KI Savitsky cites observations of 137 patients with false infringements of hernias, in which only in 10% of cases the diagnosis of acute diseases of the abdominal organs was made before the operation. NG Sosnyakov out of 294 patients with restrained hernias noted false infringement in 5, and the diagnosis of imaginary infringement was made before the operation in 2 patients. During the operation, intestinal volvulus, mesenteric thrombosis, and peritonitis were found.

Tuberculous peritonitis in the presence of a hernia can give clinical phenomena that are somewhat similar to infringement.

G.M. Gurevich observed a case of tuberculous peritonitis in the presence of bilateral

inguinal hernia in a 42-year-old patient hospitalized on an emergency basis with		diagnosis
"Restrained bilateral inguinal hernia". The operation revealed an error in the diagnosis.
Sudden infringement of previously undetected hernias
In some areas of the anterior abdominal	walls typical for hernia formation,
protrusions may remain after birth	peritoneum (preexisting	hernial
bags) that are not performed by the abdominal organs for a long time. These
preexisting, pre-prepared hernial	bags followed	education

hernial protrusions are more often observed in the inguinal regions as the remnants of a completely incomplete peritoneal-inguinal process (processus vaginalis peritonei).

The reason for the sudden appearance of hernial protrusion with its infringement is a sharp increase in intra-abdominal pressure with significant physical exertion, severe coughing, straining. The hernial protrusion is often small in size, which corresponds to the small size of the preexisting sac.

With these suddenly appeared hernias in the anamnesis, there is no indication of any signs of former hernial protrusions; there may also be no complaints of pain in areas typical of hernias.

G. Weinshenker operated on for suddenly restrained inguinal hernias3 of patients who categorically claimed that they had no protrusions in the groin area before. The protrusion in all appeared suddenly with unexpected extreme tension, after which a sharp soreness was immediately felt in the groin area. During the operation, narrow and long hernial sacs were found, typical of cases of sudden infringement.

In one of our observations, a 48-year-old patient suddenly developed pain and a protrusion under the left groin fold, which had not been observed before. On palpation, pain and swelling were determined in the area of ​​the outer femoral ring. Despite the fact that the pain subsided somewhat, it was still impossible to be sure of the absence of a restrained femoral hernia, which had not been previously detected. During the operation, the hernial sac of the femoral hernia was isolated. The contents of the sac are the left tube and the ovary. Operation Bassini.

The main symptom of sudden hernias is the appearance of acute pains associated with infringement in typical places where hernias emerge. When a patient complains of sudden pain in the groin, in the femoral canal, the navel, it is necessary, after a general examination and palpation, to determine the most painful areas that will correspond to the hernial orifice (pinching ring).

Pathological changes in strangulated hernias and complications after self-straightened, forcibly repositioned and operated strangulated hernias

Various pathological processes in strangulated hernias of the anterior abdominal wall develop not only in the area of ​​intestinal infringement, but also along its length above and below the restraining ring, in the proximal and distal segments.

Transudation into the thickness of the intestinal wall with compression of blood vessels is reflected

and on the nervous apparatus of the intestine.

V the restrained intestinal wall reveals a sharp edema and thrombosis.

comes on the mesenteric wall of the intestine.

Changes in the peritoneal cover are reduced to the process of inflammation in all its stages, subserous hemorrhages, hemorrhagic heart attacks. Sloughing of the endothelial lining reduces the resistance of the peritoneum. Along with the effusion in the cavity of the hernial sac, exudate also accumulates in the abdominal cavity.

Reactive changes in the peritoneum and fibrinous layers on the surface of the restrained organs can serve as a reason for the development of fusion of intestinal loops with each other, with the wall of the sac, with the omentum, which can be observed both after the operation, and after self-corrected and forcibly restrained hernias.

With forced reduction, very serious changes can occur both in the restrained organs and in the hernial sac, up to the rupture of the intestinal loop with the development of peritonitis.

The hernial sac, together with its contents, can be completely displaced with a violation of the anatomical relationships and displacement of the restraining ring (Fig. 11, a).

With the so-called false reduction (pseudotaxis), the restrained viscera through the torn wall of the sac can penetrate into the preperitoneal tissue and simulate the reduction of the hernial contents (Fig. 11, b). In some cases, with especially severe violence, a circular rupture of the hernial sac below the neck can be observed (Fig. 11, c).

At the present time, forcible reduction, produced by the patient himself, is rare. In hospitals, forcible reduction of a strangulated hernia is prohibited.

Rice. 11. Complications after forcibly reduced strangulated inguinal hernias

a - reduction of the entire hernia as a whole: 1 - adducting segment of the restrained intestinal loop; 2 - restraining ring, adjusted together with the hernial sac; 3 - restrained intestinal loop and hernial sac, located after forced reduction above the internal opening of the inguinal canal; b - false reduction by rupture of the hernial sac and the emergence of the intestinal loop into the preperitoneal tissue: 1 - leading segment of the restrained intestinal loop; 2 - intestinal loop, which came out through the torn section of the hernial sac into the preperitoneal tissue; 3 - restrained intestinal loop; 4 - hernial sac (empty); c - false reduction by circular rupture of the hernial sac below the neck: I - leading segment of the strangulated intestine; 2 - the neck, set together with the intestinal loop; 3 - restrained intestinal loop; 4 - empty hernial sac.

Observations show that at various times after having set themselves independently or

The clinical picture in some cases indicates partial intestinal obstruction, which can turn into acute intestinal obstruction. All these phenomena are explained by irreversible cicatricial changes - adhesions of intestinal loops between themselves,

surrounding organs, with a parietal peritoneum, which can also occur when immersed during an operation into the abdominal cavity of seemingly viable bowel loops that have only

of strangulated hernias emphasize the need for a correct assessment of the condition of strangulated intestinal loops before they are immersed in the abdominal cavity.

The peritoneal cover of the intestinal loops is more stable and undergoes necrosis later than other layers, therefore, when examining the intestine, the changes seem insignificant; the presence of peristalsis, although sluggish, can mislead the surgeon.

Observations show that in the peristaltic intestine in the mucous membrane after

scarring. Strictures are formed, narrowing the intestinal lumen, thereby determining the subsequent clinical picture.

There are the following types of intestinal stenosis after infringement: canal, annular (annular) and mixed. With canal-like stenosis, the narrowing of the intestinal loop extends along the axis of the intestine and corresponds to the length of the site of the former infringement. With annular stenosis, the narrowing is limited to the area of ​​the strangulation groove. With mixed stenosis, cicatricial changes in the intestinal wall are observed with the simultaneous development of adhesions that cause bends of the intestinal loops with symptoms of partial or complete obstruction. Borzheki (Bogszeku) described a patient in whom the adductor and outlet ends of the small intestine were communicated with an opening with a diameter of 3 mm. He also discovered a scar in another patient

altered area of ​​the small intestine over 54 cm with five narrowings, between
with which there were extensions.
	chronic			partial	obstruction	observed
short-term pain (intermittent obstruction), rumbling, discharge of fluid
bowel movements		develop		intoxication. It is required to accept in a timely manner
note		observed symptoms with mandatory consideration				all data of anamnesis.

The compensatory capabilities of the body provide satisfactory bowel function for a certain period of time. X-ray examination provides valuable guidance in the initial stages of stenosis development, therefore, the earlier it is carried out, the sooner it is possible to come to a solution to the issue of surgical intervention.

Errors in recognizing strangulated abdominal hernias

Errors in recognizing strangulated hernias are found not only in outpatient clinics and in admission departments of hospitals, but often in hospitals, which can delay timely hospitalization and surgery.

The wrong diagnosis in the recognition of strangulated hernias reaches, according to various statistics, 3.5-18 ° 0 (B.A. Petrov, O. A. Levina and G. M. Fratkina, K. T. . Kachkov).

The number of life-threatening errors in the recognition of strangulated hernias of the abdominal wall can be significantly reduced with a calm, thorough examination. Anamnesis data about the time of onset of pain and their initial localization are especially important. History may indicate cramping pain in the abdomen

poisoning". In these cases, a thorough examination of the patient, all areas of possible hernia exit, will make it possible to determine the presence of hernias of various parts of the abdominal wall, insignificant in size. Such patients should be under the supervision of not only a therapist, but also a surgeon. When examining the abdomen, slight asymmetry may not be

noticed, therefore, the patient must be examined in various positions, which is especially important in obese. Minor inconspicuous hernial protrusions can be with lateral hernias (hernia of the lunate line), especially those located under the aponeurosis of the external oblique muscle of the abdomen or intermuscularly; subtle protrusions occur with intermural inguinal hernias, with infringements at the deep inguinal ring, which must always be remembered with an unclear clinical picture. For abdominal pain, examination and palpation of the superficial inguinal ring is required.

The diagnostic error given by A.L. Petrov (1962) is indicative.

A 19-year-old patient while working, lifting a load, felt sharp pains in the lower abdomen and was taken 2 hours later to the clinic with a diagnosis of acute abdomen. The patient has vomiting, a distended abdomen, gases do not go away. The doctor on duty was diagnosed with acute intestinal obstruction. After a siphon enema, there was no improvement and it was decided to proceed with a midline laparotomy. However, the nurse of the admission department during the enema was found in the patient a painful protrusion in the right groin area. After that, the diagnosis of a strangulated hernia was made.

Of great practical importance is the surgeon's tactics for irreducible hernias, more often umbilical ones. The onset of pain, moderate tension of the hernial protrusion suggest a possible infringement. Patients with such irreducible hernias should remain under the supervision of a surgeon, and at the slightest doubt, the question of surgical intervention should be raised.

Errors in recognizing a strangulated hernia can also occur with various inflammatory processes in the abdominal cavity: acute cholecystitis, acute appendicitis, perforation of the stomach ulcer and duodenal ulcer, intestinal obstruction. An inflammatory effusion, descending into the hernial sac of an unrestrained hernia, causes the development of peritoneal changes in it. The hernial protrusion increases in size, becomes tense, painful, which corresponds to the signs of infringement. The operation undertaken for the "strangulation of the hernia" clarifies the error. Such clinical phenomena of imaginary infringement are called pseudo-strangulated hernias.

Differential diagnosis of hernia is complicated by acute inflammatory processes in

exclusion of the presence of purulent diseases, infected wounds. It is also important to examine the interdigital spaces, the perineum and the examination of the rectum. Thrombosis of the venous node under the groin fold, accompanied by soreness, induration, can also simulate a strangulated femoral hernia.

Injuries of the anterior abdominal wall hernia

Hernial sacs and their contents, regardless of anatomical location, can be subject to various injuries. More often, injuries are closed, and in no case can one vouch for the absence of a violation of the integrity of the organs released into the hernial sac. Bruises of the hernial protrusion are accompanied by the usual signs characteristic of bruises of the skin, subcutaneous tissue. With injuries without violating the integrity of the skin, there is swelling, bruising.

Bruises of inguinal hernias, especially inguinal-scrotal hernias, are characterized by a significant increase in the hernia, its blue-purple color, smooth folds. Simultaneous testicular injury complicates the closed injury and may be accompanied by a picture of traumatic shock.

In case of bruises in the area of ​​hernial protrusion, it is urgent to find out if the integrity of the abdominal organs included in the hernial

- compression of the hernial sac in the hernial orifice, causing disruption of blood supply and necrosis of the organs forming the hernial contents. Infringement of a hernia is characterized by sharp pain, tension and soreness of the hernial protrusion, irreducibility of the defect. Diagnosis of an infringement of a hernia is based on data from anamnesis and physical examination, plain radiography of the abdominal cavity. During hernia repair for a restrained hernia, resection of the necrotic intestine is often required.

General information

Hernia infringement is the most frequent and formidable complication of abdominal hernias. Restrained hernias are an acute surgical condition requiring urgent intervention, and are second only to acute appendicitis, acute cholecystitis and acute pancreatitis in frequency of occurrence. In operative gastroenterology, hernia infringement is diagnosed in 3-15% of cases.

Infringement of a hernia is associated with a sudden compression of the contents of the hernial sac (omentum, small intestine, and other organs) in the hernial orifice (defects of the anterior abdominal wall, diaphragm openings, pockets of the abdominal cavity, etc.). Any abdominal hernias can be infringed: inguinal (60%), femoral (25%), umbilical (10%), less often - hernias of the white line of the abdomen, esophageal opening of the diaphragm, incisional hernias. Infringement of the hernia is associated with the risk of developing necrosis of the compressed organs, intestinal obstruction, and peritonitis.

Types of hernia infringement

Depending on the organ squeezed in the hernial orifice, there are hernias with entrapment of the intestines, omentum, stomach, bladder, uterus and its appendages. The degree of overlap of the lumen of a hollow organ in case of infringement of a hernia may be incomplete (parietal) and complete. In a number of cases, for example, when a Meckel diverticulum or a vermiform appendix is ​​infringed, no overlap of the organ lumen is observed at all. According to the peculiarities of development, antegrade, retrograde, false (imaginary), sudden (in the absence of a hernial history) infringement of the hernia are distinguished.

There are two mechanisms of hernia infringement: elastic and fecal. Elastic infringement develops in the case of a simultaneous exit through a narrow hernial orifice of a large volume of hernial contents. Internal organs, enclosed in a hernial sac, cannot fit into the abdominal cavity on their own. Their infringement by a narrow ring of the hernial orifice leads to the development of ischemia, severe pain syndrome, persistent muscle spasm of the hernial orifice, which further aggravates the infringement of the hernia.

Fecal infringement develops with a sharp overflow of the adducting loop of the intestine, trapped in the hernial sac, with intestinal contents. In this case, the abducent part of the intestine is flattened and restrained in the hernial orifice together with the mesentery. Fecal impairment often develops with long-standing irreducible hernias.

Infringement of a hernia can be primary and secondary. Primary infringement is less common and occurs against the background of a one-step extreme effort, as a result of which there is a simultaneous formation of a previously non-existent hernia and its compression. Secondary infringement occurs against the background of a previously existing hernia of the abdominal wall.

Reasons for hernia infringement

The main mechanism of hernia infringement is a sharp one-step or periodically repeated increase in intra-abdominal pressure, which may be associated with excessive physical effort, constipation, cough (with bronchitis, pneumonia), difficulty urinating (with prostate adenoma), difficult labor, crying, etc. Development and the infringement of the hernia is facilitated by the weakness of the muscles of the abdominal wall, intestinal atony in the elderly, traumatic injuries of the abdomen, surgery, weight loss.

After the normalization of intra-abdominal pressure, the hernial gates decrease in size and infringe on the hernial sac that has gone beyond them. In this case, the likelihood of developing an infringement does not depend on the diameter of the hernial orifice and the size of the hernia.

Symptoms of a pinched hernia

Infringement of a hernia is characterized by the following symptoms: a sharp local or diffuse pain in the abdomen, the inability to correct the hernia, tension and soreness of the hernial protrusion, the absence of a symptom of "cough impulse".

The main signal of infringement of a hernia is pain that develops at the height of physical effort or stress and does not subside at rest. The pain is so intense that the patient often cannot help groaning; his behavior becomes restless. The objective status is marked by pallor of the skin, the phenomenon of pain shock - tachycardia and hypotension.

Depending on the type of strangulated hernia, pain can radiate to the epigastric region, the center of the abdomen, groin, and thigh. When intestinal obstruction occurs, the pain takes on a spastic character. The pain syndrome, as a rule, is expressed within several hours, until necrosis of the restrained organ develops and the death of the nerve elements occurs. With fecal infringement, pain syndrome and intoxication are less pronounced, intestinal necrosis develops more slowly.

When a hernia is infringed, a single vomiting may occur, which at first has a reflex mechanism. With the development of intestinal obstruction, vomiting becomes constant and becomes fecal. In situations of partial infringement of a hernia, the phenomenon of obstruction, as a rule, does not occur. In this case, in addition to pain, tenesmus, gas retention, dysuric disorders (frequent painful urination, hematuria) may be disturbing.

Prolonged infringement of the hernia can lead to the formation of phlegmon of the hernial sac, which is recognized by the characteristic local symptoms: edema and hyperemia of the skin, soreness of the hernial protrusion and fluctuation above it. This condition is accompanied by general symptoms - high fever, increased intoxication. The outcome of the unresolved infringement of the hernia is diffuse peritonitis caused by the transition of inflammation to the peritoneum or perforation of the stretched section of the restrained intestine.

Diagnosis of hernia infringement

In the presence of a hernial history and a typical clinic, the diagnosis of hernia infringement is not difficult. During the physical examination of the patient, attention is paid to the presence of a tense, painful hernial protrusion, which does not disappear when the position of the body is changed. A pathognomonic sign of hernia infringement is the absence of a transmission cough push, which is associated with the complete delimitation of the hernial sac from the abdominal cavity by the restraining ring. Peristalsis over the strangulated hernia is not heard; sometimes there are symptoms of intestinal obstruction (Valya's symptom, splash noise, etc.). Asymmetry of the abdomen and positive peritoneal symptoms are often observed.

In the presence of intestinal obstruction, plain X-ray of the abdominal cavity reveals the Kloyber bowls. For the purpose of differential diagnosis, ultrasound of the abdominal organs is performed. Infringement of the femoral and inguinal hernia should be distinguished from local tissues or by using synthetic prostheses).

The most crucial moment of the operation is to assess the viability of the restrained bowel loop. The criteria for the viability of the intestine are the restoration of its tone and physiological color after release from the restraining ring, the smoothness and shine of the serous membrane, the absence of a strangulation groove, the presence of pulsation of the mesenteric vessels, and the preservation of peristalsis. In the presence of all these signs, the intestine is recognized as viable and is immersed in the abdominal cavity.

Otherwise, if the hernia is infringed, it is required to resect a section of the intestine with the imposition of an end-to-end anastomosis. If it is impossible to perform resection of the necrotic intestine, an intestinal fistula (enterostomy, colostomy) is superimposed. Carrying out primary abdominal wall plasty is contraindicated in peritonitis and phlegmon of the hernial sac.

Forecast and prevention of hernia infringement

Mortality in case of hernia incarceration among elderly patients reaches 10%. Late seeking medical help and attempts to self-medicate hernia infringement lead to diagnostic and tactical errors, significantly worsen the results of treatment. Complications of operations for hernia infringement can be necrosis of the altered intestinal loop with an incorrect assessment of its viability, failure of the intestinal anastomosis, peritonitis.

Prevention of infringement consists in the planned treatment of any identified abdominal hernias, as well as the exclusion of circumstances conducive to the development of a hernia.

• Question 1: Hernias. Definition of the concept, etiology, pathogenesis. Elements of abdominal hernias. Anatomical features of sliding hernias. Hernia prevention.
• Question 2: Classification, general symptomatology of free abdominal hernias. Diagnostics. Indications and contraindications for surgery. Treatment results. Reasons for relapse.
• Question 3: An irreducible hernia. Causes. Clinic, diagnostics, treatment. Preparing patients for surgery. Postoperative management. Prevention.
• Question 4: Incisional hernia. Causes of occurrence. Clinic. Diagnostics. Prevention. Operation methods. Postoperative hernias are formed in the area of ​​the postoperative scar.
• Symptoms
• Treatment of incisional hernia
• Question 5: Restrained hernia. Clinic. Diagnostics, differential diagnostics. False infringement. Features of operational technology.
• Question 7: The tactics of the surgeon in case of a doubtful diagnosis of hernia infringement, in case of spontaneous reduction. Complications of forced reduction.
• Question 8: Inguinal hernia. Anatomy. Direct and oblique inguinal hernia. Congenital inguinal hernia. Diagnostics and differential diagnostics. Prevention. Operation methods.
• Question 9: Femoral hernia. Femoral canal anatomy. Clinic. Diagnostics. Differential diagnostics. Prevention. Operation methods.
• Question 10: Umbilical hernias and hernias of the white line of the abdomen. Anatomical data. Clinical picture and diagnosis of umbilical hernias in childhood.
• Question 11: Restrained hernia. Types of restraints (feces, elastic, retrograde, parietal), pathological changes in the restrained organ and general changes in the body with a restrained hernia.
• Question 12: Anatomical and physiological information about the cecum and the appendix. The influence of variants of the location of the appendix on the clinical picture of the disease.
• Question 13: Acute appendicitis. Etiology. Pathogenesis. Classification.
• Question 14: Acute appendicitis. Clinic, differential diagnosis, features of the course of acute appendicitis in children, pregnant women, elderly and senile people. Treatment.
• Question 15: complications of acute appendicitis (infiltrates, abscesses, pylephlebitis, peritonitis). Clinic. Diagnostics, treatment. Prevention.
• Question 16: Acute appendicitis. Preparing patients for surgery. The choice of surgical access and pain relief in acute appendicitis and its complications.
• 17 Management of patients after appendectomy:
• 18 Chronic appendicitis:
• 20 Ulcerative pyloric stenosis -
• 21 Perforated gastric ulcer and 12 intestine -
• 22 Bleeding ulcer of the stomach and 12 intestines
• 23 Indications for surgical treatment yabzh
• 24 Complications of peptic ulcer:
• 25 Preoperative preparation in patients with yabzh
• 26 Preoperative preparation in patients with stomach diseases:
• 27 Zhkb. Chronic cholecystitis
• 28 Acute cholecystitis
• 29 Complications of acute cholecystitis:
• 30 Choledocholithiasis
• 33 Methods of research of the extrahepatic biliary tract:
• 41. Anatomical and physiological information about the spleen. Trauma, spleen infarction. Splenic vein thrombosis. Clinic, diagnostics, differential diagnostics, treatment.
• Causes
• Symptoms
• Course of the disease
• 42. Intestinal obstruction. Classification. Patient examination methods.
• 43. Intestinal obstruction. Clinic. Diagnostics. Differential diagnostics.
• 44. Mechanical intestinal obstruction. Classification. Clinic. Diagnostics. Treatment.
• 45. Mechanical intestinal obstruction. Features of violation of water - electrolyte balance and acid-base state, depending on the level and type of intestinal obstruction.
• 50. Strangulated intestinal obstruction (volvulus, nodulation, infringement). Features of pathogenesis. Clinic. Diagnostics. Differential diagnostics. Treatment. Indications for bowel resection.
• Localization types
• Extraintestinal manifestations [edit | edit source]
• Extraintestinal manifestations
• Diagnostic tests
• Surgical complications
• 24.1. Research methods
• 69. Acute paraproctitis. Causes of occurrence. Classification. Clinic. D-ka. Treatment.
• 70. Precancerous diseases of the rectum. Etiology. Pathogenesis. Clinic. Differential diagnostics. Survey methods. Treatment.
• 72. Rectal cancer. Etiology. Clinic. D-ka. Treatment methods (palliative and radical surgery) Radiation therapy, chemotherapy.
• 73. Rectal cancer. Classifications. Metastatic pathways. Clinic, diagnostics, differential diagnostics. Treatment.
• 74. Anatomical and physiological information about the thyroid gland. Classification of diseases. Methods of research of the thyroid gland. Prevention.
• 75. Thyroiditis and strumite. Hashimoto's goiter. Riedel's goiter. Definition of the concept. Etiology, pathogenesis. Clinic. Dif. D-ka. Treatment.
• 76. Endemic and sporadic goiter. Definition of the concept. Classification. Etiology and pathogenesis. Clinic, Diagnostics. Prevention and Treatment.
• Sporadic goiter (simple non-toxic goiter)
• 77. Thyrotoxicosis. Classification, etiology, pathogenesis. Clinic. Diagnostics and diff. D-ka.
• 78. Thyrotoxicosis. Indications for surgery and preoperative preparation. Operation methods. Complications during and after surgery.
• 79. Benign and malignant tumors of the thyroid gland. Classification. Clinic. Diagnostics. Diff. Diagnosis. Flow.
• Benign tumors (follicular adenomas)
• Malignant tumors.

• Hernia infringement is understood as a sudden or gradual compression of any abdominal organ in the hernial orifice, leading to a disruption of its blood supply and, ultimately, to necrosis. Both external (in various crevices and defects of the walls of the abdomen and pelvic floor) and internal (in the pockets of the abdominal cavity and openings of the diaphragm) hernia can be infringed.

  Elastic restraint occurs at the time of a sudden increase in intra-abdominal pressure during exercise, coughing, straining. In this case, the overstretching of the hernial orifice occurs, as a result of which more internal organs than usual come out into the hernial sac. The return of the hernia orifice to its previous state leads to the infringement of the contents of the hernia. With elastic infringement, the organs released into the hernial sac are compressed from the outside.

  Fecal infringement more common in older people. Due to the accumulation of a large amount of intestinal contents in the adducting loop of the intestine, which is in the hernial sac, the discharge loop of this intestine is compressed, the pressure of the hernial orifice on the contents of the hernia increases and elastic is attached to the fecal impingement. This is how a mixed form of infringement arises.

  Retrograde infringement... More often, the small intestine is retrogradely infringed when there are two intestinal loops in the hernial sac, and the intermediate (connecting) loop is in the abdominal cavity. To a greater extent, the connecting intestinal loop is exposed to the infringement. Necrosis begins earlier in the intestinal loop located in the abdomen above the pinching ring. At this time, the intestinal loops in the hernial sac may still be viable.

  Parietal infringement occurs in a narrow pinching ring, when only a part of the intestinal wall, opposite to the line of mesentery attachment, is pinched; observed more often in femoral and inguinal hernias, less often in umbilical hernias. Disorder of the lymph and blood circulation in the strangulated area of ​​the intestine leads to the development of destructive changes, necrosis and intestinal perforation.

  Pathological picture. In the strangulated organ, blood and lymph circulation is disturbed, due to venous stasis, fluid is extradited into the intestinal wall, its lumen and the cavity of the hernial sac (hernial water). The intestine acquires a cyanotic color, the hernial water remains clear. Necrotic changes in the intestinal wall begin with the mucous membrane. The greatest damage occurs in the area of ​​the strangulation groove at the site of compression of the intestine by the restraining ring.

  Over time, pathomorphological changes progress, gangrene of the restrained intestine sets in. The intestine becomes blue-black, multiple subserous hemorrhages appear. The intestine is flabby, does not peristalsize, the vessels of the mesentery do not pulsate. Hernia water becomes cloudy, hemorrhagic with fecal odor. The intestinal wall can undergo perforation with the development of fecal phlegmon and peritonitis. The entrapment of the intestine in the hernial sac is a typical example of strangulated intestinal obstruction.

  Infringement of the intestine is accompanied by significant changes in its adductor loop, in which a lot of intestinal contents accumulate. It stretches the intestine, squeezes the intramural vessels, disrupting blood and lymph circulation, which causes damage to the mucous membrane. At the same time, a violation of blood and lymph circulation occurs in the discharge part of the restrained intestine. The toxins accumulated as a result of decomposition are absorbed into the bloodstream, causing intoxication of the body. The reflex vomiting arising from infringement contributes to the rapid development of a deficiency of water and microelements. The progression of intestinal necrosis, phlegmon and hernial sac leads to purulent peritonitis.

Internal entrapment of the intestine in animals (Incarceratio et strangulation intestinorum) is a type of intestinal obstruction in which the intestinal loops enter the natural or pathological opening of the abdominal cavity and are restrained there (incarceratio), as well as when the intestinal loops are lacing with a connective tissue cord or ligament (strangulatio) ... This disease can be observed in all species of animals, with strangulation most often recorded in cattle, and incarceration in horses and pigs.

Etiology... The most common form of intestinal trapping in animals is internal and external hernias. For internal hernias, veterinarians include infringement of the intestinal loop in the expanded inguinal ring and the openings of the greater omentum, as well as the mesentery, peritoneum or diaphragm when they rupture. It is customary to refer to external hernias as infringements in the openings of the femoral canal, umbilical, scrotum, torn abdominal muscles.

Strangulation occurs in animals when the natural openings are abnormally wide or, as a result of old age, exhaustion or decreased muscle tone, are enlarged. Incarceration in animals occurs with an elongated spermatic cord, a tumor hanging on the leg; ligaments (gastro-splenic, renal-splenic, sickle ligament of the liver); desolate umbilical artery and cords in chronic peritonitis. In animals, the loops of the small intestines are most often impaired and much less often of the large ones.

The reason for the infringement of the intestinal loop in animals is a sharp increase in intra-abdominal pressure with tension of the abdominal press, when the animal is forced to exert a large pulling force, during jumping over obstacles, when males are sitting, strong labor attempts, and much less often with tenesmus, a sharp upsetting of the animal when it is steep turn, with a long descent from the mountain.

Pathogenesis... In animals, as a result of prolapse into the hole or strangulation of the intestine, compression of the venous vessels in the dropped loop occurs, blood stagnates in the veins, as a result, the wall of the restrained loop is strongly infiltrated. In the intestine above the site of obstruction and in the abdominal cavity, a yellowish to reddish effusion with an admixture of fibrin flakes accumulates.

In the dropped loop, nutrition is disturbed, and the increasing compression of the intestine at the site of hemostasis leads to necrosis of the prolapsed section of the intestine. A sick animal, as a result of squeezing the nerve receptors of the intestine and mesentery at the site of the obstruction, experiences severe constant pain. In the initial period of the disease, an increase in pain in a sick animal is facilitated by spastic contractions of the intestine stretched by gases and chyme.

Above the place of obstruction in the strangulated loop and intestines, the accumulated chyme rapidly undergoes fermentation-putrefactive decomposition with the formation of toxins and gases, which ultimately leads to the development of intoxication and flatulence.

In the small part of the intestine, above the place of obstruction, there is a process of release of water-salt effusion and the absorption process is disturbed, dehydration occurs in the body and intoxication increases. All these processes lead to a disorder in the activity of the cardiovascular, nervous and other systems of the body. In the body of a sick animal, metabolism, pigmentation, antitoxic and other functions of the liver are disturbed. Great changes are taking place in the morphological and biochemical composition of the blood. A sick animal has an increase in blood viscosity, the content of non-protein nitrogen, bilirubin up to 2-3 mg% with a direct fast or two-phase reaction; at the same time, the content of chlorides and reserve alkalinity increases. There is a decrease in the number of leukocytes, with a relative neutrophilic leukocytosis.

Pathological changes... When opening a dead animal, the strangulated or strangulated part of the intestine is colored dark or black-red, stretched with gases and bloody liquid with a putrid odor. The intestinal wall is thickened; loosened; the mucous membrane is black-red, covered with a dirty gray bloom, necrotic in places. In this case, the section of the compressed intestinal wall is anemic and stands out with a gray-white annular interception. The intestines, which are located in front of the place of obstruction, are strongly distended with gases and chyme, which has a watery consistency with an admixture of blood. The posterior part of the intestine is empty or the blind and large colon contains a lot of feces. When opening the abdominal cavity, we find an abundant transudate mixed with blood and fibrin flakes. In some dead animals, we find diffuse peritonitis and sometimes rupture of the intestines.

Clinical picture... In cattle, the disease begins with severe bouts of colic. The sick animal groans, hits the stomach with its hind legs, steps over its legs, looks back at the stomach, often lies down and gets up. The gait of such an animal is tense. After 6-12 hours, the colic attacks in the animal weaken or disappear, while the general condition of the sick animal deteriorates sharply, and general weakness sets in. On clinical examination, we note a frequent, weak pulse, 100-130 beats per minute. The body temperature rises slightly, but the skin is cold on palpation. At a later stage, we note a slight flatulence of the rumen, its contents become soft, sometimes watery. Intestinal peristalsis is not audible during auscultation. The number of bowel movements is reduced.

In horses, the disease is manifested by the fact that a sick horse falls to the ground, rolls around. At the onset of the disease, attacks of colic can be periodic, and as the pathological process intensifies, the pain in the animal becomes permanent. The animal's movements are slow, limited; horses tend to avoid sudden falls, are in forced positions for longer: they stand on their wrists, stretch their torso, lie on their backs or assume the position of a sitting dog, etc. The visible mucous membranes of the animal are congestedly hyperemic. The animal's eyes fall, the gaze becomes motionless. The sick horse sweats, has a wobbly and unsteady gait, and notice muscle fibrillation. The body temperature rises. The pulse becomes small, frequent, up to 70-90 beats per minute, it is not always possible for the veterinarian to feel it. The blood pressure of a sick animal drops rapidly. Shortness of breath appears, which is most pronounced with the expansion of the stomach and flatulence of the intestines. With intestinal flatulence, the horse's stomach is enlarged in volume, with percussion we get a loud tympanic sound.

Intestinal peristalsis during auscultation at the onset of the disease is enhanced, uneven, further weakened and by the end of the disease completely disappears. The horse stops defecating.

In pigs and dogs, the clinic of the disease is manifested by the fact that they often lie, jump up, change places, squeal, moan, dogs roll on the ground. After a few hours, anxiety in animals weakens or completely disappears, however, the patient's condition worsens; they have persistent vomiting and constipation. With the onset of intoxication, dogs and pigs weaken, their temperature drops. In sick dogs, bimanual palpation can be felt by a veterinarian for swollen bowel loops.

Flow... In horses with mechanical obstruction of the small intestine, the disease proceeds very quickly - 18-24 hours, rarely longer; in cattle, the disease lasts up to 2-5 days. With strangulation of the colon, the course of the disease is slower. The disease proceeds especially quickly with diaphragmatic hernias with prolapse of the small or large intestines into the chest cavity, sometimes the stomach. Veterinarians should keep in mind that shortness of breath, cyanosis of visible mucous membranes and a state of collapse that quickly occurs in a sick animal, causes death of the animal within the first hour.

Diagnosis On the basis of clinical signs of the disease, the veterinarian puts on internal entrapment of the intestine on the basis of clinical signs of the disease; in horses and cattle, rectal examination has invaluable assistance in making a diagnosis. During rectal examination, the bowel loop that has fallen into the hernial sac is very painful, its leading end is stretched with its contents, and its discharge end is empty. The loop, laced up with a cord, a ligament, is very painful. Palpation through the rectum probes separate loops, which are stretched by gas. For example, when the left pillars of the large colon are infringed by the renal-splenic ligament, we find flatulence and their displacement. Moving the hand inserted into the rectum along the swollen pillars, one can reach the constriction site and feel the parts of the incompletely closed ring (the base of the spleen, the highly strained renal ligament, the left kidney and part of the peritoneum), in which the left pillars are restrained. Infringement of the small colon and rectum is accompanied by strong straining of the animal without excretion of feces. In rectal examination, the rectum is empty, and the inserted hand rests against an obstacle, the mucous membrane in front of the obstacle is collected in folds. With umbilical, femoral, scrotal and abdominal hernias, examination and palpation of the hernial sac gives the veterinarian every reason to make a diagnosis.

Forecast. According to veterinary statistics, it is very rare for animals to recover without surgery.

Treatment... Veterinary specialists begin treatment measures after the pain syndrome in the animal has been removed; for its removal, intravenous administration of chloral hydrate, 33% alcohol solution or analgin is used. At the first stage, the veterinarian resorts to an attempt to restore patency in the intestine by the rectal method. In horses, the restoration of patency during strangulation of the left columns of the large colon in the renal-splenic ligament is carried out in the standing position of the horse. The veterinarian holds the hand inserted into the rectum between the ligament and the restrained intestine, turns the palm upward and, slightly lifting the folded ligament of the intestine, tries to gradually press the pillars against the palate with his thumb to push the columns to the left abdominal wall, pressing at the same time with the back of the hand on the spleen.

In bulls, during strangulation of the intestinal loop with the spermatic cord, the veterinarian grabs the spermatic cord into a fist, pulling it as far forward and downward as possible and then pulling it back with a quick movement to the middle of the pelvic cavity. During this procedure, the cord is torn, and the strangulated bowel loop is released. The loop, restrained in the holes of the greater omentum or mesentery, is released at the onset of the disease, before the onset of edema and flatulence in the animal, pulling it upwards posteriorly. If all attempts to eliminate internal intestinal infringement are unsuccessful, then it is necessary to urgently resort to surgical intervention - laparotomy. The aldehyde state of the sick animal is eliminated by intravenous administration of 300-600 ml of 5-10% sodium chloride solution, subcutaneous administration of epinephrine, ephedrine and caffeine. When the stomach expands in a sick animal, its contents are removed through a probe, this procedure greatly facilitates the general condition of the sick animal. When carrying out conservative treatment, it is recommended to give ichthyol and other antimicrobial substances inside. Removal of gases from the intestine is carried out by puncture.

Prophylaxis... Prevention of internal intestinal infringement consists in the observance by the owners of the animals of the rules for their operation (one should not allow large traction efforts, large jumps over obstacles, sudden settling downs). Timely take measures to eliminate hernial sacs, correctly carry out the technique of castration of animals.

Infringement of abdominal hernias occurs as a complication if the prescribed regimen is not followed. This is a dangerous condition in which internal organs are compressed in the hernial orifice, and this is followed by life-threatening disorders.

All abdominal hernias require surgical treatment due to the risk of entrapment.

Patients with such a diagnosis are prescribed a sparing regimen, diet, bandage, medications and other measures. All this helps to exclude pinching of the hernia of the abdomen before the operation. Abdominal hernias are of different types, depending on the location. They have some distinctive pinching symptoms and factors.

How does hernia infringement occur?

For some reason, internal organs can exit through the openings in the abdominal cavity. Normally, the natural openings are narrow and elastic, but when the pressure inside the abdominal cavity is disturbed or the ligaments are injured, the tissues weaken and the lumens expand.

Most often, the intestines, part of the stomach, the bladder, the omentum, the kidneys, and the uterine appendages leave their anatomical place. This happens in the area of ​​the white line of the abdomen, umbilical ring, groin and thigh.

The hernia gets its name from the place in which it occurs. More often, inguinal and umbilical hernias are diagnosed in adults and children, less often the defect occurs in the lumen of the white line and thigh.

All hernias of the abdomen, in contrast to diaphragmatic and vertebrates, have one common symptom - a swelling in the form of a lump directly at the site of the protrusion of the organs. The defect can be of various sizes, sometimes surgeons have to remove giant hernias in the groin and near the navel, when part of the intestine or the entire organ is in the gate.

A hernia consists of the following elements:

• content- part of one or more organs;
• Gates- the area of ​​the exit of organs between the muscles and ligaments;
• bag- formation from the skin or part of an organ that surrounds the contents.

Infringement of a hernia can occur in the area of ​​the hernial sac and gate. At this moment, the contents begin to squeeze, blood circulation is disturbed, tissue necrosis occurs.

Internal organs can be impaired at the time of a sudden increase in load and intra-abdominal pressure. The first signs relate to sensations. Severe pain appears in the area of ​​the defect, it radiates to the back and legs. When the pressure rises sharply, the hernial orifice expands, more organs enter the bag, then the opening returns to its previous size. This is how the infringement happens.

Distinguish between primary and secondary infringement. In the first case, a complication occurs immediately from the moment a hernia appears. This is preceded by a high load, as a result of which the organs come out under the skin or into the adjacent cavity and immediately restrained in the area of ​​the hernial orifice or sac. Secondary infringement does not occur immediately, but can appear at any time with an already existing hernia.

Symptoms

A pinched abdominal hernia gives early and late symptoms. The first warning signal will be pain and incorrigibility of the defect. Late ones begin in the process of ischemia and tissue death in the hernial sac.

Early signs of infringement of abdominal hernias with pinching of part of the intestine:

• intense paroxysmal pain;
• repeated vomiting without relief;
• hiccups, heartburn, belching;
• a noticeable but slight increase in the volume of the abdominal cavity;
• bloating without gas.

When the omentum is pinched, the symptoms are less pronounced. There is pain, there is nausea, but no vomiting. Outwardly, the complication increases, it becomes dense. A specific sign of infringement will be the absence of a cough jolt.

Infringement can be determined independently, especially when the hernia has already been diagnosed and the patient knows about the existing risk of complications. Surgeons are often approached with a complaint of pain and the inability to correct the defect, which will not complicate the correct diagnosis.

Late symptoms of a pinched hernia, regardless of the squeezed organ:

• redness of the skin over the protrusion;
• accumulation of fluid in the abdominal cavity;
• general malaise, apathy;
• chronic fatigue;
• fever, fever up to 40 degrees.

Less commonly, you can observe a complication such as phlegmon. The purulent process bears a particular threat, quickly moving to neighboring tissues.

Inguinal

With inguinal infringement, edema occurs in the perineum, the swelling increases and hurts. This is complemented by the inability to correct the hernia, increasing its size. The state of health worsens, the temperature rises, urinary retention, constipation, and bloating are observed.

Pinching of the bladder leads to painful passing of urine. When the intestines suffer, there is no stool, gases accumulate, which further aggravates the condition.

Umbilical

Infringement of organs in the region of the umbilical ring has pronounced symptoms:

• paroxysmal pain;
• lack of stool, constipation;
• rumbling in the stomach, flatulence;
• vomiting of blood, excretion of blood in feces;
• irreducibility of the defect;
• persistent nausea and repeated vomiting without relief;
• concomitant disorders of the digestive tract.

Umbilical hernias often manifest with intoxication, weakness, dizziness, impaired coordination, and confusion.

Femoral

The femoral protrusion is relatively rare. It appears on the front of the thigh. The most severe complications will be peritonitis and tissue necrosis.

Clamping of organs with a femoral hernia is manifested by the following clinic:

• pain that worsens during movement and straining;
• showing the skin of the leg;
• dyspeptic symptoms;
• inflammation of the skin in the area of ​​the hernia;
• frequent constipation, which can result in intestinal obstruction.

White line of the abdomen

With a hernia of the white line, intestinal obstruction almost never occurs, which distinguishes this type of disease from others. But there is a risk of shock due to circulatory disorders.

Symptoms of compression of organs with protrusion in the area of ​​the white line of the abdomen:

• bloating;
• anemic syndrome, pallor of the skin;
• tachycardia, hypotension;
• dyspepsia;
• general malaise.

Types of infringement of abdominal hernias

Distinguish between retrograde, fecal, parietal, elastic, mixed infringement. The clinical picture will depend on this. The pinch can also be internal and external, depending on the location.

Types of infringement and their distinctive characteristics:

1. Elastic.

It appears under the influence of a high load on the abdominal cavity. A sharp increase in pressure "pushes" the organs into the hernial sac, where they are squeezed, which is facilitated by the stretching of the hernial orifice at the moment of strong muscle tension.

1. Calovoe.

Has a different development mechanism. There is a gradual accumulation of feces in the part of the intestine located in the hernial sac. The reason will not be an increase in the load, but a significant increase in the bowel loop, which leads to squeezing. This is accompanied by a violation of gastrointestinal motility, more often this type of infringement is observed in the elderly.

1. Mixed.

Infringement occurs due to the accumulation of fecal masses or high load, these factors are combined, while only one of them could not lead to complications due to insignificant severity. The condition is accompanied by all signs typical of infringement.

1. Retrograde.

There is a squeezing of several segments of the intestine at the same time, but one suffers the most, and it must be saved from inflammation and necrosis. It is rarely diagnosed, mainly with giant hernias.

1. Parietal.

Infringement of a part of the intestinal loop, which happens when it does not completely pass through the hernial orifice. It ends with necrosis, but intestinal obstruction is rare.

What is dangerous infringement

A patient with a strangulated abdominal hernia should be hospitalized immediately. As soon as the organs are compressed, irreversible processes begin, it is dangerous to delay the operation.

Attempts to correct a complicated hernia will never give the desired result; on the contrary, they will only aggravate an already serious condition. The hernial sac can rupture, then there are signs of peritonitis or "acute abdomen": the abdominal cavity is solid, increases in volume. At the same time, the patient suffers severe pain.

A strangulated abdominal hernia leads to the following consequences:

1. Necrosis- the death of organs in the hernial sac. This is due to impaired blood flow and lymph drainage. First, the mucous membrane dies off, then the process passes to the muscle layer, which will no longer allow the organ to be preserved.
2. Phlegmon- develops as a result of necrosis, but not only. The patient's condition deteriorates greatly, the digestion process is disrupted, signs of intoxication appear. The inflammatory process spreads to the surrounding tissues.
3. Peritonitis- an acute disorder in which the peritoneum becomes inflamed. The condition is extremely serious, the goal of emergency care will be to save the patient's life, which is not always possible, even with timely treatment.

How is it diagnosed

Pinching is determined by the doctor already during the external examination of the patient and palpation of the abdominal cavity. The main diagnostic signs will be the hardness of the protrusion, the impossibility of reduction, the absence of a cough jolt.

Additionally, the method of X-ray and ultrasound of the abdominal cavity is used. After the examination, the surgeon decides on an emergency operation. After the main treatment, conservative therapy is carried out to normalize the patient's condition, prevent recurrence and postoperative (ventral) hernia.

Treatment methods

After examination and confirmation of infringement, the patient is hospitalized in the surgical department. The type of surgery and the likelihood of complications depends on how quickly the patient gets to the doctor.

Preparation for the operation is quick. The option of anesthesia is selected, then a catheter is placed and the stomach is washed. Emergency surgery is performed using epidural anesthesia.

Operation

Surgical treatment for a restrained hernia consists of the following stages:

1. Skin incision.
2. Layer-by-layer dissection of tissues to create access to the hernial sac.
3. Opening a hernia, removing fluid.
4. Dissection of the hernial ring.
5. Determination of organ vitality.
6. Resection of the damaged part of the intestine.
7. Plastic hernia orifice with the installation of an implant or tissue tension.

Rehabilitation

After the operation, the pain syndrome worries for some time, so pain medications and injections are prescribed. When the treatment has passed without complications, the patient is discharged from the hospital for 3-5 days. The doctor will prescribe medication, bandage, rest and diet.

The early recovery period includes the following activities:

• taking pain relievers and antibiotics in case of complications;
• bed rest, any movement is permissible only in a bandage;
• elimination of the load on the abdominal muscles;
• prevention of constipation and bloating;
• adherence to a diet;
• reception of fortifying agents, immunomodulators, vitamins.

A postoperative bandage will be an important measure after surgical treatment. An emergency operation increases the risk of re-illness, and this can be prevented by creating conditions for an even load on the muscles of different groups.

A bandage is a temporary measure, and after the wound has healed and the body's forces restored, you need to get away from it, and start strengthening the abdominal muscles, which will serve as a supporting corset throughout your life.

Recurrent abdominal hernia

The reasons for the re-development of the disease will be medical errors and non-compliance with the regimen after the operation. Regardless of the factor, the recurrent disease will be treated surgically. It also happens that one patient in his life can undergo several operations, which is associated with a frequently recurring hernia. And after any surgical technique, there is a risk of infringement.

What affects the development of a hernia after surgery:

• non-compliance with the rest regime;
• violation of the diet;
• quick return to physical work;
• refusal to wear a bandage;
• selection of an inappropriate surgical technique;
• congenital muscle weakness that cannot be corrected surgically.

In order to prevent relapse, it will be good to do medical gymnastics, and in the future, sign up for a gym and do exercises on the muscles of the press, legs and back regularly. Excess weight also contributes to organ bulging and ligament weakness, which needs to be taken care of by reviewing diet and lifestyle.

After the operation, many people need to get rid of bad habits that contribute to muscle wear and tear and their premature aging. This applies to smoking, alcohol, physical inactivity. Systemic diseases are also important, which are accompanied by cough, indigestion. These factors contribute to an increase in intra-abdominal pressure, which, as a result, leads to recurrence of the disease.