An abdominal hernia is considered a fairly common disease. At the same time, it occurs regardless of gender and age.
This term refers to the protrusion of any internal organ that occurs due to increasing pressure on the abdominal wall. Visually, it looks like a certain formation of a round shape that occurs on the side or front surface of the abdomen.
If you search by the classifier for the word "hernia", in ICD-10 a whole section will open devoted to just such diagnoses. It covers paragraphs K40-K46, includes both congenital and acquired pathologies of this type. For example, an umbilical hernia is designated as K42, and a corresponding protrusion on the anterior abdominal wall is designated as K43.
Any hernia is a rather dangerous disease, it completely changes a person’s life and, even worse, can lead to serious complications, which in the absence of adequate treatment result in death. As a rule, we are talking about such a thing as infringement of a hernia of the abdomen.
Basic concepts
Pinched hernia is the most common complication in this situation. Of all diseases of the abdominal organs, it occurs as often as acute pancreatitis and cholecystitis, and is inferior only to acute appendicitis.
According to statistics, it accounts for up to 15% of acute conditions in gastroenterology. True, in different types of pathology, the frequency of spread can vary significantly. For example, most often problems arise with the inguinal and umbilical forms of the disease. While pinching a hernia of the white line of the abdomen is much less common. Which, however, does not make such a condition less dangerous.
When infringement of a hernia occurs, the blood supply is disturbed. That is, it turns out that the internal organs that are inside this "bag" or protrusion (that is, the small intestine, omentum, etc.) are compressed. In this case, acute pain occurs, and after some time internal bleeding may open.
Also, a hernia of the abdominal cavity is dangerous because in case of pinching, necrosis (i.e. death) of the affected tissues can occur.
As a rule, conservative treatment in such cases does not give anything. And after the diagnosis, an emergency operation is done.
It is worth noting that the disease can cause a number of complications, for example, colitis of the abdomen (intestines), etc.
Types of Pinched
Often people are interested in the question of what it is - a hernia of the stomach, than to treat a pathology. Moreover, they mean protrusion of any internal organs of the abdominal cavity.
In fact, protrusion and infringement of the stomach are relatively rare, which is associated with the very mechanism of the formation of the disease. An intestinal hernia is much more common, sometimes the urinary bladder is infringed, and in women, the uterus and appendages.
All cases of the development of pathology can be divided into two types: occurring by an elastic or fecal mechanism. In the first embodiment, a simultaneous loss of a large amount of future hernia contents through relatively narrow "gates" is observed. In the future, such a protrusion cannot "settle" on its own. Since they are infringed by the narrow ring of the gate, severe pain occurs in the abdomen. Muscles are cramped, which exacerbates the situation.
As for fecal infringement, it develops when the intestinal loop that has fallen into the hernial sac is full of contents. Most often, this situation is typical for cases of protracted protrusions.
Also, all pathologies of this type can be divided into primary and secondary. Primary are usually associated with the use of simultaneous, but excessive effort. Excessive physical exertion - and now it hurts in the stomach, although before there was no hernia. Secondary infringement occurs when problems have already arisen before.
Reasons for the development of pathology
If there is a pinched abdominal hernia, the consequences can be very unpleasant. They have already been considered above - right up to death. Therefore, many are wondering if effective prevention methods exist. To answer this question, you need to consider the causes of infringement of the hernia.
The protrusions themselves appear due to the fact that intra-abdominal hypertension occurs, that is, the pressure rises, and it exceeds the resistance of the abdominal wall. Since the provoking factors in this case are obesity and muscle weakness. It can be argued that successful prevention largely consists in normalizing weight and strengthening muscles.
But these are not the only reasons provoking the development of pathology. These include:
- excessive physical stress;
- traumatic injuries of the relevant organs;
- very strong cough;
- intestinal atony and constipation caused by it;
- surgical interventions (associated not only with suppuration or poor healing of wounds, but also with improperly sutured materials that are rejected by the body, and this also happens when the absorbable sutures used in operations lose strength even before a scar forms in their place);
- pathology of the prostate.
At the same time, sharp weight loss can also contribute to the development of pathology. In women, the cause may be pregnancy, especially if it ended in a difficult birth. In older people, the main risk factor is intestinal atony.
Infringement occurs according to one of the mechanisms described above. It is associated with the fact that with the normalization of intra-abdominal pressure, a decrease in the hernia gate is observed. The likelihood of such a development of events does not depend on the diameter of the said gate or the magnitude of the protrusion itself.
Considering a phenomenon such as a hernia of the stomach, what it is and how to treat it, it should be noted that there are people who are immediately at risk:
- People who have a hereditary predisposition to such a pathology.
- If we are talking about umbilical hernia, then the risk group includes primarily babies under the age of one year, as well as women after childbirth. In men, inguinal hernias are more common.
Signs
A condition in which an abdominal prick is not necessarily associated with a hernia. This may be other pathologies of the digestive tract, and a doctor can make a more accurate diagnosis depending on the clinical picture and the results of laboratory and instrumental studies.
Symptoms of pinching a hernia of the abdomen are as follows:
- Sharp abdominal pain, which can be both spilled and local in nature. Its distinguishing feature is that it occurs with physical effort, at its peak (moreover, it can be walking, but at rest, unpleasant sensations do not subside).
- First - a single vomiting, which is reflex in nature. As intestinal obstruction develops, vomiting intensifies and becomes constant, can take on a fecal character. But with partial pinching of the hernia of the abdomen there are no symptoms of obstruction, so this symptom may be absent.
- Nausea and eructation (the latter most often occurs when the large intestine enters the hernial sac).
- Bloating without gas.
In case of partial pinching of the hernia, frequent urination can be observed, and they are accompanied by pain. Traces of blood may be noticeable in urine. Especially often this happens when the bladder is pinched. Sometimes tachycardia and a decrease in blood pressure are observed, the skin becomes pale.
Paroxysmal abdominal pain in this condition does not occur so often, although it is possible with intestinal infringement. In general, pains are felt for several hours, if after that they abruptly stop, there is no reason for joy - this means that the restrained tissues die out and nerve fibers die. Against the background of a hernia, colitis may develop.
At the same time, the abdomen hurts in any department, sometimes the pain can radiate in the groin or thigh. It can be so strong that the patient begins to moan involuntarily. At the same time, symptoms of intoxication are observed, including fever.
Diagnostics
Even if there are signs of pinching of the abdominal hernia, this does not mean that the doctor is dealing with this disease. Moreover, up to a point, the symptoms can be blurred.
In the early stages, an accurate diagnosis is not immediately possible. The patient is not bothered by anything, the protrusion is visually imperceptible (although with strong pressure it can be painful). And in the end, the therapist can not always suspect a hernia. Although more experienced doctors have such an opportunity, because they have their own diagnostic techniques that can clarify the picture.
But in general, at least an ultrasound scan is recommended. And if we are talking about a postoperative hernia or relapse, or there is a suspicion that the doctor is dealing with a complex multi-chamber case, then we need to additionally do a CT scan of the anterior abdominal wall. In any case, this will not hurt, but will help to get a more accurate picture.
A physical examination of the patient is mandatory. The presence of tension and pain during the examination, which does not disappear even after the patient changes the position of the body, can indicate a hernia. In this case, you can listen to peristalsis over the restrained hernia. But sometimes the doctor notes a symptom of obstruction in certain noises.
Sometimes it is recommended to conduct a survey radiography of the abdominal cavity. As well as ultrasound, it has an important advantage - it allows you to check the condition of all organs and differentiate the hernia from other diseases, which include both gastrointestinal tract pathologies and inguinal lymphadenitis.
Surgery
If hernia is diagnosed, surgery is inevitable. The so-called hernioplasty, that is, hernia repair, is performed. Today it is done both in a classic way and laparoscopically. At the same time, children undergo autoplasty, that is, they use their own tissues from a small patient, and adults use alloplasty, that is, artificial materials, also called nets.
No matter what type of hernia is diagnosed according to ICD-10, a hernia repair, also called a tension technique, can be used in any of these cases.
During this operation, the walls of the hernial canal are strengthened by their own tissues and nets. This is not a new method, it has been used for a long time and successfully. But even with such brilliant results, the probability of a relapse of the pathology is 10-15%.
If a second operation is performed, the risk of relapse rises to 50%. This is not surprising, because even a fortified canal is still a weak tissue, since scars have already formed on it after surgery.
To avoid this, various methods of suturing are used - not only edge to edge, but also overlap to strengthen the problem area. But this gives a good result only if the protrusion itself is small. With large hernias, even such advanced techniques can lead to relapse. It is clear that the less experience a surgeon has, the higher the likelihood of complications and repetitions.
When healing a large hernia, other problems may occur. For example, the problem leads to a dangerous increase in abdominal pressure precisely because the stomach has to be sutured, the abdominal wall contracts, the organs inside are rammed more densely than before. Of the postoperative complications, problems with cardiac function and breathing should also be distinguished.
The recovery period after surgery is at least a week, or even more. And another six months after that you will have to wear a bandage. For several months it will be necessary to reduce physical activity.
Plastic
Around the beginning of the 90s, in Russia, plastic is increasingly used in such cases, namely laparoscopic surgery as a more effective and modern method. After such an intervention, there are practically no complications, since the synthetic material used in this case is not rejected by the body.
The plastic itself can be compared to a patch on clothes. In a simplified form, this can be represented as follows: the surgeon inserts the mesh into the hernial opening from the inside, and then fixes it properly. Such a grid becomes a kind of framework for blood vessels, nerves and connective tissue. The percentage of relapses after such operations is negligible - less than 0.5%. And even then they mainly arise when the patient was not careful during the recovery period.
The advantages of the operation are that during the operation there is no stretching of the tissue, so the sutures heal faster, and the pain will be weak. Plastic surgery is indicated for all patients over 16 years old. Although diabetes is a contraindication for normal surgery, laparoscopy can be performed. But only more careful monitoring should be ensured in the postoperative period.
Operations of this kind are done using a mesh of polymer fiber. The mesh structure ensures that the material sprouts through the recipient’s own cells and soon becomes almost the same as tissue of natural origin.
Previously, in such cases, just mesh made of polypropylene or prolene was used. They really are not rejected by the body, but today combined products are considered more effective, where some of the fibers are prolen and the other is vicryl, the absorbable material from which the threads are made for surgical operations.
Plastic surgery is performed in a laparoscopic manner, literally three punctures are made, so suppuration is excluded. The rehabilitation period does not last long, on the third day of the patient it will be possible to write out. At the same time, he does not have to wear a bandage, although he still needs to refrain from lifting weights.
When can I wear bandages
If a person is diagnosed with a hernia of the anterior abdominal wall, surgery is indicated. However, often in pharmacies you can see special bandages that are designed to treat pathology. In fact, they do not work quite like that. Products cannot stop the disease, they can hold it by force.
Such a bandage is a wide belt made of strong, but elastic fabric, which closes the hernia gate and purely mechanically prevents protrusion. Thus, the product cannot be considered an alternative treatment for symptoms of pinching of the abdominal hernia, although it helps to reduce the burden on the problem area, stabilize intra-abdominal pressure, relieve pain, and also prevent pinching.
That is why a bandage becomes the only possible option for patients who are contraindicated in surgery. This happens, for example, in severe systemic diseases, in addition, surgery is not done for older people. Surgical interventions are also contraindicated after a heart attack (at least in the next few months).
That is, if a hernia of the anterior abdominal wall is diagnosed in an elderly person, then he will have to wear such an elastic bandage for life. In all other cases, it is not recommended to use such a dressing for a long time, since this can only injure the hernia or lead to its increase.
But bandages can be considered an excellent preventive measure, they are recommended to be worn by people who are at risk, for example, pregnant women, those who are experiencing strong physical exertion, etc. When choosing a product, you need to make sure that it is made of high-quality hypoallergenic material. And at the same time, you should immediately study the rules for caring for him.
Hernias in adults and children: what are the differences?
Abdominal pinched hernias and adult symptoms were discussed above. But in children this problem arises quite often, especially in babies under the age of one year. Some abnormalities in development, as well as congenital weakness of the connective tissue, usually lead to its appearance.
But any factors leading to an increase in intra-abdominal pressure can provoke a protrusion. For example, it can be a loud, literally heart-rending cry. Even constipation, a strong cough, bloating and a sharp decrease in the weight of the child as a result of intestinal infection can affect.
In a child, infringement of a hernia is accompanied by restless behavior. Externally, the protrusion looks like a slight swelling, but over time, the skin may turn red at this place, sometimes swelling of the surrounding tissues is observed. Another characteristic symptom is vomiting.
Not all hernias that can develop in a child require immediate surgical intervention. Although, with the appearance of an inguinal variety of the disease, this issue does not need to be dragged out, since with infringement a severe violation of blood supply occurs, which can lead to death.
In order not to miss the moment of the development of such a pathology, the baby should visit the surgeon for a routine examination at least once a year. For children, minimally invasive, that is, laparoscopic techniques are used.
But umbilical hernia is not a danger. In children, it is almost never infringed, and doctors simply monitor the condition of the baby until about 4-5 years old. It is interesting that small hernias in children can be repaired independently, because the child grows and develops. For prevention, you can wear special bandages.
Conclusion
Pinching a hernia of the abdomen is a rather dangerous condition that can lead to death of the patient. It is impossible to ignore such a problem in any case, you need to contact a specialist in a timely manner to prescribe therapy.
It is also necessary to remember that no folk remedies and wearing bandages will save you from pathology, but only slow down the process. In any case, a hernia can only be cured by surgery.
Additionally, other methods can be used, but only after a full examination as an additional therapy, which can only be prescribed by the attending physician after the operation.