Alarming symptoms and treatment of strangulated umbilical hernia

A strangulated umbilical hernia is a serious complication of the surgical plan, which is characterized by an acute severe condition of the patient, where the leading conditions are two syndromes: acute obstruction and pain.

This condition is considered one of the most dangerous among all complications of hernia pathology.

Infringement of an umbilical hernia is formed due to bulging and subsequent pathological pinching of the internal organs of the abdominal cavity. For a correct understanding of the picture of pinching, you should understand the anatomy of a hernia.

Disease pathogenesis

Any organ of the abdominal cavity can be infringed: intestines, kidneys, bladder, greater or lesser omentum.

The hernia as such consists of three elements:

1. The gate is a defect in the soft tissues, which can be compared with a small hole through which organs fall out. Its dimensions vary from a few to 20-25 centimeters. Most often, the gate is formed due to discrepancies in the muscles, fascia or ligaments.
2. The bag is, in fact, the hernia itself. Under the bag is meant a certain part of the abdominal cavity, which, under the influence of a number of factors, has stretched and exited through the hernial ring. The bag itself has the following elements: the neck (a distant section), the body - the widest and most voluminous part, and the top. Most often, the bag is pear-shaped. The size of the bag in the initial stages of herniation can be compared with the size of a plum, in the latter - with several soccer balls.
3. The contents of the hernia are parts of the organs that came out of the abdominal cavity.

The main provoking factor of pinching is a sharp increase in intra-abdominal pressure.

Often people who do not know about the presence of a hernia are engaged in physical exercises, power loads. At this moment, due to the strong contraction of the abdominal muscles, the pressure in the peritoneum instantly increases. Organs in the hernial sac are pushed out even more. When the load on the muscles has disappeared, the pressure is normalized, but the organs do not retract: the hernial gates can no longer pass through a huge volume of organs. According to this mechanism, a pinched umbilical hernia is formed.

In medicine, there are three clinical stages of pinching:

1. Period one : shock and severe pain.
2. Period of imaginary well-being.
3. Diffuse peritonitis - inflammation of the tissues of the abdominal cavity.

Clinically recorded are the following indicators:

• weakening of the pulse, the heart rate increases;
• lowering blood pressure;
• frequent, irregular and shallow breathing.

In the second period, a number of symptoms partially disappear, the pain disappears, but this is not an indicator of the patient's well-being.

Varieties of infringement of the umbilical hernia

There are several types of this formidable complication:

Elastic restraint.

This variant of development occurs suddenly, during a strong increase in pressure in the abdomen. Physical activity, coughing, severe sneezing, chronic constipation are the most common causes of education. The gate is stretched. Most often, intestinal loops lend themselves to infringement. With prolonged pinching, a complete stop of local blood flow is observed, arteries and veins are not able to supply blood and nutrients to the required place.

As the complication develops, the intestine acquires a blackish tint, multiple, but small hemorrhages are fixed in place.  

Fecal infringement.

Usually, this condition is most often recorded in people who are overweight, in the elderly, and in those who are prone to constipation. The main pathological chain is fecal stasis. The fecal variant of the complication develops against the background of various disorders of the motor functions of the intestinal tract, when parts of the digestive tube are weakened and do not move. Also, coprostasis is associated with a decrease in the tone of the intestinal walls.

Often this type of pinching is formed due to a large accumulation of feces. If an elastic variant is attached to it, a combined form is formed.

Retrograde pinching.

This type of complication is characterized by the fact that several intestinal loops are located in the bag.

Richter's hernia - parietal infringement.

With this variant of development in the pathogenesis, compression is observed not of the entire intestine, but only of its separate wall. In this case, the clinical picture is poorly manifested. Richter's hernia is the most favorable complication.

There are a number of provoking reasons:

• sedentary lifestyle;
• rich food that is difficult to digest.

The main difference from elastic infringement is the speed of development: coprostasis develops slowly, symptoms increase gradually. The clinical picture is blurred due to minor pain and the presence of a symptom of a cough shock. In addition, vomiting almost never occurs, and the general condition of the patient is determined to be stable.

Symptoms of infringement

The specificity of the clinical picture largely depends on the type of pinching, on the organ that is in the hernial sac, on the elapsed time. So, the leading symptom is pain. It appears suddenly, it is strong and sharp in character, localized at the site of the hernia. Sometimes the pain is so severe that patients fall into a state of shock and even collapse. Often, painkillers do not help relieve pain.

Also, the following signs of infringement come to the fore:

1. Acute violation of digestive functions . There is vomiting of intestinal contents, sometimes with the content of feces. The patient complains of severe nausea. Signs of constipation are fixed.
2. When the omentum is infringed, the pain is not so pronounced, and vomiting is intermittent. Often, the act of vomiting is recorded only once.
3. During any physical activity, even during normal movement, the patient feels movement in the area of ​​​​the hernia.
4. Psychophysiological disorders: a person becomes irritable, gets tired quickly, apathy, lack of appetite, sometimes an anxiety syndrome is formed. The skin turns pale.

With the development of inflammatory processes, an intoxication syndrome is formed. The body temperature rises greatly, the rhythm of breathing is disturbed. Edema is observed at the site of the hernia, the skin turns blue.

The mechanism of pinched umbilical hernia in adults proceeds according to the same type as in children. In newborns, infringement is also possible. In this case, the child will experience common symptoms: loud crying, adoption of unnatural body positions. An older baby will indicate pain in the umbilical cord area on its own. Parents can observe such manifestations: the navel is swollen, has a bluish tint.  

Diagnostics

For accurate diagnosis, three points are important:

1. Severe and sharp, sudden onset pain in the navel area.
2. Impossibility to correct the hernia, in the horizontal position the protrusion does not disappear.
3. The symptom of a cough shock is negative.

 

 

In general, the diagnosis does not take much time, since usually patients inform their doctor about the presence of a hernia. The difficulty is diagnosing complications in the elderly: their clinical picture is sluggish.

First aid

The main thing for the patient and for the people around him is to call an ambulance team as soon as possible and remain calm. Panic generates unnecessary actions that can only harm the patient. It is strictly forbidden to set the hernial sac on your own.

The patient is advised to take a horizontal position, breathe evenly, deeply. You can not take painkillers, as they lubricate the clinical picture, which makes it difficult for doctors to diagnose. The list of prohibited drugs also includes: laxatives, antispasmodics. You can not take warm baths and apply warm compresses to the affected area.

Treatment

The only way to cure the complication is surgery. Only with the help of intervention is it possible to eliminate acute symptoms and eliminate the cause of the pathology.

The most common options for operations:

1. Mayo method.
2. Sapezhko method.

During the intervention, the bag is opened from the side. The hernial ring is dissected, the clamped organs are released and set back into place. The sac itself and necrotic tissue are removed. The operation is associated with several risks: infection and adhesion of organs to the wall of the bag. In such cases, the protrusion is removed completely, without first opening the bag.