Strangulated hernia: symptoms, types, diagnosis, help and treatment

Why does the infringement occur?

The causes of strangulated hernia are associated with a sharp or persistent increase in intra-abdominal pressure. This condition develops under the influence of external or internal factors:

• excessive physical activity;
• lifting heavy loads;
• chronic constipation;
• hacking cough;
• intestinal atony;
• weakened abdominal wall muscles;
• abdominal injuries;
• sudden weight loss;
• abdominal surgeries.

Internal organs caught in the hernial orifice are unable to correct themselves. Due to the overly stimulated tone of the muscles that form the hernial orifice, their size decreases, the organs become pinched, and signs of strangulation of the hernia appear.

With a hernia of the Spigelian line and other elastic strangulations, necrosis develops in the strangulated tissues within a few hours, and the risks of peritonitis and intestinal obstruction increase.

Complications and consequences of intervertebral hernia

Untimely treatment of a dangerous pathology leads to dysfunction of the pelvic organs, muscle atrophy, and progression of neurological disorders.
Prolonged pinching of the intervertebral hernia leads to tissue necrosis. The pain increases to an unbearable state. The sensitivity and reflexes of the lower half of the body are significantly weakened. Paralysis, reproductive dysfunction, impotence in men, and infertility are possible. Complete recovery of a long-ignored condition is impossible even after an operative procedure.

Types of pathology

According to pathogenesis in surgery, the following types of strangulated hernias :

• elastic – associated with persistent spasm of the muscles of the anterior abdominal wall;
• fecal - develops as a result of a sharp overflow of the adductor part of the intestine located in the hernial sac.

Depending on which organ is pinched in the hernial orifice, there are pathologies with: pinching of the mesentery, parts of the intestine, omentum or stomach. With an inguinal hernia, the bladder, uterine appendages (in women), and spermatic cords (in men) may be compressed.

Special types of infringement include:

• Retrograde - at least three intestinal loops enter the hernial sac, two of which are in good condition, and necrosis develops in the third.
• Parietal - partial compression of the intestine in the area opposite the mesenteric edge.

Primary infringement is most often provoked by a single spasm of the abdominal wall muscles. Secondary develops as a complication of a previously diagnosed hernial formation.

External abdominal hernia

April 30, 2021

Abdominal hernia is a protrusion or protrusion of abdominal organs through defects or “weak spots” of the abdominal wall while the outer integument is intact. The weakest points of the abdominal wall, which are clinically important, include: the inguinal canal, the umbilical ring, the area of ​​the white line of the abdomen, most often above the navel, the Spigelian line.

Abdominal hernias are among the most common surgical diseases; therefore, the treatment of such patients is not only a medical problem, but also a socio-economic one. The name “hernia” in Russian comes from the word “gnaw”, which indicates the unpleasant sensations that occur during the formation of hernias, and are manifested in the violation of “gnawing” the integrity of the abdominal wall and the release of its contents under the skin.

In the 5th century AD Celsus introduced the term “Hernia” (hernia), and therefore the science of studying hernias became known as herniology.

To understand the problem of the disease, let's take a little look at the anatomical features of this pathology. As can be seen in the diagram, the hernia consists of several parts: the hernial orifice, the hernial sac, the hernial contents and the external hernial membranes.

The hernial contents can be the abdominal organs or parts thereof (most often these are loops of the small intestine, omentum, wall of the colon or bladder). Thus, a hernia is like a sac with a small hole that allows the internal organ to come out.

The classification of external abdominal hernias is based on two basic principles:

1. the name of the hernia corresponds to the anatomical areas where they form (inguinal, femoral, umbilical, postoperative or ventral hernias, as well as hernias of the white line of the abdomen and internal hernias);
2. according to the ability of the contents of the hernial sac to be reduced into the abdominal cavity - reducible and irreducible.

An example of an internal hernia is a hiatal hernia. They can be of two types: sliding or paraesophageal. Hiatal hernia occurs more often in women than in men.

What are the causes of hernias?

The causes of hernias include:

• obesity;
• pregnancy: during pregnancy, the mother's abdomen stretches, which increases the likelihood of hernias;
• heavy lifting, severe cough, constipation: cause tension in the muscles of the anterior abdominal wall, which leads to increased intra-abdominal pressure;
• sudden weight loss: People who suddenly lose weight are at increased risk of developing a hernia;
• genetic predisposition: if one of your parents had hernias, then there is a chance that you will also have one;
• age: the older we get, the higher our chance of “earning” a hernia;

Other causes of hiatal hernia include obesity, pregnancy, very tight, tight clothing, sudden physical exertion, muscle tension, and coughing.

How to check if you have a hernia?

As a rule, the disease is characterized by the following features:

• the disease develops gradually and most often begins with discomfort during physical activity;
• hernial protrusion appears later, manifesting itself during exercise and disappearing at rest;
• Over time, the visible formation increases and ceases to be reduced or disappears at rest.

Pay attention to:

• the appearance of a protrusion (swelling, formation) in the area of ​​the navel, groin, abdomen, which increases in a vertical position, during physical activity, when straining, and disappears or decreases in size in a horizontal position. The protrusion increases in size over time and takes on a round or oval shape. With indirect inguinal hernias, the contents of the abdominal cavity in men can descend into the scrotum.
• the appearance or intensification of pain in the protrusion area when doing physical exercise, lifting heavy objects, when coughing or sneezing, at the end of the day, or after a prolonged vertical position (standing still).
• The severity of the pain syndrome can vary: from discomfort to severe pain (the presence of pain syndrome more often indicates the occurrence of a complication - pinching).

Please note that if any symptom characteristic of a hernia appears, such as protrusion, discomfort, pain during physical activity, this is a reason to consult a doctor. A timely diagnosis will help avoid life-threatening conditions and serious complications.

What is the danger of a hernia?

A hernia of any location has a risk of developing complications.

Complications of hernias include:

• infringement;
• irreducibility;
• inflammation;
• coprostasis.

A strangulated hernia is the most common and dangerous complication, requiring immediate surgical treatment . In this case, the organs that have entered the hernial sac are subjected to compression in the area of ​​the neck of the hernial sac in the hernial orifice.

Any organ located in the abdominal cavity can be pinched. More often, the loops of the small intestine and the greater omentum are pinched; the vessels supplying the intestine are compressed, which can result in necrosis (death of a section of the intestine), followed by the development of peritonitis. In such situations, in no case should you try to reduce the hernial protrusion into the abdominal cavity; you need to call and wait for doctors. A strangulated hernia always requires emergency surgical treatment, unlike non-strangulated hernias.

To avoid such complications, the presence of a hernia (i.e. hernia defect) is an indication for surgical treatment.

Treatment

Unfortunately, there are no conservative treatment methods. There are no pills or exercises to treat hernias. To eliminate a hernia, it is necessary to reduce the entire contents of the hernial sac, and the hernial orifice (the hole through which the hernia emerges) must be sutured to such a size that subsequently the hernia will not be able to exit through them again.

Currently, there are several methods of surgical treatment of hernias. The choice of technique depends on the type of hernia, the age of the patient, anatomical features, gender and the qualifications of the surgeon. The sooner an unstrangulated hernia is operated on, the better the prognosis for the patient’s health!

We treat inguinal hernias, umbilical hernias, femoral hernias, postoperative hernias, and hernias of the white line of the abdomen.

Our Outpatient Surgery Center actively uses hospital-replacing technologies, which have a number of advantages over hospitals:

The use of modern minimally invasive surgical techniques allows us to minimize pain in the postoperative period and ensure high cosmetic efficiency. We use only modern equipment, suture materials and mesh grafts from leading companies such as B|Braun, Johnson & Johnson, etc.

Modern methods of anesthesia allow surgical interventions to be performed without deep sedation of patients and intubation anesthesia, which significantly increases the safety of operations and reduces the time of the early postoperative period.

Surgical operations do not require hospitalization of the patient in a hospital and are performed in more comfortable conditions, and the ability to return to a familiar environment on the same day after the operation does not create psychological discomfort and saves time.

The low risk of postoperative infectious complications is ensured by the absence of hospital-acquired infection.

What to do if you have a hernia or suspect one?

Recommendations

• Contact a surgeon: only a qualified doctor can make the correct diagnosis. Whether you want to have surgery or not is up to each individual, but you need to know your diagnosis. And once the diagnosis is made, there are two options: either live with the hernia, or agree to surgery. Remember that a hernia tends to increase over time, it limits physical capabilities, introduces a cosmetic defect and can be strangulated at any time.
• Try not to lift weights: this will strain the muscles and create a lot of pressure in the abdominal cavity. It is necessary to lift weights correctly: when lifting something heavy, bend your legs at the knee joints, while your back should remain straight. The main work should be done by the leg muscles, not the stomach or back.
• Wearing various hernia bandages : indicated only for those people who are not able to withstand surgery. Surgery for such people for a hernia is contraindicated for health reasons. On the one hand, the bandage prevents the hernia from coming out; on the other hand, when worn for a long time, it contributes to a strong weakening and thinning of the connective tissues of the anterior abdominal wall - the so-called atrophy from inactivity.
• In case of hiatal hernia: do not eat foods that may irritate the stomach lining. Elevate the head of your bed a few centimeters to prevent stomach contents from refluxing into the esophagus. You should not lie down or go to bed immediately after eating.

What preventative measures are there?

If you are overweight: you need to watch your diet. This does not mean that you need to sharply limit yourself in food. Rapid weight change is very bad for health. After all, the body got used to its weight, it accumulated it gradually. If you suddenly go on a strict diet and force the body to lose more than 10% of its previous weight in a short period of time, this can lead to various diseases, including the development of a hernia. The body's regulatory systems do not have time to respond to such changes. It is considered normal to lose 1-2 kg per month. If you manage to lose a couple of kilograms, do not try to lose weight further. It’s better to try to keep your weight at this level for some time.

Prevent and treat constipation: Eat more fluids, fruits, vegetables and whole grains every day. Avoid "fixing" products, i.e. those that cause hard stools.

Reduce the amount of carbonated drinks and coffee in your diet. Exercise regularly. Follow a routine and eat at about the same time 3-4 times a day. If you feel the urge to defecate, do not delay it.

If the hernia suddenly hurts:

Take a horizontal position, relax your stomach and gently stroke it until it straightens and stops hurting. If the pain does not go away within an hour, call an ambulance; most likely, a strangulated hernia has occurred. In this case, immediate surgery is indicated, since the strangulated intestine may die and peritonitis may develop.

Strangulated hernia: symptoms of the disease

❗ What signs can be used to judge a developing pathology:

• sharp pain at the location of the hernial formation;
• muscle tension in the protrusion area;
• inability to straighten a pinched organ;
• absence of cough impulse transmission.

The clinic of a strangulated hernia is characterized by a general deterioration in the patient’s well-being. The skin becomes pale, the heartbeat quickens, and vomiting occurs. With the development of intestinal obstruction, vomiting becomes fecal in nature and becomes constant.

With prolonged strangulation, signs of painful shock appear - decreased blood pressure and tachycardia. At the site of the hernial protrusion, phlegmon forms - a purulent inflammatory process without clear boundaries of the lesion. If a strangulated umbilical hernia or other protrusion is not eliminated in time, the outcome is diffuse peritonitis.

What is Spinal Protrusion and Intervertebral Disc Herniation?

The discs, spinal cord and nerve roots are best seen on MRI scans . The condition of the disc and spinal cord can be judged only very roughly from ordinary x-rays.

Intervertebral disc protrusion is a protrusion of the disc into the spinal canal of the spine without rupture of the fibrous ring. Typically, protrusions do not cause pinched nerves, but pain occurs in the intervertebral joints or back muscles. If left untreated, spinal protrusion can develop into a disc herniation.

1 – normal discs 2 – spinal cord from which the nerves exit 3 – disc herniation has compressed the spinal cord and the exit site of the nerve

A herniated disc is accompanied by a rupture of the fibrous ring of the intervertebral disc, through which a fragment of the nucleus pulposus protrudes. A prolapsed disc fragment compresses the nerves (compression radicular syndrome), most often the sciatic nerve is affected, causing inflammation and swelling of the surrounding tissues, hence the pain and forced posture. Large herniated discs can compress the vessels or contents of the spinal canal and lead to paralysis of the lower half of the body, bladder and intestines.

The sciatic nerve is damaged more often than others because it begins in the lumbar spine, which is most susceptible to the formation of hernias. Inflammation of the sciatic nerve (sciatica) is manifested by pain from the buttock to the lower leg or foot, and a feeling of tension in the popliteal region. Severe lesions of the sciatic nerve are manifested by weakness (paresis) of the foot and loss of sensation in the leg. Read more about the sciatic nerve

Diagnostic measures

✅ Diagnosing a hernia infringement is not difficult. In most cases, an external examination is sufficient, during which you can detect a painful protrusion in the groin area or on the anterior abdominal wall. A clear sign of the disease is the absence of a cough impulse and symptoms of intestinal obstruction.

, abdominal ultrasound and radiographic examination are prescribed for differential diagnosis .

How is a strangulated hernia treated?

⚠ Therapeutic tactics for strangulated hernia consist of emergency surgical intervention.

During the operation, the surgeon releases the compressed organs and examines the extent of their damage. If necrotic areas are found in the intestines, they must be removed immediately. The hernial opening is closed with special synthetic materials or the patient’s own tissues.

In case of a strangulated hernia of the white line of the abdomen and other parts of the abdominal wall, it is prohibited:

• adjust the protrusion independently;
• take laxatives;
• administer antispasmodics and analgesics.

Treatment of strangulated hernia in our clinic

Specialists at the herniology center in Kaliningrad are ready to provide routine care to patients with hernias of the anterior abdominal wall. Emergency operations in case of strangulation are carried out in emergency hospitals in the city.

☝ We recommend that you seek routine help in a timely manner and not wait for serious complications such as strangulated hernias. In this case, the risks of complications will be minimal, and surgeons will do everything possible to get you back to your normal life as quickly as possible.

To find out the details of hernia treatment at the clinic for reconstructive surgery of the anterior abdominal wall, sign up for a consultation by phone: ☎ +7 (4012) 971-961.