Stomach hernia – migration of the internals surrounded with an external (parietal) leaf of a peritoneum under skin or in various departments of an abdominal cavity through defects musculo a layer. Hernias of a stomach are formed in weak points of a belly wall. Uncomplicated hernia of a stomach is shown by painless protrusion under skin which is freely set. The complicated hernia becomes painful, ceases to be set. The diagnosis of hernia of a stomach is made on the basis of clinical examination, performing ultrasonography of abdominal organs, a gerniografiya. Treatment of hernia of a stomach exclusively surgical; carrying a bandage is shown only in the presence of contraindications to operation.
Stomach hernia – protrusion of abdominal organs together with an external leaf of a serous cover through a forward wall of a stomach; sometimes - moving of bodies and loops of intestines to openings of a bryzheyka or a diaphragm within an abdominal cavity. Today various hernias of a stomach each 5 people on 10 thousand population have; from them not less than 80% - men, other 20% - women and children. About 30% of all surgeries in children's surgery are carried out concerning stomach hernias. At adults inguinal and femoral hernias, are more often diagnosed for children – umbilical. Stomach hernias are most widespread in preschool age and after 45 years.
On frequency all ventral hernias are distributed as follows: inguinal hernias meet in 8 cases from 10, postoperative and umbilical hernias of a stomach are diagnosed in an equal ratio – on 8%, femoral - in 3% of cases, and diafragmalny - less than for 1% of patients. Today in abdominal surgery new techniques of operation are developed (beznatyazhny) which guarantee the low frequency of a recurrence.
Stomach hernia reasons
Hernias of a belly wall do not arise spontaneously, their emergence requires a combination of a number of pathological factors and time. All reasons of hernias of a stomach are subdivided into the protrusions contributing to formation and making. The first of them include congenital weakness of sinews and muscles, and also the acquired changes (as a result of operations, injuries, exhaustion) owing to which weak points of a corset of a trunk are formed (in the field of femoral and inguinal channels, an umbilical ring, the white line of a stomach, etc.).
The making causal factors stimulate increase of intra belly pressure and formation of hernia of a stomach in such weak point. Carry to them: hard physical work, tumors of abdominal organs, hoarse cough at chronic pulmonary pathology, a meteorizm, ascites, violations of an urination, locks, pregnancy, etc. It is necessary to notice that the listed mechanisms of development of a disease have to operate long time - only in this case stomach hernia will be created.
Classification of hernias of a stomach
All hernias of a stomach are divided by location on external (overstep the bounds of a belly wall under skin) and internal (bodies move to the increased openings of a bryzheyka of intestines or a diaphragm within an abdominal cavity). On volume hernia of a stomach can be full or incomplete. Full hernia is characterized by the fact that the hernial bag together with contents is behind stomach wall borders. At incomplete hernia of a stomach the hernial bag leaves an abdominal cavity, but not borders of a wall of a stomach (for example, at slanting inguinal hernia contents can settle down in the inguinal channel).
Hernias of a stomach can be set or not set. Initially everything the created hernias of a stomach are set – when applying insignificant effort all contents of a hernial bag rather easily move to an abdominal cavity. In the absence of due observation and treatment stomach hernia volume considerably increases, it ceases to be set, i.e. becomes not set.
Over time the risk of the hardest complication of hernia of a stomach – its infringement increases. Speak about the restrained hernia when bodies (hernia contents) are squeezed in hernial gate, there is their necrosis. There are different types of infringement: obturatsionny (kalovy) arises at an excess of a gut and the termination of a passage of kalovy masses on intestines; strangulyatsionny (elastic) – at displacement of vessels of a bryzheyka with a further necrosis of a gut; regional (Richter's hernia) – at infringement not of all loop, and only the small site of a wall of intestines with a necrosis and perforation in this place.
In separate group allocate special types of hernias of a stomach: congenital (it is caused by anomalies of development), sliding (comprises the bodies which are not covered with a peritoneum – a blind gut (), a bladder), Littre's hernia (contains a diverticulum of a lean gut in a hernial bag).
Stomach hernia symptoms
Displays of ventral hernias depend on their arrangement, the main sign is existence of directly hernial education in a certain area. Inguinal hernia of a stomach happens a braid and a straight line. Slanting inguinal hernia - congenital defect when the vaginal shoot of a peritoneum does not grow thanks to what the message of an abdominal cavity with a scrotum via the pakhovy channel remains. At slanting inguinal hernia of a stomach intestinal loops pass through an internal aperture of the inguinal channel, the channel and leave through an external aperture in a scrotum. The hernial bag passes near a seed kanatik. Usually such hernia right-hand (in 7 cases from 10).
Direct inguinal hernia of a stomach – the acquired pathology at which weakness of an external abdominal ring is formed and intestines together with a parietal peritoneum follows from an abdominal cavity directly through an external abdominal ring, it does not pass near a seed kanatik. Often develops from two parties. Direct inguinal hernia is restrained much more less than slanting, but recurs after operation more often. Inguinal hernias make 90% of all hernias of a stomach, at the same time 95-97% of all patients – men after 50 years. About 5% of all men have inguinal hernias. Rather seldom the combined inguinal hernia meets – at it arises several hernial protrusions which are not connected among themselves at the level of an internal and external ring, the most inguinal channel.
At femoral hernia of a loop of intestines leave an abdominal cavity through the femoral channel on the forward surface of a hip. In most cases women of 30-60 years suffer from this type of hernia. Femoral hernia makes 5-7% of all ventral hernias. The sizes of such hernia usually small, but because of narrowness of hernial gate it is inclined to infringement.
At all above described types of hernias patients notice the roundish elastic education in inguinal area decreasing in situation on a back and increasing in a standing position. At loading, a natuzhivaniye morbidity in the field of hernia appears. At slanting inguinal hernia intestinal loops can be defined in a scrotum, then at reposition of hernia rumbling of a gut is felt, at an auskultation over a scrotum the vermicular movement is heard, at percussion is defined timpanit. These types of hernias should be differentiated with lipomas, inguinal lymphadenitis, inflammatory diseases of testicles (orkhity, an epididymite), a kriptorkhizm, abscesses.
Umbilical hernia – movement of a hernial bag outside through an umbilical ring. In 95% of cases it is diagnosed at early age; adult women have this disease twice more often than men. At children up to 3 years perhaps spontaneous strengthening of an umbilical ring with treatment of hernia. Adults have the most frequent reasons of formation of umbilical hernia of a stomach – pregnancy, obesity, ascites.
Hernia of the white line of a stomach is formed at a divergence of direct muscles around an aponeurosis on the median line and an exit through this opening of loops of intestines, stomach, the left share of a liver, an epiploon. Hernial protrusion can be formed in nadpupochny, okolopupochny or subumbilical area. Often hernias of the white line of a stomach happen multiple. They can be formed at the complicated current of the postoperative period (infection of a wound, formation of hematomas, ascites, development of intestinal impassability, at patients with obesity). Feature of such hernia of a stomach – the hernial bag and hernial gate are located in the field of a postoperative hem. Surgical treatment of postoperative hernia is carried out only after elimination of action of the making factor. The most rare hernia of a forward belly wall settles down in the field of the semi-lunar line (it passes practically parallel to the median line, from two parties from it, in the place of transition of a cross muscle of a stomach to a fastion).
Diagnostics and treatment of hernia of a stomach
Consultation of the gastroenterologist is necessary for performing differential diagnosis of hernia of a stomach with other pathology. For establishment of the exact diagnosis usually happens rather simple survey, however for the purpose of definition of tactics of surgical treatment a number of additional inspections which will allow to reveal what bodies are contents of a hernial bag is required, and also to estimate their condition. For this purpose ultrasonography and a survey X-ray analysis of abdominal organs, a barium passage X-ray analysis on a small intestine can be appointed. In difficult situations consultation of the endoscopic surgeon, a diagnostic laparoscopy is required.
Numerous researches in the field of gastroenterology and surgery showed that conservative treatment of hernias of a stomach is absolutely inefficient. In case of detection at the patient of uncomplicated hernia of a stomach the planned gryzhesecheniye is shown it, at infringement of hernia the emergency operation is required. Around the world more than 20 million surgeries concerning stomach hernia, are annually carried out from them about 300 thousand – in Russia. In the developed countries 1 operation for the restrained hernia is the share of 9 planned interventions, in domestic clinics indicators it is a little worse – on 5 planned gryzhesecheniye 1 urgentny. Modern methods of diagnostics and surgical treatment of hernia of a stomach are directed to early detection of this pathology and the prevention of complications.
In former years the classical methods of gryzhesecheniye consisting in an ushivaniye of hernial gate, closing with their own fabrics prevailed. Now more and more surgeons use beznatyazhny techniques of a gernioplastika at which special synthetic grids are used. Such operations are more effective, after their application of a recurrence of hernia of a stomach practically does not happen.
At detection at the patient of hernia of an esophageal opening of a diaphragm various operations (an endoscopic fundoplikation, a gastrokardiopeksiya, operations of Belsi) allowing to reduce hernial gate and to prevent moving of abdominal organs to pleural are used.
Operations on elimination of external hernias of a stomach can be performed under local anesthesia, including with use of endoscopic techniques. At any kind of a gryzhesecheniye first of all the hernial bag is opened, internals (hernia contents) look round. If loops of intestines and other bodies which got to a hernial bag are viable - they are set in an abdominal cavity, plasticity of hernial gate is made. The technique of operation is developed for each type of hernia, and surgery volume in each case is developed individually.
If the emergency gernioplastika of the restrained hernia is made, at survey of loops of intestines the necrosis, perforation with the beginning peritonitis can be revealed. In this case surgeons pass to an expanded laparotomy during which audit of abdominal organs is carried out, is removed nekrotizirovanny parts of intestines and an epiploon. After any operation for a gryzhesecheniye carrying a bandage, the dosed physical activities only on permission of the attending physician, observance of a special diet is shown.
Conservative treatment (carrying a bandage) is shown only when carrying out operation is impossible: at the elderly and exhausted patients, pregnant women, in the presence of an oncopathology. Long carrying a bandage promotes relaxation of a muscular corset and provokes increase in the sizes of hernia therefore usually it is not recommended.
Forecast and prevention of hernia of a stomach
The forecast at uncomplicated hernia of a stomach conditional and favorable: at timely surgical treatment working capacity is restored completely. A recurrence after a gryzhesecheniye is observed only in 3-5% of cases. At infringement the forecast depends on a condition of bodies in a hernial bag, timeliness of carrying out operation. If the patient with the restrained hernia of a stomach it is long does not ask for medical care, there occur irreversible changes in internals, and the patient's life not always manages to be saved.
Prevention of formation of hernias of a stomach – the moderate physical activities allowing to strengthen a muscular corset and to prevent weakening of a forward belly wall. It is necessary to avoid the making factors: for this purpose it is necessary to eat properly (to include enough cellulose, water in a diet), to monitor regular depletion of intestines.