UMBILICAL HERNIA
CONGENITAL UMBILICAL HERNIA A.exomphalos minor B.exomphalos major INFANTILE UMBILICAL HERNIA AETIOLOGY 1.weakness of umbilical scar from infection of umbilical cord stump 2.increase intra abd pressure CLINICAL FEATURES *There is umbilical protrusion which increases with cough or crying *The edge of defect can be palpated as firm ring *obstruction &strangulation are rare below the 3 years TREATMENT Reassurance of the parents &follow up are the usual measures.the defect closes spontaneously within two years in most of cases *correction of any cause increase intra abd pressure *operation is indicated when the defectis>2 fingers wide or when the hernia persists after the age of 2 years.sac is excised &the defect is closed with few stitches of non absorbable material e.g proleneADULT UMBILICAL HERNIA(PARAUMBILICAL HERNIA)
AETIOLOGY is more in middle aged females,especially in obese multiparous women.its actually paraumbilical not umbilical hernia. The defect lies in linea alba.most of cases above the umbilicus,looks like a crescent .strangulation&irreducibility are common due to narrow neck,sharp edge &adhesions inside the sac. CLINICAL FEATURES Painless swelling above umbilicus which gives an expensile on cough.mild dragging pain.severe pain indicates strangulation. TREATMENT SURGERY *for obese wt reduction is advised prior to surgery The content is reduced ,sac is excised,then Mayo`s repair *Mesh hernioplasty if the defect is large,the abd wall is weak,or hernia is recurrent.using polypropylene meshEPIGASTRIC HERNIA
Start as protrusion of extraperitoneal fat through defect in the supraumbilical part of linea alba&is called fatty hernia of linea alba.as the protrusion enlarges the fat pulls through defect a small peritoneal pouch which may contain intestine or omentum &is called epigastric hernia CLINICAL FEATU RES May be symptomless it may cause local pain or dyspepsia There is swelling in the epigastrium which is soft frequently irreducible &give expansile impulse on cough TREATMENT If there is pain surgeon should be sure that it is not due to underlying disease e.g peptic ulcer or gall stone Operation is performed by excision of the protruding extraperitoneal fat& the hernia sac followed by simple closure of linea alba defect.if the defect is large its repaired by Mayos` operationINCISIONAL HERNIA
Is a hernia that develops at the site of previous abd incision.the commonest cause is wound infection. TREATMENT If the patient unfit for surgery&provided the hernia is reducible abd binder will keep the hernia reduced Surgery 1.anatomical repair 2.hernioplasty
BURST ABDOMEN
Predisposing factors A.preoperative factors 1.obesity 2.factors which cause poor healing as malnutrition,cirrhosis, DM,jaundice,corticosteroid 3.patient with respiratory problems as chronic bronchitis,bronchial asthma &chronic obstructive lung disease 4.the nature of primary disease for which the operation was performed e.g patient with abd malignancy are usually malnurished &patient with peritonitis will have abd distention &wound sepsis B.operative factors 1.muscle cutting incision 2.vertical >transverse incision 3.rough surgical technique with excessive trauma to the muscle blood vessel &nerves 4.use of absorbable suture in closure of the aponeurotic layer of abd wall. Good bites should be taken on either side of this layer using non absorbable suture 5.insertion of drainage tubes through the main wound C.postoperative factors 1.poor recovery from anaesthesia leading to strong coughing 2.presistant increase intra abd pressure due to repeated coughing,vomiting,hiccough,or abd distension 3.haematoma of the wound 4.wound infection is the most important factor .the tissues become friable due to collagen lysis allowing sutures to cut through themTYPES 1.PARTIAL the deep layers burst but the skin is intact.this actually produces incisional hernia 2.COMPLETE Clinical features 1.A warning sign to the occurrence of burst is the red sign where a serosanguinous discharge soaks the dressing 2.Burst usually occurs on 6th-8th day postoperatively 3.Feeling as if something gives way 4.Symptoms of I.O may be present Treatment *cover the prolapsed bowel by sterile dressing *NG tube&I.V infusion *urgent surgical closure after washing by N/S& reduction of bowel using retention sutures *antibiotics