Eventration

Eventration

    * Introduction
    * Treatment
Eventrations output is a visceral parietal peritoneum under the skin covered by a breach of the abdominal wall occurred after surgery or trauma. The most important and most common are eventrations occurring postoperatively. Eventrations postoperative frequency is at least 10% of abdominal operations. A third of these occur in the first five years and at least another third occur 5-10 years after surgery. Eventrations may be involved in causing two categories of factors: factors related to the surgical act and factors and factors related to the patient's biological background. The first category we can mention: suppurative wound, type of laparotomy performed, immediate postoperative complications (eg acute retention of urine, which increases intra-abdominal pressure) and biological factors related to the background of the patient are: age, consumptive diseases, large physical effort , or small and repeated obesity. A patient with eventration is usually a history of surgery and medical history should focus on the nature of primary surgery (septic or aseptic), the time of primary surgery until the appearance eventrations, any wound suppuration. Clinical examination will determine the size eventrations, if it is reducible or not, if there occlusive syndrome, circulatory or respiratory disorders. Treatment is surgery and if there is urgency occlusive syndrome, where treatment is elective, you must pass at least six months after primary surgery or to stop any suppurative process in the wound. The objectives of surgery are: sac dissection, treatment and reintegration content in ab ¬ visceral abdominal wall and reconstruction domain.
ETIOPATHOGENIC Obesity and infection are two of the most important causes of eventrations. Fat mass by itself make problems for surgical incision and wound infection leads to healing and prevent scarring deficiency. Hypertension, diabetes mellitus, cardiac and renal disease often accompanies obesity and complications than surgical treatment and postoperative wound healing. Factors that contribute to the development eventrations are divided into factors related to the surgical act and biological factors related to the patient's background. Factors related to the surgical act are: - The type of laparotomy, the oblique and vertical paramedian give the highest percentage of eventrations because anatomical dissection and involving inervatiei plans at this level; incisions eventrations subombilicale also give thanks to increased intra-abdominal pressure at this level; - Immediate postoperative complications such as acute urinary retention, cough, vomiting, paralytic ileus, intra-abdominal pressure put by increasing tension suture aponeurotic plane; - Suppurative wound is the factor most often incriminated in causing hemostasis eventrations and poor appears to be due to the appearance of a hematoma that becomes infected, either due to failure to observe rules and antisepsie sepsie. Also at increased risk of wound suppuration it shows septic operations, such as colo-rectal surgery or peritonitis. Factors related to the biological background of the patient are consumptive diseases (anemia, neoplasia), obesity, age, physical effort and repeated large or small.
TYPES OF eventrations After opening the parietal distinguish dimensions: - Eventrations small, easily reducible; - Eventrations large, wide hole through which herniaza a large mass of abdominal viscera, hardly reducible; - Eventrations giant with very large hole through which a large part of herniaza ¬ tional abdominal viscera causing cardiocirculatorii and respiratory disorders.
SIGNS AND SYMPTOMS Loss of integrity of the abdominal wall reduces intra-abdominal pressure and cause significant changes. The most important change is respiratory dysfunction. When there is a large eventration during breathing is a paradoxical movement of the abdominal wall similar to that of voucher mobile rib (fracture of at least two consecutive ribs, each side was fractured in at least two places), diaphragmatic function is ineffective and leads to entry viscera in the hernia sac. Reduce abdominal pressure by eventration cause swelling and stasis in the mesenteric venous system and inferior vena cava splahnic. Atony and distension of hollow viscera appears and decreasing ability to increase intra-abdominal pressure at urination and defecation difficulties arise. Back pain is a common symptom and is induced lordosis that occurs due to shrinkage of large muscles and decreased muscle efficiency straight. Superjacent skin and subcutaneous tissues are stretched and damaged large eventrations. The skin becomes hypoxic, atrophic, subcutaneous fat-free and spontaneous ulcers occur. These sores are hard to heal and require intensive treatment antibicrobian both locally and systemically to prevent sepsis. Clinical examination will record: eventration hole size, appearance aponeurotic edges, reductibilitatii assessment and functional disorders caused by the eventration, transit disorders, especially cardio-circulatory and respiratory.