According to the international classification of diseases, the ICD-10 abdominal hernia code is from K40 to K46. It all depends on the type of education, its location, problem. There are hernia codes:
- K40 – inguinal;
- K41 – femoral;
- K42 – umbilical;
- K43 – a hernia in the anterior abdominal wall;
- K44 – diaphragmatic;
- K45 – other hernias in the peritoneum;
- K46 – unspecified.
The occurrence of the problem occurs for the following reasons:
- Features of the structure of the body of a particular person. Congenital or acquired defects, abnormalities of the abdominal cavity.
- Heredity to the formation of protrusions.
- Hard physical work with tension on the abdominal muscles.
- Reinforced bleeding of the lower press.
- Eating disorders and stool disorders (constipation).
- Frequent angry crying or crying in infants.
- A strong, continuous cough of the type of whooping cough.
- Adenoma of the prostate gland and urination difficult against this background.
- Sagging abdominal muscles.
- An unsuccessful surgical intervention with improper suturing of the peritoneal tissues.
A hernia does not occur suddenly. For its formation, time and a number of the listed disposing factors are necessary.
- Symptoms and signs
- Diagnosis and treatment methods
- Possible complications and consequences
- Prophylaxis and prognosis
- Abdominal hernia
- Types of abdominal hernias in men, methods of diagnosis and treatment
- Types of abdominal hernia
- Causes of pathology
- How dangerous is the disease?
- Driven by
- How to recognize a hernia on the stomach
- Types of abdominal hernia
- Signs of a hernia of the abdomen
There are various types of abdominal hernias. They are classified in this way:
According to the degree of formation and development:
By the method of origin:
- congenital – is an abnormality of the fetus;
By the presence of various complications:
- simple – uncomplicated;
- complex – accompanied by peritonitis, irreparability, infringement, inflammation.
If possible, correct: correctable and not amenable to conservative treatment.
In the course of the course, primary hernias, recurrent (recurring) and postoperative, are distinguished.
Symptoms and signs
The clinical picture of the pathology depends on the type and type of protrusion. There are such signs depending on the problem:
- Inguinal hernia. It is localized in the inguinal canal zone. It can be observed along the spermatic cord (oblique) or at the posterior groin wall (straight). More often, an oblique protrusion has the shape of an oval and at the same time goes into the labia in women or the scrotum in men. The hernia is painful. Inguinal direct protrusion is less infringed, but often recurs, unlike oblique.
- The thigh. The size of the lateral protrusion is about 1-2 cm. The problem is localized in the groin closer to the hip. The bump is soft, mobile to the touch. Therefore, it is difficult to confuse it with an ordinary wen or omentum.
- Postoperative. It is located in the area of unsuccessful abdominal sutures. Accompanied by pain due to irritation of the vagus nerve, nausea, vomiting.
With various types of abdominal protrusion, one can feel the hernia gate – the so-called push of the internal organs during coughing in a patient.
Diagnosis and treatment methods
To identify and confirm a hernia, you should consult a surgeon. Only he can see and pinpoint the type of problem. The doctor will conduct a standard examination and external palpation of the desired area. If there are doubts or suspicions of other pathologies, the doctor prescribes an ultrasound of the abdominal organs, radiography of the passage of barium of the small intestine or OBP (survey x-ray). In rare cases, diagnostic laparoscopy is performed.
Treatment tactics are selected depending on the degree of complexity of the pathology.
More often the surgeon makes a decision on surgical intervention for hernia. Conservative therapy is used only in the case of an initial uncomplicated protrusion or for elderly patients who are contraindicated in surgery. In this case, the patient is recommended to wear a bandage, reduce physical activity, normalize nutrition.
Reduction is carried out in the absence of infringement.
A standard operation is performed for complex hernias, as well as in the presence of strangulated protrusions. Small hernias are operated under local anesthesia. For large, a full abdominal operation is performed. The problem area is strengthened with a polypropylene mesh (mesh transplant). This helps prevent relapse.
There are times when the patient undergoes an emergency excision. Indications for this are necrosis of restrained tissues, perforation of the walls of the internal organ, peritonitis. An extended laparotomy is performed to assess the condition of the internal organs of the peritoneum. All necrotic areas of the omentum and intestines must be removed.
After the operation, wearing a bandage is shown. Physical activity is temporarily contraindicated. It is advisable to follow a diet for soft stools. Defecation should take place without straining.
Possible complications and consequences
The most terrible and dangerous complication of any protrusion is its infringement. Part of the body is compressed in the hernia gate. From this comes tissue necrosis, their death and decay. Doctors distinguish between these types of infringements:
- Strangulation or elastic. The vessels of the mesentery of the intestine are squeezed.
- Obstructive. An intestinal inflection occurs. The movement of feces in this case stops. Constipation may occur, which will lead to further poisoning of the body by the waste of its vital functions.
- Regional. A small part of the intestine is affected, and not its entire loop.
In no case do not try to treat a hernia with folk remedies. This can provoke serious pathologies and complications up to death.
Prophylaxis and prognosis
In order not to encounter a hernia in the future, it is recommended to take a number of such preventive measures:
- regular moderate physical activity;
- body weight control;
- diet and proper nutrition;
- the exclusion of excessive physical exertion, weight lifting;
- avoidance of peritoneal injuries;
- treatment for any chronic diseases that provoke an increase in intra-abdominal pressure;
- in newborns, it is necessary to monitor the correctness of bandaging the umbilical cord and perform thorough care for the birth scar; it is advisable to show the belly button of the baby to the visiting sister for the first two months;
- It is advisable not to let the baby cry for a long time, scream.
It is very important to follow all the recommendations of the attending surgeon after the operation. This will avoid recurrence of hernia.
With uncomplicated protrusion, the prognosis for the patient is conditionally favorable. The main thing is to turn to the surgeon for help in time. Relapses are rare. In only 3-6% of cases.
If we are talking about a restrained hernia, the prognosis depends on how sooner or later the patient seeks help from a specialist. The later the operation will be performed, the less chance of a favorable outcome. Failure to consult a doctor threatens the patient with a fatal outcome. The protrusion will continue to grow. Then its infringement will occur, and in the peritoneal organs the process of tissue death begins. The patient will live with such changes only if the doctor is able to conduct an extensive operation and save the remaining organs from further necrosis.
A hernia of the abdomen is a pathological process, as a result of which the protrusion of the peritoneum with the insides beyond the borders of the abdominal cavity occurs. Externally, such a formation looks like a tumor, the skin, as a rule, is not broken.
A hernia on the abdomen in adults is prone to proliferation, reaching pathologically huge sizes. In some cases, its contents may go out, which is extremely life threatening. It must be understood that such an education cannot go away on its own, therefore only medical assistance is required.
Abdominal hernia occurs in both adults and children. Such a pathological process can also be diagnosed in women and men, but abdominal hernias in men are much more common.
The nature of the clinical picture will depend on its form. The uncomplicated form of such a disease can be characterized by only a slight protrusion in the abdominal wall of a painless nature. Signs of an abdominal hernia of a complicated nature will be accompanied by extremely unpleasant symptoms: abdominal pain, limited mobility, protrusion cannot be corrected.
Diagnosis is based on a physical examination, laboratory and instrumental examination methods. Treatment of abdominal hernia is only surgical. In exceptional cases, a bandage is prescribed for a hernia of the abdomen, but only when, for certain circumstances, the operation is not possible. It should be understood that conservative therapy does not eliminate the problem at the root, and a band for a hernia of the abdomen after prolonged wearing only aggravates the pathology.
With an uncomplicated form of such a pathological process and timely treatment, the prognosis will be conditionally favorable. In this case, relapse is extremely rare – only in 3-5% of cases. With an impaired form of pathology, the prognosis will depend on the condition of the internal organs in the hernia, as well as on the timeliness of the therapeutic measures.
The abdominal wall in its structure is a complex anatomical structure, the main function of which is to maintain the abdominal organs. In fact, a certain balance is developed between the resistance of the abdominal wall and intra-abdominal pressure. When, as a result of certain etiological factors, this balance is disturbed, protrusion of organs occurs through the weaknesses of the peritoneum. As a result, a tumor forms, which is difficult to confuse with any other disease.
Abdominal hernia in men, as well as abdominal hernia in women, may be the result of such etiological factors:
- pathological processes of connective tissue;
- congenital or acquired weakness of the abdominal wall;
- age changes;
- prolonged fasting;
- excessive physical exertion;
- difficult labor;
- complicated pregnancy;
- chronic, angry cough;
- chronic constipation;
- abdominal injuries;
- postoperative scars;
- chronic perivisceritis.
In other words, any factor in which an overstrain of the abdominal wall occurs can provoke the formation of a hernia. In adulthood, the most common cause of the manifestation of such a pathological process is weight lifting and complex pregnancy. In children, such a disease can occur due to prolonged, angry crying and constipation.
It is important to understand that only a doctor can determine exactly why such a pathology occurs. To conduct self-diagnosis and self-medication in this case is not only impractical, but can be life threatening.
Classification of abdominal hernia is carried out according to several principles: etiology, clinical and morphological signs, stage of development and localization.
By origin, such an education may be:
- primary or congenital – occurs with abnormalities in the development of the fetus;
- secondary or acquired – develops due to injuries, weight lifting, as a complication after severe pathological processes, operations, and so on.
By localization, the following types of abdominal hernia are considered:
- lateral abdominal hernia;
- hernia of the Spigelian line of the abdomen.
Based on the clinical picture, a hernia is:
The following forms are distinguished by the nature of the location of the herniform sac:
- external hernia of the abdomen;
- internal hernia of the abdomen.
By the nature of the pathological process, the following subspecies are considered:
The latter form is characterized by extremely unfavorable prognoses, since tissue necrosis with associated complications can develop.
It should be noted that a hernia of the Spigelian line of the abdomen is most common, but an accurate diagnosis is made only by examination.
The initial stage of development of the clinical picture is asymptomatic. As education increases, the clinical picture may be characterized by more pronounced symptoms.
In general, the symptoms of abdominal hernia are as follows:
- acute pain, which becomes stronger if the patient moves, lifts weights;
- with physical activity and even just coughing, laughing, the hernial sac protrudes;
- at the initial stage, only a small subcutaneous formation is present;
- when a person assumes a horizontal position, the protrusion can set itself.
In addition to the general clinical picture, there will also be specific signs, the nature of which will depend on which organ is involved in the pathological process.
Additionally, a clinical picture of the following nature may be present:
- temperature increase;
- weakness, general malaise;
- nausea and vomiting;
- pain in the epigastric zone;
- constipation, which take the character of chronic;
- violation of the urination process – frequent urges that do not bring relief, soreness and discomfort in the lower abdomen.
It should be noted that the localization of the manifestation of the pain syndrome will depend on the type of hernia, so pain can be present on the side, in the navel and in the groin.
If there is a pinched hernia of the abdomen, then the patient’s condition will deteriorate quite rapidly. If emergency medical care is not provided, even death is not ruled out.
Diagnosis of a hernia of the abdomen is based on a physical examination of the patient, a personal history, as well as instrumental and laboratory research methods.
First of all, the doctor examines the patient. During this stage of diagnosis, it clarifies the nature of the clinical picture, how long the symptoms began to appear, and studies the patient’s personal history. In particular, attention should be paid to the lifestyle and scope of the patient.
The next stage of the examination will be the following diagnostic measures:
- standard laboratory tests;
- Ultrasound of the abdominal cavity;
- survey radiography;
- radiography of the passage of barium through the small intestine;
- diagnostic laparoscopy.
Based on the results of the studies, treatment will be prescribed.
Treatment is often radical: a hernia is removed on the abdomen, in some cases the affected organ is removed (partially or completely, depending on the stage of the necrotic process). A special mesh is also used for abdominal hernia, which allows the most effective treatment of the anterior wall of the abdominal cavity.
Conservative treatment in this case is ineffective, because it does not eliminate the problem, but only slows down its further development. This method of therapy is prescribed only when the operation is unacceptable for certain medical indicators. In this case, a band for a hernia of the abdomen can be used.
It must be understood that the bandage for a hernia of the abdomen with prolonged wear will only aggravate the pathological process, since it helps to relax the muscle corset.
Additionally, the patient is prescribed drug therapy and diet. Physical activity and even activity are prohibited.
The prognosis will depend on the severity of the pathological process and the timeliness of the beginning of therapeutic measures. As for prevention, there are no specific methods. Measures should be taken to prevent etiological factors. Self-medication is excluded.
Types of abdominal hernias in men, methods of diagnosis and treatment
Perhaps the healers of antiquity would be very surprised to find out with what frequency the usual medical diagnosis is used in our everyday life, and it’s completely not the case. It all started from those distant times when men were taken into the army for as many as 25 years. Of course, who could, paid off even then, and the doctors, who added several peasant rubles to their pockets, wrote in the documents and said that the man was unsuitable for military service because he was suffering . garbage. But this meant nothing more than the fact that the conscript had an abdominal hernia (lat. Hernia). Signs of abdominal hernia formation in men gave the disease its Russian name. The Russian name itself was strengthened behind this pathology from the verb “gnaw”. This indicates those unpleasant sensations arising from a violation of the integrity of the tissues and protrusion of part of the contents of the abdominal cavity.
Indeed, before, when ordinary people were characterized by hard physical labor, a hernia in men was encountered quite often. This is a condition in which bulging of organs from the cavities occupied by them in a normal state occurs.
Types of abdominal hernia
Inguinal hernia is most common. More than two thirds of all diagnosed diseases are inguinal, and they develop more often in men over forty against the background of general aging of the body or injuries.
Femoral hernias form at the joints of the muscles of the abdominal cavity and hips. Unlike inguinal, it is much more often diagnosed in women.
Epigastric hernia develops due to muscle failure in the upper middle part of the abdominal cavity. This type of abdominal disease in men is diagnosed three times more often than in the fair sex.
Patients of all ages can boast of umbilical hernias, especially infants and preschoolers.
Incisional hernia appears at the site of the postoperative suture. At the same time, “fresh” is capable of both a fresh inner seam and an old one. So pathology at the site of the old section can develop after a few months or years.
Causes of pathology
One of the main reasons for the appearance of acquired pathologies is the failure of the abdominal wall, resulting from the specifics of its structure. In the muscles of the abdomen there are especially delicate places where the likelihood of the formation of the disease is always high. Cases when the integrity of the muscles is violated due to abdominal operations or injuries belong to the same category. At the same time, pathology can develop completely imperceptibly for the patient even without noticeable attempts or loads.
There are also other factors that cause the failure of the walls of the inguinal region and the appearance of protrusions in these places.
- genetic predisposition;
- tissue transformations associated with age;
- extreme weight loss due to prolonged fasting or illness (lack of protein in the diet always leads to weakening of muscle tissue);
- muscle wall stretching due to gestation, obesity, ascites, etc.
Provoke the formation of protrusions are capable of factors leading to an increase in intra-abdominal pressure such as:
- physical stress. At the same time, this includes not only lifting weights, but even playing wind instruments, glass blowing, or inflating inflatable toys or balloons;
- heavy birth;
- regular constipation, impaired urination;
- persistent cough;
- in babies, the development of the disease often provokes a prolonged cry or cry.
How dangerous is the disease?
Such pathologies are not safe at all. The appearance of a hole in the abdominal muscles is always fraught with serious complications, the most dangerous of which is the infringement of the protrusion of the muscles. If this happens, blood flow to the pinched organ stops, it begins to die. Therefore, if a loop of the intestine or other organ is pinched, the patient is at mortal risk, and only emergency surgery can correct the situation. In this case, by the time of surgery, there is a high probability that a pinched organ will already be unviable. The operation in this case will be very traumatic, which means that, most likely, good forecasts after its completion are unlikely to be discussed.
Infringement of the contents of the hernial sac is also fraught with the development of peritonitis (inflammation of the abdominal cavity), severe pathologies of the liver and kidneys, intoxication of the body, and acute intestinal obstruction.
Such pinching of organs occurs in about 10-12 of a hundred cases of diseases and most often with umbilical, inguinal and femoral formations.
However, even if the formation is not prone to infringement, over time, the opening in the muscles increases and the contents of the hernial sac can exit the abdominal cavity, which is fraught with a number of unpleasant symptoms. So, protrusion of a part of the rectum beyond the muscle wall causes regular constipation, exit of the bladder – severe pain when urinating, and if the hole becomes very large, several organs can “fall out” at once. In the latter case, the patient may have serious breathing problems. In especially difficult cases, a person literally carries a huge hernia in his hands, which contains not only a significant part of the intestine, but also an omentum and even a part of the stomach. Such a situation is a big problem even for experienced surgeons and a huge danger to the patient himself. After all, the risk of pinching organs always remains.
Also, for any large, long-existing pathology, inflammatory processes are characteristic, especially when the patient has been wearing a bandage for a long time. Due to inflammation of the shell of the hernial sac, he himself is coarsened. In addition, the risk of fusion of the bag itself and its contents increases, which can lead only to great complications.
Among other things, such an education, especially of large sizes, is a serious cosmetic defect, which often scares patients even more than the likelihood of pinching organs and emergency surgery.
Medical practice there are many cases where patients were well aware of the existence of this pathology, while not rushing to the doctor, for many years getting used to the fact that an unpleasant bulge on the abdomen periodically reminds itself of a sore spot. Some using various manipulations managed to adjust the protrusion on their own.
There were also cases when the patient had absolutely no idea that he had such a pathology up to the moment when an infringement of the organs that had already occurred was already occurring.
Nevertheless, there are signs of abdominal hernia in people, the manifestation of which indicates the need for immediate specialist advice:
- the presence of a soft, painful to the touch bulge or nodule in the lower abdomen or groin;
- the size of the bulge increases with muscle tension or in a standing position;
- pain in the lower abdomen, giving in the leg;
- the skin over the protruded area turns red.
If the bulge increases in a standing position or with a load on the abdominal muscles, and in a relaxed or lying position it decreases or practically disappears, the outlet of the muscle wall is still small, and its edges are elastic. Such an entity is called correctable.
If the “bump” can be set in a prone position, but it still appears in a standing position, a larger amount of abdominal contents already falls into the hernial gate and this formation is called permanent.
The third stage of hernia is uncontrollable. The hole in the muscles becomes even larger and the “bump” is no longer self-adjusting even when lying down, unless you push it back with your fingers on purpose.
Less commonly, a person develops a hernia of the abdomen. Symptoms may include the following:
- bowel obstruction;
- difficulty emptying;
- an increase in body temperature to 38,5 ° C and above for no apparent reason;
- severe abdominal or groin pain;
- nausea and vomiting.
Such symptoms in men require immediate medical attention, as they indicate a direct threat to life.
If the development of a hernia occurs in the lower abdomen at the junction with the muscles of the hips, part of the bladder may enter the opening of the muscle wall. This causes symptoms that are very similar to the symptoms of acute cystitis, which can be misleading. The patient begins to be treated with cystitis, and pinching of part of the bladder continues until the necrosis of part of its wall. Urine begins to flow into the abdominal cavity, into the intestines and spleen, causing profuse bleeding.
In order to avoid the development of such a condition, in the event of any pain in the lower abdomen, a visit to the doctor should not be postponed.
The only treatment is surgery. Such a pathology is not able to “grow” back, and the hole in the muscle wall is not able to overgrow on its own. Over time, the hernia gate will only increase, and in proportion to them, the risk of pinching the organs.
The only kind of hernia that can disappear on its own is the umbilical cord in babies up to 5 years old. All other types of disease require surgical intervention, regardless of the stage of development. However, it should be remembered that the earlier the operation is performed, the less likely the occurrence of various complications and the more effective the treatment.
The treatment consists in the fact that a peculiar patch of a special material is placed on the hernial gate – an allograft, which fuses with muscle tissue, preventing the hernia from developing again. The percentage of recurrence of the disease after such an operation does not exceed 1-2%.
How to recognize a hernia on the stomach
The exit under the skin of the groin, thigh, back or abdomen, into the scrotum or into the chest cavity of the internal organs from the abdominal cavity is called a hernia of the abdomen. Visually, a hernia of the abdomen looks like a tumor with smooth contours and intact skin.
The reasons for which a hernia of the abdomen occurs can be divided into two types:
Congenital. We are talking about anatomical abnormalities that facilitate the exit of internal organs from the peritoneum. Acquired. The disease can develop due to injuries, operations and other influences that violate the integrity of the abdominal cavity, even in a person who is not prone to the formation of a hernia of the abdomen. Acquired causes also include weight lifting, obesity, childbirth, and pregnancy.
Types of abdominal hernia
The disease is usually classified according to various anatomical and clinical factors:
By origin. In this case, there is also a division into acquired and congenital abdominal hernias. According to the clinical picture. The patient may develop a complication in the postoperative period, be a relapsing or primary disease. According to the stage of development. Full hernias – the contents of the hernial sac extend under the skin, within the hernial canal and the initial ones (the contents are not squeezed out).
Hernias can be external and internal. In the first case, the hernial contents protrude outward through the openings of the abdominal cavity. In the second, it fills various pockets of the abdominal wall and does not go under the skin.
Hernia is also divided into restrained and uncomplicated. The first is a serious complication that requires surgical intervention. With the second there is a chance to cope, the hernia can be repaired without performing surgical treatment.
Signs of a hernia of the abdomen
There are several main symptoms that help to recognize a hernia:
Bulging out a hernial sac, the size of a pea to a medium watermelon. Pain The area of the appearance of the pathology noticeably swells.
Pain is characteristic of the initial stage of the onset of the disease. The pain is acute and becomes stronger when the patient moves: he takes a deep breath, coughs. At the same time, a bulging hernial sac appears, protruding through the hernial gate. At this time, elements of the intestine are not yet visually visible on the front wall. At the initial stages, the hernia manifests itself as a tumor-like subcutaneous seal.
Usually, protrusion during palpation is painless. In some cases, it independently disappears or sets itself when a person takes a horizontal pose of the body.
Different types of hernia of the abdomen may have their own specific signs. In this case, the symptoms will depend on which organ of the peritoneum or part of it formed the hernial sac:
In the case of intestinal loops, you can see the symptoms of another disease – “intestinal obstruction.” The patient will suffer from constipation, nausea, experience acute pain, his temperature will rise. In the case of the bladder, abnormalities in the process and frequency of urination can be noticed. A hernia of the white line of the abdomen is characterized by protrusion with tension of the anterior abdominal wall (when a person is “inflated”) and pain in the epigastric zone. An umbilical hernia manifests itself as nausea and pain that a person will experience when feeling a hernial sac in the navel area; Inguinal hernia is characterized by increasing pain in the groin and lower abdomen. The patient will find a characteristic protrusion in the area of the inguinal canal, feel muscle weakness. A femoral hernia has similar symptoms. But the place of its deployment is already different. Characteristic signs are aggravated pain in the lower abdomen with full straightening of the body and an upset urination.
In order to accurately classify the type of hernia, differential diagnosis is necessary. You can not rely only on symptoms and signs.
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