Hernia of the white line of the abdomen, also called epigastric hernia, is the bulging of the abdominal organs through a gap between the muscles along the midline of the abdomen.
It is the middle line, running from the epigastric to the suprapubic region, called the white abdominal line. Usually a hernia is located in the epigastric region( above the navel by 8-10 cm).
The hernia of the white abdominal line in medicine refers to the hernia of the anterior abdominal wall. Most often, this disease occurs in men from 20 to 35 years. According to observations and statistics, protrusion of this type ranges from 2% to 10% of the total hernia frequency.
The concept of
The hernia of the white line of the abdomen is the process of protrusion of the hernial sac and preperitoneal tissue through the slit-like space passing along the midline of the abdomen.
In this type of hernia, the patient suffers from a painful tumor-like protrusion located on the anterior abdominal wall.
Possible pain syndrome, as well as disorders of dyspeptic type, among which:
- nausea;
- vomiting;
- bloat;
- flatulence;
- constipation.
According to ICD-10, a white abdominal hernia is classified in the section "K43 - Hernia of the anterior abdominal wall".
For diagnostics, it is necessary to consult a surgeon and perform some instrumental studies, including a radiograph of the stomach, herniography, gastroscopy, ultrasound and CT of the gastrointestinal tract.
Classification
All types of hernia of the white abdominal line are divided into 2 main types, depending on the location of their localization. So, distinguish okolopupochnye and directly hernia of the white line of the abdomen.
The localization of the periapical hernia is next to the umbilical ring, they can be located to the left, to the right, above or below the navel. Hernias of the white line of the abdomen are always localized above the navel.
In a separate group, there is a ventral type of a hernia of the white abdominal line. There is such a hernia after the operation at the site of the scar. Characteristic features of this hernia is its protrusion during straining, in the horizontal position of the body of the hernia is not visible.
Ventral hernia is also subdivided into several subspecies:
- small - practically does not affect the structure of the abdomen, it is visible only when straining;
- average - occupies one of the parts of the abdominal wall;
- extensive - occupy the entire area of the anterior wall of the abdominal cavity;
- giant - deals with several areas of the abdominal wall.
Causes of
The main cause of this hernia is the weakness of connective tissue in the area of protrusion. The tissues are thinner, the muscles along the central line of the abdomen diverge, and an opening appears through which the protrusion extends.
In this case, patients are diagnosed with diastasis of the rectus abdominis muscles. In this case, the white line can expand considerably and reach up to 10 cm.
Tissue weakening occurs for a variety of reasons. Among them:
- obesity;
- frequent constipation;
- heavy physical exertion;
- pregnancy;
- postoperative scars;
- prolonged or persistent cough;
- abdominal edema - ascites;
- congenital predisposition;
- age-related muscle weakness.
Symptoms of pathology in women and men
Symptoms of a hernia of the white abdominal line in men and women are the same, pathology does not depend on sexual characteristics. In some cases, the hernia can manifest itself only by protrusion, which is characteristic of the initial stage of pathology.
Also, the disease in men and women is accompanied by the following symptoms:
- nausea, followed by vomiting;
- pains of a different nature - with bends, bends and other movements;
- stretching of the muscles of the midline of the abdomen;
- pain after meals;
- eructation, heartburn, hiccough.
With the progression of the disease, signs of pathology also increase:
- pains intensify and become unbearable for the patient;
- vomiting pains the patient constantly;
- in fecal masses can be detected by blood;
- to correct the hernia becomes impossible.
In the event of a hernia being squeezed, patient care must be emergency. For any of the manifestations, it is worth immediately contacting the clinic.
Hernia of the white abdominal line in children
This pathology is more common in adults, but the hernia of the white line of the abdomen may appear in children. In small patients, this problem occurs in only 1% of cases.
In the first stage of the disease, a child forms a lipoma of the preperitoneal type. Often the disease remains at this stage and does not develop anymore. But in some cases, the lipoma still turns into a full hernial sac.
At the final stage, the formation has a hernia gates and a hernial sac with loops of the small intestine, as well as the transverse colon and in some cases - the walls of the stomach.
It is possible to determine the presence of a hernia of the white abdominal line in the child with the naked eye at the last stage. Most often, the pathology is located locally, but there are also cases in which the child has several hernias, located one on the other.
Photo of a child with a hernia of the white abdominal line
Children with this pathology usually suffer from pains that intensify after meals, physical labor or during an act of defecation. An address to a doctor should be timely, as a hernia can be hurt and give the child constant pain, nausea and discomfort.
During pregnancy and after childbirth
Pregnancy is one of the predisposing factors to the appearance of a hernia of the white line of the abdomen. Increase in the volume of the uterus and intra-abdominal pressure is the cause of this pathology.
Also in prevention measures pregnant women are recommended to observe the following rules:
- to avoid excessive physical exertion;
- to avoid lifting any weights;
- wearing uncomfortable, tight clothes;
- to avoid factors that may lead to increased intra-abdominal pressure.
In case of detection of a hernia, the pregnant woman should be observed at the surgeon during the entire period of pregnancy. After delivery, an operation is prescribed.
Stages of
The development of a hernia of the white abdominal line occurs in 3 main stages: the stage of pre-bumper lipoma, the initial stage and the stage of final formation.
- The first stage is characterized by the release of the preperitoneal tissue through a sagging defect in the tendon fibers. At the initial stage, the formation of a hernial sac begins, where a part of the omentum or part of the small intestine enters.
- At the stage of the already formed hernia, the patient has all the components of the pathology: a hernial sac with a hernial contents, a hernia gates.
- At the final stage, a hernia of this type can be determined both visually and by palpation. The correction is not carried out and is dangerous.
The hernia of the white line of the abdomen almost never reaches large and especially large sizes. Sometimes the formation process stops at all on the formed lipoma and does not progress any more.
How dangerous is protrusion?
The danger of a hernia, like any other disease, is its complication. This can lead to many unpleasant symptoms. The pain can reach such limits, when the patient is able to experience even a pain shock.
Among the complications may be peritonitis, necrosis, intestinal obstruction. However, the most dangerous is still the infringement of the hernia.
Infringement of
Infringement of hernia occurs in the late stages of the disease. Usually this happens when the protrusion is already noticeable to the naked eye. Herniated at the site of hernia gates.
According to statistics, each 10 hernia of the white line of the abdomen is impaired.
Even if the patient does not experience any particularly unpleasant symptoms, it must be remembered that in addition to the external protrusion of the formation of a hernia, it can still get hurt. This will lead to a loss of blood supply to the organ squeezed in the hernia gates and, as a consequence, peritonitis.
You need to go to the clinic when the patient experiences such alarming symptoms:
- nausea, vomiting, vomiting;
- aggravated and not passing pain in the abdomen;
- prolonged constipation;
- presence of blood in the stool;
- at acceptance of a horizontal position and an easy pressing on a protrusion of a hernia is not set.
The patient can also have signs such as skin pallor and hardening of the abdominal muscles. In case of such a symptomatology, the patient should immediately go to the hospital for a surgical intervention of the doctor and eliminate a life-threatening defect.
Diagnostics
The main diagnostic method involves a primary examination of the patient by a surgeon. The doctor palpates the protrusion site and collects an anamnesis.
Some instrumental diagnostic methods can also be applied. Many people are wondering why such an accurate diagnosis is needed, if the hernia is visible even to the naked eye and the diagnosis is clear?
The need for instrumental research is explained by the fact that these methods allow us to determine at what stage the disease is located, what are its characteristics and what organs fell into the hernial sac.
In addition to the examination, you can appoint:
- gastroscopy;
- X-ray dna and stomach;
- Ultrasound of herniated formation;
- CT of abdominal organs;
- gerniography with contrast application.
Treatment of a hernia of the white line of the abdomen
Discharge from the hernia of the white abdominal line is possible only by performing a surgical procedure. No diet, folk and preventive methods can not remove the hernia. Prevention and diet therapy are necessary only after the removal of the disease by a doctor.
Surgery to remove
The main type of removal of the hernia of the white line of the abdomen is hernioplasty. This operation has two varieties:
- Hernioplasty using local tissues. This method involves suturing the hernia with the use of the patient's connective tissues. This method is far from the most reliable. After carrying out hernioplasty of this type in 20-40% of cases the hernia recurs.
- Gernioplasty with the use of synthetic prostheses. Operative intervention is carried out using a special net that covers the defect. This method is more reliable, it almost never leads to a relapse of the disease.
To eliminate hernia with this method, only a few punctures of about 1 cm in size are done. Relapse with this type of operation is very rare, and after it, patients do not have gross scars.
Video shows laparoscopic surgery for a herniated white abdominal line:
Complications after removal of
Among the complications that appear in patients after surgery, it is particularly worth noting the following:
- relapse of a hernia of the white line of the abdomen;
- fever;
- suppuration of the postoperative cicatrix;
- feels numb around the seam;
- not stop bleeding from injury;
- swelling around the rumen;
- redness of a wound.
If you find these problems, you should immediately see a doctor.
Recovery
The rehabilitation period after the operation of a hernia of the white abdominal line imposes certain circumstances. Patient is prescribed some painkillers, and also recommends:
- frequent and long walks in the fresh air;
- small physical exertion;
- does not specifically prohibit the use of any alcoholic beverages, it is forbidden to smoke.
The wound is treated daily with antiseptics, dressing is performed. A prerequisite is to follow a diet. This allows you not to overload the gastrointestinal tract.
The diet also allows you to restore normal defecation and avoid constipation. Also, an excellent assistant in the recovery is a special underwear, which reduces the risk of relapse.
An important condition for patients who worked before the onset of a hernia in a heavy industry is to move to an easier job. The rehabilitation process usually takes several weeks. After complete healing, the patient can return to work.
The cost of
The cost of an operation to remove a hernia is difficult to determine. Only the surgeon who has previously conducted all the diagnostic tests can voice the expenses that will be required for the operation.
The price includes:
- anesthesia;
- medicines used in the recovery period;
- payment of a medical hospital, in case of an operation in a private clinic.
Cost of operation depends on several factors:
- type of operation( classical removal, removal through punctures, laser surgery and others);
- degree of neglect of the disease;
- choice of clinic, each hospital has its own rates.
If the operation is carried out in a private clinic, the cost is also affected by the qualification of the physician who conducts a primary examination and prescribes the operation.
Reviews
Patients' opinions about the operations are very different. But most agree that it is impossible to postpone the operation in any case. Folk methods, diets and self-correcting hernia of the white line of the abdomen do not bring any result.
Patients report that hernioplasty gives complications, and the recovery period is more severe and painful. In order to restore the most pain-free, you have to take painkillers.
Laparoscopy is also a more attractive procedure in terms of aesthetics. The operation does not leave large scars and practically does not spoil the attractiveness of the skin.
The only disadvantage of laparoscopy, which patients' reviews say is a higher cost of surgery compared to hernioplasty.
Treatment without surgery
Therapy of a hernia of the white abdominal line without surgery is not possible. To help a patient without surgery is possible only if the lipoma has very small dimensions, and it is not impaired.
Medications do not give the proper therapeutic effect. The drugs help only in the fight against the pain syndrome.
In case the patient came to the doctor with a complaint about a small lipoma, there is little chance that the doctor will manage to correct it.
In this case, the patient is assigned to wear an abdominal bandage or special underwear and a therapeutic massage, which can be performed correctly only by a highly qualified doctor.
Prognosis and prevention of
Prognosis is favorable in case of timely removal of the hernia. Whether the hernia will recur depends on what surgical method was used for hernia repair.
To prevent the emergence of a hernia of the white line of the abdomen, it is recommended to engage the abdominal muscles and constantly train them. Also it is worth paying attention to your diet, weight and bad habits.
As prevention it is necessary to exclude the appearance of prolonged constipation, as well as the frequent upsurge of heavy weights.