EXTERNAL ABDOMINAL HERNIAS

EXTERNAL ABDOMINAL HERNIAS

DEFINITION: is a protrusion of a viscus or part of viscus, usually within a peritoneal sac, through a defect in the abdominal wall AETIOLOGY CONGENITAL -Unobliterated processus vaginalis causes congenital inguinal hernia -Unobliterated physiological umbilicus of foetus causes congenital umbilical hernia ACQUIRED -Raised intra abd pressure :chronic cough,straining at micturition or stool,heavy work,obesity,huge abd swelling -weak abd wall due to obesity,senility,debility,pregnancy,weak scar&damaged nerve supply of muscle


COMPONENT 1.SAC neck,body&fundus 2.CONTENTS e.g ometum,intestine,part of bowel circumference(Richters`),Meckels` diverticulum(Littres`) 3.COVERINGS COMPLICATIONS 1.Irreducibility adhesion ,overcrowded 2.obstruction features of I.O 3.Strangulation 4.inflammation of content e.g appendix 5.hydrocele of hernial sac 6.torsion of omentum

STRANGULATED HERNIA

Means constriction of contents leading to interruption of their blood supply Incidence > common in femoral then Para umbilical, inguinal CAUSES -extrusion of new contents following straining -repeated attempts at reduction producing edema CONSTRICTING AGENTS -Resistant structure outside the sac as superficial or deep inguinal ring -neck of sac -bands of adhesions within the sac CONSEQUENCES 1.Impeded venous return 2.later arterial supply impaired 3.gangrene occur 4.peritonitis SYMPTOMS 1.Acute pain in hernia 2.sudden enlargement 3.irreducible 4.symptoms of I.O GENERAL EXA. Neglected cases hypovolaemic or septic shock LOCAL EXA 1.tense 2.tender 3.irreducible 4.no impulse on cough


TREATMENT URGENT SURGERY PREOPERTIVE PREPARATIONS 1.NG tube suction 2.I.V Ringer lactate 3.I.V antibiotic OPERATIVE -Open sac ,evacuate toxic fluid,divide constricting ring -contents examine if viable reduction.if nonviable small intestine resection&anastomosis,large bowel resection &colostomy,omentum excised -herniorrhaphy or hernioplasty. POSTOPERATIVE 1.NG &fluid continued until bowel sounds are audible 2.antibiotic 3.remove drains

SLIDING HERNIA

Where a viscus forms apart of the wall of the sac .the commonest are bladder,cecum &segmoid.common in old standing hernias .in male &old age

INGUINAL CANAL

SPERMATIC CORD


CONTENTS 1.vas deferens 2.testicular a. 3.pampiniform plexus of veins 4.artery of vas 5.testicular lymphatics 6.genital branch of genitofemoral nerve 7.testicular autonomic nerves 8.remnant of processus vaginalis COVERING 1.int.spermatic fascia derived from transversalis fascia 2.cremastric m.& fascia from int.obliq. m. 3.ext.spermatic fascia from ext. obliq. aponeurosis