Strangulated hernia

Strangulated hernia

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Major complication of hernia strangulation is external, internal and eventrations. The presence of a hernial sac strictiunea intestinal segment to train a serious obstruction can rapidly lead just 6:00 into the herniated loop necrosis. Strangulated hernia is an abdominal emergency that requires rapid diagnosis and treatment.
It is believed that about 6% of total external hernia strangulation reach. Frequency varies with the type of hernia strangulation: 30-40% of the femoral, 5-8% and 3-5% of the umbilical from the bikini line. However, in practice strangulated inguinal hernia is most often encountered because of its high frequency.
The clinical picture of a strangled hernia include painful distention of the hernia, it can not be handled manually through the abdominal wall, nausea, vomiting and symptoms of intestinal obstruction. Vascular ischemia caused by strangulation hernia leading to intestinal perforation and peritonitis.
Strangulation hernia can occur at any age but commonly occurs between 40-80 years with a maximum frequency in the sixth decade of life. It found a higher frequency of hernias strangled in elderly patients. Male sex is more often affected. Eventrations bottlenecks occur more commonly in women.
Being a complication that can worsen in a short time through the loop necrosis bottlenecks, determining how early diagnosis of strangulation hernia is the best method of decreasing postoperative mortality and morbidity. Major complications secondary strangulation of a segment of bowel herniation include: bowel obstruction, peritonitis, phlegmon piostercoral, late complications of lung and intestinal stenosis.
Treatment in recent strangulation 6 hours to do it to reduce the hernia by taxis, after a prior sedation of the patient. Failure to reduce bottlenecks and by taxis older than 10 to 12 hours will be addressed surgically. Usually surgery is performed under general anesthesia but can also resort to local or locoregional anesthesia, depending on the field.
The prognosis is generally favorable. It is dependent on many factors such as duration of intervention onset, need bowel resection, patient age and land and complications: peritonitis.
Pathogenesis
Strangulation of the hernia sac lies in engaging in a more voluminous content, which is irreducible. Edematiaza herniated organs are due to venous stasis and muscular-aponeurotic ring deveniy enable re not too narrow in the belly of the bag contents. In producing strangulation, outside effort that factor, we have an important role fibrous ring (for crural and umbilical hernia) and neck bag (inguinal hernia). Strangulation of the hernia sac within the umbilical hernia occurs and inghinoscrotale bulky, either by the diaphragm to divide the bag, that dress looks multidiverticular or by adhesive, clips or agglutination of the loops, secondary to chronic inflammatory processes.
As a predisposing factor, strangulation usually occurs in patients with hernias old hernia bandages carriers, those with irreducible hernias, bulky. The sharp increase in intra-abdominal pressure, following an intense effort variable can force a larger amount of visceral chance to enter the hernial sac. Aponevroticofasciale structures relative elasticity of the package bag in train a major embarrassment venous circulation and lymphatic return. Edema increases resulting constriction and stasis, install a vicious cycle that suppresses the flow and aretriala, compression or thrombosis and leads to irreversible damage, visceral tissue necrosis.
Lesions that are produced by strangulation hernia sac concern (which is globular, relaxed, red-purple) and its contents: liquid-looking variable (from serocitrin upset fetid always septic) and herniated viscera (small intestine 60-80% of cases, 15% of cases omentum, colon, 5% of cases).
Strangulated intestine goes through three developmental stages can be recognized intraoperatively: Congestion during the gut-viable -Bruising period, characterized by ischemic events Gangrene and perforation-period, the leaves wither aspect of the loop thin-walled, soft, brittle.
In the trench of strangulation injuries are highest and more advanced stage than the rest of the intestinal loop strangled. Perforation closed loop space strangled hernia sac produces a collection of purulent phlegmon piostercoral fecal-time-which can grow locally, without communication with the great peritoneal cavity, forcing inflammatory phenomena, usually evident in the surrounding tissues. The time leading to gangrene in intestinal loop varies depending on the intensity of constriction and circulatory factors are described situations gare gangrene occurs after 3-4 hours.
Causes and Risk Factors
Predisposing factors for a hernia strangulation already include: -Exercise, adhesion formation, inflammatory clamps -Occurs in older patients, hernia bandages carriers Irreducible hernia-in, bulky.