrusions. It does not depend on its location and the contents of the hernia. The main provoking factor is fast and strong contractions of the abdominal muscles, as a result of which the pressure on the hernia gate rises sharply from the inside.
Infringements can provoke:
- Sharp movements (jerks) when lifting heavy objects.
- Starting tremors when jumping high or water.
- Muscle contractions with severe coughing.
- Strain during defecation with constipation or urination in the presence of prostate adenoma.
- Long and severe attacks of sneezing.
The predisposing factors that favorably influence the formation of infringements include:
- Frequent and difficult processes of childbirth.
- Fast weight loss.
- Peritoneal wall injuries.
- Excessive power loads.
Symptoms of parietal infringement
Symptoms of Richter's infringement are varied, but doctors take pain first. Moreover, the nature of the pain (localization and intensity) can vary significantly depending on where the pathology is located. Pain can be observed both at the site of infringement, and throughout the abdomen.
Curiously, the pain is initially acute. As necrotic changes develop in the organ, the pain syndrome fades. This is because the nerve endings begin to die off and the transmission of the alarm signal to the brain stops. Thus, gradually the pain is replaced by a sense of anxiety. This causes a person to think that the pain has stopped and you can not rush to the doctors.
The clinic of Richter infringement of the hernia is as follows:
- The skin is very pale. This is accompanied by severe tachycardia (heart rate increases to 120 beats per minute) and a decrease in pressure. The presence of these symptoms means that a pain shock has developed.
- If nevertheless obstruction develops, the patient will have complaints of nausea and vomiting, which looks like an attack, but does not bring a sense of relief.
- Blood may appear in the urine.
- The presence of an irreparable defect is determined by the presence of large protrusions that are in a constant strong voltage.
- There are no coughing tremors.
Diagnosis of Richter infringement
Despite the fact that such infringement often gives doctors a lot of trouble during the diagnosis, in most cases, comparing the patient’s complaints with the test results helps in determining the correct diagnosis.
A visual examination of the patient who came to the doctor with certain complaints is mandatory. A characteristic protrusion that does not disappear with a change in body position and causes pain when pressed is a sure sign of pinching. Another important sign is that the patient does not have a coughing push. That is, if a person begins to cough, then fluctuations in the hernial sac will not be felt, since his narrowed hernial gates block him from the peritoneal cavity.
To diagnose Richter infringement, the following methods are used:
- Survey radiography of the abdomen (often ineffective).
- Ultrasound examination of the abdomen.
- Computed tomography.
- Magnetic resonance imaging.
The last two methods are less common and are used only if it is difficult to make the correct diagnosis after ultrasound and radiography.
First Aid Rules
First of all, first aid is to call a doctor. If the situation has reached the point that the patient needs urgent medical attention, then surgical intervention cannot be dispensed with. It will be carried out taking into account the patient’s vital indications, and the only contraindication is the situation when the patient is in a dying state.
The first help for such a person will be to ensure complete peace. You need to put it on your back, and put a pillow or a folded blanket under the basin. This will help to compensate for the insufficient blood circulation of organs caught in the area of infringement.
Invalid first aid measures
It is strictly forbidden:
- To put the patient in a bath with warm or hot water.
- Put a warm heating pad or compress on the affected area.
- Give medicines with a laxative effect, analgesics or antispasmodics.
- Trying to fix an irreparable restrained hernia on your own.
The only permissible action - with severe pain, you can put an ice bladder on the site of infringement of the hernia.
Performing prohibited actions may result in:
- The vascular walls will be damaged and bleeding will begin.
- The hernial membrane will be damaged.
- Necrotic tissue can enter the peritoneal cavity, and peritonitis will begin to develop.
- A deformation of the hernial neck will occur.
Infringement Treatment
Richter infringement can be treated only under operating conditions. Often, independent attempts to correct a restrained hernia do not help, but, on the contrary, exacerbate the patient's condition.
A patient with an identified infringement is immediately sent to the operating room. There, specialists will choose a method of treatment. These methods include:
- Classic surgery.
- Laparoscopy
Classic surgery
The operation on Richter infringement is carried out by a full section of the location of the defect. In the process, the surgeon examines and evaluates the state of hernial protrusion, as well as its contents. After this, the protrusion is made into the peritoneal cavity, but only if necrotic changes in the internal organs are not found during the operation. The intervention ends by suturing the defect with the patient's own tissues or with special nets. If damage to the internal organs is detected, the surgeon performs an excision to healthy tissue, and only after this, suturing is performed.
Laparoscopy
The treatment of Richter infringement in this way began recently. The laparoscopy procedure is carried out by introducing special tools and a camera through the incisions of a small size, allowing you to monitor the progress of the intervention. Having fixed the problems, the surgeon performs plastic surgery of the internal organs. It is carried out using a special medical stapler or mesh transplant.
Despite the fact that laparoscopy is a fairly young procedure, it is used more often than surgery, as it allows you to minimize interference with the patient. In addition, after laparoscopy, complications very rarely occur, postoperative scars appear and the tissues closest to the hernia are practically not injured. However, some experts still believe that with this type of intervention it is not possible to give a full assessment of the degree of tissue damage that are involved in the pathological process. That is why some surgeons still prefer a classic operation.
Rehabilitation process
During the first days after surgery, the patient feels discomfort in the place where the hernia was located. The duration of the pain syndrome depends on how complicated the intervention was. The full rehabilitation period is from a week to a month and a half and can be extended by decision of a doctor.
Contrary to popular belief, doctors recommend a gradual introduction of physical activity after surgery. First of all, walk. In no case should you lift weights and generally expose the body to great physical exertion. A light morning workout will be helpful.
Preventive actions
People who are at risk or have a genetic predisposition to developing hernias need to follow certain rules in order to exclude the possibility of Richter infringement.
First of all, you should abandon heavy physical exertion. Proper nutrition should not be neglected. Refusal of bad habits also reduces the risk of developing a hernia and its infringement. People who are inclined to fullness need to accustom themselves to a mobile lifestyle.