Signs and treatment of a hernia of the white line of the abdomen

A hernia of the white line of the abdomen is a disease that is characterized by the protrusion of the internal structures of the peritoneum through the cracks formed along the white line of the abdomen. From 3% to 12% - such a prevalence of this disease among all hernias, while in children it is recorded in one out of a hundred cases. Most often, such a hernia occurs in middle-aged men - from 20 to 30 years. As a rule, in the hernial sac are located: intestinal loops, parts of the greater or lesser omentum.

Anatomical reference

To understand and understand the picture of a hernia, attention should be paid to the anatomical and physiological features of the abdominal wall.

It consists of the following layers:

Actually the peritoneum. This is a thin layer of connective tissue. Its task is to envelop the cavity of the peritoneum from the inside, it also covers some of the internal organs of the peritoneum.
Adipose tissue is a layer that covers the peritoneum.
Transverse fascia - strong and strong sheets, consisting of connective tissue. They strengthen the elements of the abdominal wall. (The fascia acts as a sheath for the muscles, enveloping and protecting them.)
The muscles of the press . They cover almost the entire anterior surface of the abdominal wall. They are located symmetrically, on both sides of the peritoneum. Outside, the muscles are covered with fascia.
Superficial layer of adipose tissue.
Skin covering.

A narrow zone devoid of muscles is directed along the center line of the abdominal wall. In this zone, there are fasciae that connect the left and right sides of the peritoneum. The white line of the abdomen is the same zone. It is uneven: towards the upper region, the white line expands to three centimeters and narrows downwards.

Most often, it is in a wide area that a hernial protrusion occurs.

Causes of the disease

Factors contributing to the onset of the disease are divided into two groups:

Causes that lead to a weakening of the structures of the white line of the abdomen and contribute to the divergence of the fascia.

These include:

hereditary factors: the more close relatives suffering from a hernia, the higher the likelihood of its formation in the next generation;
overweight: obese people have an excessive mass of subcutaneous fat in the abdominal wall. Because of this, its structures are weakened, stretched, which increases the risk of a hernia;
surgeries and abdominal trauma. Any scar on the abdomen that remains after surgery or injury is a weak spot favored by hernias;
pregnancy: in women during the period of gestation, the structures of the peritoneum are stretched and weakened, the muscles can diverge in different directions.

The second group is the reasons that increase intra-abdominal pressure:

inadequate physical activity on an unprepared body. Often this includes novice athletes or people whose lifestyle is associated with power loads;
constipation, chronic cough and sneezing - during these acts a person has to strain, which increases intra-abdominal pressure;
in women: difficult and prolonged childbirth, also the large size of the child.

Stages of development of pathology

A hernia is a long process that goes through several stages, of which there are three:

Preperitoneal lipoma. It appears after exposure to the stomach of several factors. At this time, a small gap is formed - a hernial ring.
Initial stage . Elements of the peritoneum partially fall into the already formed gate.
The final stage is the formation of a full-fledged hernia with all the components:

hernia sac - abdominal wall;
hernia gate - gaps in the white line of the abdomen;
the contents of the hernia - the intestines, parts of the stomach, omentum.

Symptoms of a hernia of the white line of the abdomen

In the early stages of hernia formation, there are no characteristic symptoms, except for a slight protrusion in the abdomen. The presence of a painless neoplasm is the very first sign. It is soft to the touch, of a normal color, in a horizontal position it can disappear on its own. Usually, an incipient hernia is discovered by chance - during palpation of the abdomen or on examination in front of a mirror.

Later, painful sensations appear in the area of the protrusion, which intensify after eating, exercise, or any other situation where intra-abdominal pressure rises.

After the final formation of a hernia, it has the following signs:

the neoplasm is elastic;
located along the white line, near the navel;
the average diameter of the protrusion is from 1 to 10 centimeters;
painful after exertion, painless at rest;
increases in size with increasing pressure in the abdomen.

Such a description is typical for a stable and smooth course of the disease.

Hernia of the white line of the abdomen in newborns

In children, this subtype of hernia is formed due to the weakening of the connective tissues. Most often, such a defect is a congenital tissue anomaly. After birth, babies have a small protrusion in the abdomen, which, after a while, increases.

Clinical picture:

the child becomes restless after eating, begins to cry; with prolonged crying, intra-abdominal pressure increases, which affects the increase in bulging;
the baby may vomit;
belching after eating;
stool retention;
small accumulations of blood clots are observed in the feces.

The treatment is carried out manually: the surgeon, after detection, sets the protrusion on his own, after which he fixes the place where the hernia was. In the future, the child is shown physiotherapy exercises, gymnastics. In other, severe cases, the baby undergoes surgery.

Strangulated hernia of the white line of the abdomen

Infringement is one of the complications. This term refers to a sudden violation of the function of the organ that is located in the hernial sac. Infringement of a hernia of the white line is formed with a rapid increase in pressure inside the abdominal cavity.

Usually, infringement is associated with the following symptoms:

periodic nausea, vomiting of intestinal contents;
blood is found in the stool;
lack of gas discharge;
pronounced pain syndrome in the affected area of the abdomen;
in a horizontal position, the hernia does not disappear on its own.

If the organs are infringed, it means that they are slowly destroyed and die. This condition needs to be treated urgently. The only way is an emergency operation.

Diagnostic measures

Diagnosis is based on the examination of the patient and the data of instrumental research methods. First of all, the doctor studies the local signs of hernial pathology, after which he makes the first conclusions about the location and size of the protrusion.

Instrumental research methods have the greatest diagnostic power:

Radiography using contrast materials. During the study, contrast enhancers are introduced into the cavity of the stomach, after which the contours of the organ are visible in the picture. The purpose of such a study is to study whether part of the stomach fell into the hernial sac.
Gastroduodenoscopy . After the introduction of a drug that reduces local sensitivity, a probe with a camera is inserted into the patient's oral cavity. Such a study will provide information about the state of the stomach and its mucosa. Also, gastroduodenoscopy determines the retraction of the stomach into the pathological process.
Ultrasound diagnostics. Using this method of research, it is possible to assess the state of the abdominal organs and study the involvement in the hernial process.
Computed and magnetic resonance imaging . This diagnostic method gives a layered image of the organs of interest, visualizes their location relative to each other.

Also, such diagnostic methods make it possible to distinguish a hernia from other diseases of the stomach and intestines: ulcers, gastritis, pancreatitis, diseases of an oncological nature.

Treatment of a hernia of the white line of the abdomen

Removal of a hernia of the white line of the abdomen is the only way to completely cure the disease. There is no conservative therapy in this case. When the hernia has a stable course, surgery is carried out in a planned manner. Urgent surgery - if there are signs of pinched organs.

Types of interventions:

Stretch plastic . A hernia is sectioned, after which the white line of the peritoneum is pulled together with sutures, which strengthens its wall. This plastic has its drawbacks: a large incision, a high probability of re-protrusion.
Stretch-free plastic. To strengthen the anterior wall of the peritoneum, doctors use synthetic fabrics - mesh prostheses. In terms of effectiveness, tension-free plastic has a lower likelihood of recurrence than tension.
Laparoscopy of a hernia of the white line of the abdomen . During laparoscopic intervention, the surgeon makes three punctures through which special instruments are inserted to remove the hernia. After the operation, the doctor applies mesh tissue. Laparoscopic surgery has a number of advantages: low probability of recurrence, absence of large scars, short recovery period.
Peritoneal surgery . During this operation, three punctures are also made through which a balloon is inserted, which is inflated. So, a small space is formed, making it possible to access the protrusion and remove it.

In case of complications, an emergency operation is performed. During an emergency intervention, the surgeon removes necrotic tissue and, if necessary, part of the affected intestine.

Rehabilitation

The healing process does not end with just one operation. The last stage of therapy is the recovery of the patient. Diet is one of the central ways in which a patient recovers. After the operation, the patient is given a lot of water, a little later - liquid soups and broths. Diet on the following days: solid food enriched with vitamin complexes. It is recommended to take the food that does not cause increased gas formation and constipation.

The dietary diet also involves the fragmentation of nutrition: the patient should eat food in small portions.

A bandage for a hernia of the white line of the abdomen has its advantages: reducing the likelihood of postoperative hernia, maintaining sutures, maintaining weak abdominal muscles. It should be remembered: a hernia bandage without surgery does not have therapeutic purposes, in special cases, the illiterate use of a medical device is even harmful.

Physiotherapy

Exercise therapy is not only curative, but also preventive. All exercises are prescribed by a rehabilitation specialist. As a rule, physical therapy exercises are aimed at restoring the tone of all the muscles of the body, but the most attention is paid to the abdominal muscles.

After the operation, many people wonder if it is possible to pump the press. Yes, you can. Pumping the press after removing the hernia is an important point in strengthening the muscles of the anterior wall of the abdomen. However, exercises for the press must be carried out correctly, namely: the patient needs to bend his knees. In this case, the load is reduced. In addition to the press, you can perform regular push-ups - this is how most of the muscles of the body are involved, especially the muscles of the press and the shoulder area.

It is not recommended to pump the press with a hernia. The load on the press dramatically increases the pressure inside the peritoneum, which is the underlying cause in the development of a hernia.

In addition to physiotherapy exercises, the patient is prescribed massage sessions, self-massage, physiotherapy procedures, and therapeutic exercises in the pool.

Forecast

With timely diagnosis and successful treatment, the prognosis is favorable. The risk of recurrence of a hernia is determined by the type of operation. Also, the further well-being and condition of the patient largely depends on how much he complies with the prescribed treatment and how conscientiously he follows the instructions regarding rehabilitation.

For the purpose of prevention, it is recommended to lead an active lifestyle, follow a nutritious diet, dose the load at work and in the gym. In the future, you should control body weight, avoid constipation.