The department of faculty and hospital surgery of the medical faculty of the
Tashkent medical academy
Complications of the
hernias of the abdomen
The history of the doctrine of hernias
The first written mention of
abdominal hernia refers to the time
of
Erbes
papyrus
in
Egypt.
Information about hernias was found
in the works of Hippocrates (V
century BC.), Celsus (I c. BC), Galen
(II century AD.), Heliodorus (IV
century AD.) . In particular, Celsus,
gave the classical definition of hernia
- protrusion of viscera through the
acquired and congenital "gate",
calling
it
a
hernia.
In 1804, Cooper published a
two-volume
work
"The
Anatomy
and
surgical
treatment
of
abdominal
hernias." He described the
transverse fascia, the inguinal
canal and some other entities.
Paying attention to the pubic
ligament, which now bears his
name, Cooper had no idea how
important it is for the modernAustin Cooper
Rev Austin
treatment of hernias.
(1759-1830), father of
Cooper (1804-1871),
grandfather of Austin Damer Cooper
(1831-1900) and great grandfather of
Austin Nathaniel Cooper (1853-1898)
Historic breakthrough in herniology
associated with the name of the Italian
surgeon E.Bassini, to create a single
concept in the surgical treatment of
inguinal hernia. In 1884 Bassini first
described the technique of surgery for
inguinal
hernias,
and
laid
the
foundations
for
the
modern
understanding of the role of the
posterior wall of the inguinal canal in
the herniation. He developed the
concept of reconstruction of the inguinal
canal has revolutionized the surgery of
inguinal hernias. Methods and principles
of the plastic used Bassini, gradually
occupied the leading position.
Complications of the hernias
of the abdomen
Not replacable
Coprostasis
Strangulation
Complications at 10-15% of
patients with hernia
Inflammation
Types of the strangulation of the
hernias
Elastic strangulation
Excrement
strangulation
Retrograd
strangulation
Near-wall (Richter’s) strangulation
Clinic of the strangulated hernia
• Sharp begining
• Pain in the area of hernia
• Unreplacement of the earlier setting
hernia
• Sharp pain, compaction, effort of the
hernia
• The symptom of «cough pushing» is
negative
Stages of the operation for the
strangulated hernia
1. Tightly section of the tissues to the
2.
3.
4.
5.
6.
aponeurosis and stripping of the hernia’s
sac
Opening of the hernia’s sac, liquidation
of the hernia’s water, keeping
strangulated organ
Section of the strangulative ring
Identification of the vitality of the
strangulated organs
Resection of the not viable organs
Plastic of the hernia’s gates
Signs of not viable intestine
• Absence of the peristaltic
• Absence of the pulsation of the
mesenterial vessels
• Blue-black color
• Absence of the brilliance of the
peritoneum
Tests to indentify the vitality of the
intestine
• Novocain test
• Mechanical test
• Test with the «hot compress»
Separation of the
hernia’s sac
Opening of the
hernia’s gate
Section of the strangulative ring
Resection of not viable part of the intestine
Intraintestinal anastomosis “side-by-side”
Nasoenteral probe
Intubation of the small
intestine
Independent or forcible setting of the
strangulated hernia
It is impossible to define the state
of the strangulated organ
Possibility of setting with the
strangulative ring
Possibility of defeat of the
strangulated organ
Complications of the forcible setting
of the hernia
Inflammation of the hernia
Sources of the infection of the hernia’s sac
From the
inside
•Strangulation of the
intestine
•Acute appendicitis
•Diverticulitis
Terminal ileitis
•Typhoid fever’s ulcers
•Perforation of the small
intestine
From the
outside
•Inflammatory processes
of skin
Defeats of the skin
epydedimitis, orchitis
lymphadenitis
Unreplacement
The complication of the hernias, connected with the formation
of the soldering among hernia’s bag and hernia’s content as
a result of their trauma or aseptic inflammation
Unreplacement
Hernia and loose-hanging abdomen
Coprostasis
- stasis of the excrements in the intestine
The development of the coprostasis
promote:
•Unreplacement of the hernia
•Less activity of the life
•Rich feeding
Coprostasis more frequently occurs:
•At fat patients of elder age
•At men at the inguinal hernias
•At women at umbilical hernias
Treatment of the
coprostasis
• It is necessary to reach the evacuation of
•
•
•
the content of the intestine
At setting hernias it is necessary to try to
keep the hernia at set state
Use small enemas with the hypertonic
solution, glycerin
The using of the purgatives is
contraindicated!
Prevention of the
complications of the hernias
The surgical treatment of all the
patients with the hernias in
planned regime
DUTIES of the general practitioners
• Carrying out sanitary - educational work on education of the population,
•
•
•
•
•
•
•
promote healthy lifestyles, prevent disease development.
Implementation of preventive work aimed at identifying early and latent
forms of the disease and risk factors.
Implementation of dynamic monitoring of the health of patients with
carrying out the necessary examination and improvement.
Emergency assistance in emergency and acute conditions.
Timely consultation and hospitalization of patients in the prescribed
manner.
Conducting medical and rehabilitation activities in the amount
corresponding to the requirements of qualifying characteristics.
Examination of temporary disability of patients in accordance with the
Regulations "On the procedure of issuing sick leave" and the direction of
VTEK.
Organization of health - social and household assistance in conjunction
with social protection agencies and services of charity alone, the elderly,
the disabled, the chronically ill.
The main responsibility is to provide primary health care - social assistance, in accordance with the
requirements of the qualification characteristics and obtain a certificate.