Classification of hernias and main manifestations

A hernia is a disease that is characterized by a pathological protrusion of an organ from its natural biological location through natural openings in the body, or pathological openings. The released part of the organ or the organ itself, at the same time, remains intact and continues to work, although not always at the proper level.

The hernia consists of three main elements:

1. Hernia gate. This is a part of the body that appears to be a defect through which the organ or its parts pass. Gate sizes vary from a few centimeters to 2-3 decimetres. With pathologies such as neuropathic hernia, there may not be a gate at all.
2. Hernial sac . This element is a part that has stretched and exited through the gate under the influence of internal pressure. The bag, in turn, consists of a neck, a body (the largest part) and an apex. As a rule, the bag is pear-shaped. The dimensions of the latter can reach the dimensions of a watermelon or a soccer ball.
3. Content . These are directly organs that have gone beyond their normal location. Often the content is the organ closest to the gate. If the content consists of several organs, then doctors call such a hernia combined.

Causes and mechanism of hernia formation

The root of the formation of pathological protrusion lies in the imbalance between pressure in the cavity, restraining forces and "weak" places in soft tissues (muscles, fascia). The mechanism of formation itself lies in the fact that, due to some external factors, the pressure in the cavity increases to a level where the restraining forces such as muscles can no longer resist. As a result of this, in those places where the muscles overlap each other (such places can be called cracks) or touch, a place is formed through which several organs, one organ or part of it, exit.

In addition, a person has congenital natural weaknesses in the anterior wall of the peritoneum. These places include the inguinal canal, which sometimes does not grow after birth. Weaknesses can also be an acquired phenomenon due to any injuries throughout life, surgeries, pregnancies, aging.

It is customary to divide the factors of hernia formation into two large groups:

1. predisposing circumstances . This group includes individual features of the structure of the body, genetically determined factors, gender differences, age-related changes in the body.
2. Conditioning factors . These include the group of causes that directly affect the increase in internal pressure, such as: frequent work with a heavy load, strength exercises, chronic cough, long-term constipation, difficult urination - all this directly increases the pressure.

Hernia classification

Due to its versatility and diversity, the disease is classified according to many principles.

It is customary to adhere to the clinical classification of hernias:

1. According to the origin of the disease:

• Congenital. This group is formed even before birth - during the period of intrauterine development of the fetus. Pathology develops as a result of genetic disorders and is generally defined as a malformation of the infant;
• Acquired. These hernias, one way or another, were received during life.

2. Presence of complications:

• Complicated. This term is understood as a sudden disruption of the activity of an organ or any content that is in a hernia. This includes various types of infringement, stagnation of feces, inflammation, irreducibility, rupture of the contents;
• Uncomplicated - these are those hernias, the course of which is favorable, the treatment of which is not difficult and does not carry serious consequences.

3. Are we correct:

• Irreducible - these are protrusions, the back wall of which has somehow overgrown over time, or there are adhesions that do not allow the contents of the bag to be set back;
• Reducible - hernias that are easily amenable to repositioning an organ or part of it to a normal anatomical location.

4. Course of the disease:

• Primary. These are those hernias, the protrusion of which in a person occurred for the first time;
• Recurrent. This definition refers to a pathology that has formed again after its complete cure. The disease may reappear after a few years;
• Postoperative - this is the group of hernias that formed immediately after surgery as a result, for example, of tissue dissection or poorly applied sutures.

5. By stage of education:

• Beginners. This is a part of the organ or the organ itself is in a position of getting out of its position;
• Channel. The contents are in the anatomical canal, but not yet in the hernial sac;
• Full. Hernias that have already left the canal and are located directly under the skin.

Types of hernias

The final formulation in the diagnosis is determined by the location of the hernia that has arisen, therefore, differences in the types of hernias are repelled from this.

1. Inguinal hernia.

This is one of the most common diseases in this class. The frequency of detection of pathology is about 70% of all hernias. Also, most often this species is found in men of working age due to the fact that they are associated with the constitutional features of the stronger sex.

Among inguinal hernias, oblique and direct are distinguished. The first subtype of hernia passes through the inguinal canal and approaches the inguinal ring, then the contents descend along with the spermatic cord into the scrotum. In women - in the region of the labia majora. The direct variant of the pathology passes through the inguinal fossa from the abdominal cavity.

Despite their anatomical differences, these hernias share common symptoms:

• heaviness in the lower abdomen;
• a tumor-like formation that disappears in a calm lying position;
• sharp pain when lifting and any load on the peritoneum;
• heaviness when moving and performing standard household chores.

This type can also be combined, when hernial sacs that do not have interconnections protrude from several sides at once.

2. Umbilical hernia.

Most often, this group of ailments occurs in women. The main provoking factor in development is the period of pregnancy and, in fact, childbirth. As a result of the impact of the fetus, the abdominal muscles and the umbilical canal lose their elasticity properties.

The main symptoms of a hernia of the navel:

• constant dull pain in the abdomen;
• a bulge around the navel;
• frequent nausea and occasional vomiting;
• tendency to constipation;
• discoloration of the skin in the umbilical region

This hernia is dangerous by disruption of blood circulation, tissue necrosis and sometimes death.

3. Hernias of the white line of the abdomen.

This type is common among the male population. The entrance gates are holes and crevices located on the surface of the abdomen. Through them, as a rule, an omentum comes out, pulling a layer of the peritoneum with it. There are three types of location for this kind of protrusion: above the navel, around the navel, and below the navel.

The disease is manifested by such signs:

• chronic pain in the abdomen;
• along the line there is a bulge and a tumor-like formation that occurs against the background of tension in the abdominal muscles;
• intestinal disorders: belching, constipation, heartburn and nausea.

Infringement of this hernia leads to severe pain, the appearance of blood in the feces, flatulence and impaired defecation.

4. Hernias of the spine.

The disease is characterized by protrusion of the intervertebral discs into the spinal canal, affecting the spinal cord, adjacent nerves and surrounding tissue. As a result of prolonged pressure, the fibrous ring located in the disc is destroyed; the vertebra located on top fits more closely to the bottom one and “squeezes out” the intervertebral disc instead of the least resistance. The disease most often succumbs to people from 25 to 50 years.

The main signs accompanying the disease:

• pain in the spine;
• depending on the level of the hernia, the sensitivity on the skin of the hands or feet may be disturbed;
• non-specific symptoms: fatigue, irritability, headaches, fever;
• dizziness;
• occasional problems with digestion, urination or defecation.

This pathology threatens to narrow the spinal canal, which can lead to serious damage to the spinal cord. The defeat of this department of the peripheral nervous system threatens with paralysis or paresis.

5. Schmorl's hernia.

This type of protrusion also affects the spinal column: a hernia damages and causes deformation of the intervertebral disc with rupture of cartilage. The differences between this disease and the previous pathology are that Schmorl's hernia does not show any signs of its existence. This disease is detected only with the help of an x-ray machine. The only thing that can give out an ailment is subtle pain in the back and rapid fatigue.

What are hernias? One large group of this disease is hernia in newborns, which includes:

6. Diaphragmatic hernia.

The essence of the disease is the movement of the abdominal organs into the chest cavity through the diaphragmatic opening.

The child immediately after birth has the following symptoms:

• difficulty breathing, respiratory failure may develop;
• bloating after swallowing;
• blue skin of the face, chest, blue color also acquire visible mucous membranes;
• after feeding, the infant may experience choking without coughing.

Untimely detection of this painful condition leads to the death of the newborn.

There are pathological bulges that are extremely rare.

These include hernias:

1. The xiphoid process. This structure has a natural opening through which the organs of the gastrointestinal tract can exit.
2. Obturator. They affect older women. The disease concerns the compression of the obturator nerve. The pain may appear in the pelvis, knees, or hips.
3. Ischial. Typical for men. It is manifested by compression of the sciatic nerve, which leads to the formation of pain in the lower extremities and pelvis.

Hernia complications

A complication is said when, against the background of the presence of the underlying disease, a secondary pathology occurs.

Complications include:

1. Inflammation of a hernia.

It usually occurs acutely. The inflammatory process entails the appearance of sharp pains, vomiting. Against its background, body temperature rises, soreness in the protrusion. An extreme variant of this complication is the phlegmon of the hernial sac, in which the tissues and contents of the sac can be killed.

The phlegmonous variant also develops due to pinching. In this case, in the area of ​​pathological bulging, blood and lymph circulation is disturbed. This condition can lead to severe symptoms, namely: fever, bloating, vomiting with the smell of feces, impaired consciousness (up to stunning). The standard treatment option is surgery.

2. Infringement.

This term is understood as a sudden compression (squeezing) of the contents of the hernia sac. Infringement is characterized by a high percentage of deaths (from 3% to 8%). Any organ can succumb to such a phenomenon. Circulatory disorders are the main factor affecting the normal functioning of the pinched organ.

Main symptoms:

• constant vomiting, sometimes it can be mixed with feces;
• swelling of the peritoneum;
• retention of gases and feces;
• externally observed pallor on the face;
• cooling hands and feet;
• dry tongue.

Infringement is elastic and fecal. In the first variant of the complication, intra-abdominal pressure rises sharply, which leads to a sudden contraction of the abdominal muscles. This, in turn, contributes to the rapid exit of organs through the gate.

The second type is fecal infringement. With this option, the feces and everything associated with them are pinched in the intestinal loop, which is located in the hernial sac. The extreme outcome of such a complication is coprostasis - a condition in which feces are retained in the lumen of the colon without the possibility of exit. This complication lends itself to urgent surgical intervention.

During the operation, doctors try to achieve the following goals:

• examine the body for its condition;
• release the contents of the bag;
• remove necrotic tissue;
• to carry out plastic surgery of the hernia gate.

3. Irreducible hernia.

This complication is said if the hernial sac is fixed in a certain place without the possibility of its reverse reduction. The formation of such a complication is the result of adhesive processes, when connective tissue is formed between the contents (organs) and the walls of the hernial sac. Most often, this complication occurs in abdominal hernia surgery.

This complication is almost asymptomatic, which makes diagnosis difficult. However, the disease makes itself felt by disorders of the food chain, but often this is not coupled with irreducibility. Treatment is surgery. During the operation, surgeons open the bag in its thinnest part, peel off the contents from the walls and suture the bag neck.