扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 22. External Hernia

Hernia

Hernia

Historical HerniaHernia has beendocumentedthroughout historyvarying success ateither reduction orrepair

Historical Hernia Hernia has been documented throughout history varying success at either reduction or repair

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Trusses & Techniques

Abdominal wall herniaGeneral considerationinguinal herniafemoralherniaincisional herniaumbilial hernia

Abdominal wall hernia ◼ General consideration ◼ inguinal hernia ◼ femoral hernia ◼ incisional hernia ◼ umbilial hernia

General considerationDefinitionHerniameans a sprout,and protrusionExternalabdominal wallherniaisanabnormalprotrusion of intra-abdominal tissue or the whole orpart of a viscerathrough an opening or fascialdefectinthe abdominal wall.Most external abdominal wall hernia occurinthegroin

General consideration Definition Hernia means a sprout, and protrusion External abdominal wall hernia is an abnormal protrusion of intra-abdominal tissue or the whole or part of a viscera through an opening or fascial defect in the abdominal wall. Most external abdominal wall hernia occur in the groin

Etiology1.intensityofabdominal wall decreasesCommonfactors:1)sitethatsometissuespassthroughtheabdominalwall, eg.spermatic cord-male,round ligament of uterus-female(in theinguinal canal)2)bad development of abdominal white line3)incision,trauma,infectionetal.defectincollagensynthesis orturnover2.intra-abdominalpressureincreasesChronic cough,chronic constipation,dysuria,ascites,pregnancy,cry

Etiology 1. intensity of abdominal wall decreases Common factors: 1)site that some tissues pass through the abdominal wall, eg. spermatic cord – male ,round ligament of uterus – female (in the inguinal canal) 2) bad development of abdominal white line 3) incision, trauma, infection et al. defect in collagen synthesis or turnover 2. intra-abdominal pressure increases Chronic cough, chronic constipation, dysuria, ascites, pregnancy, cry

PathologicalanatomyComposition:Coveringtissue:skin,subcutaneoustissueHernial sac:protrusionofperitoneumNeck of the sac:is narrowwhere the sac emergesfromtheabdomenbody of the sacHernial contents:smallintestine,major omentum

Pathological anatomy Composition: ⚫ Covering tissue: skin, subcutaneous tissue ⚫ Hernial sac: protrusion of peritoneum, ⚫ Neck of the sac: is narrow where the sac emerges from the abdomen body of the sac ⚫ Hernial contents: small intestine, major omentum

smallintestineabdominalwallintestinalprotrusionholeinabdominal wall说说咱家娃

Clinicaltypes1.reducible herniais one ofinwhichthe contentsofthe sacreturntothe abdomenspontaneously orwithmanualpressure when the patientisrecumbent.2.irreduciblehernia is one whose content or part ofcontent cannot be returnto the abdomen,butwithoutserioussymptoms.Herniasaretrapped by the narrowneckSliding herniais one inwhichthe wall of a viscusformsa portion of thewall of theherniaoftheherniasac,itismaybecolon(on theleft),caecum(ontheright)orbladder(on eitherside)Belongstoirreduciblehernia

Clinical types 1. reducible hernia is one of in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent. 2. irreducible hernia is one whose content or part of content cannot be return to the abdomen, but without serious symptoms. Hernias are trapped by the narrow neck Sliding hernia is one in which the wall of a viscus forms a portion of the wall of the hernia of the hernia sac, it is may be colon(on the left), caecum(on the right) or bladder(on either side). Belongs to irreducible hernia

3. incarceratedhernia:is one whose content cannot bereturnedtotheabdomen,withseveresymptoms4.strangulatedhernia:denotes compromise totheblood supply of the contentof the sac.Incarceratedhernia and strangulatedherniaare thetwostages ofapathologiccourseRichterhernia(intestinalwallhernia):Aherniathat has strangulated or incarceratedapartof theintestinalwall withoutcompromising thelumen.Litterhernia:a herniathathas incarceratedtheintestinaldiverticulum(usually Meckeldiverticulum)

3. incarcerated hernia: is one whose content cannot be returned to the abdomen, with severe symptoms 4. strangulated hernia: denotes compromise to the blood supply of the content of the sac. Incarcerated hernia and strangulated hernia are the two stages of a pathologic course Richter’hernia (intestinal wall hernia): A hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen. Litter hernia: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum)