Pediatric surgery. Internal abdominal hernias (most important)

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Pediatric surgery. Internal abdominal hernias (most important)

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43. Internal abdominal hernias

Malformations of the intestine and mesentery in some children cause incomplete narrowing of the lumen of the intestinal tube with a violation of its function, which creates the prerequisites for the periodic occurrence of attacks of acute obstruction. Similar conditions can also be associated with the presence of congenital cystic formations of the abdominal cavity and other causes. The first signs of the disease usually occur months or years after birth due to the weakening of the body's compensatory capabilities and changes in the nature of nutrition.

Recurrent bowel obstruction most often occurs in connection with the infringement of the intraperitoneal hernia and compression of the intestinal lumen by cystic formation.

Movement of intestinal loops into defects in the mesentery, omentum, or peritoneal pockets (without the exit of the viscera from the abdominal cavity) is commonly called internal hernias, which in children, as a rule, are congenital.

If the displaced intestinal loops are covered with sheets of peritoneum, which form a kind of hernial sac, then such internal hernias are called true. In cases of displacement of organs through the opening in the mesentery or other congenital defects, hernias occur that are not covered by the hernial sac, and they are called false. In children, paraduodenal hernias are predominantly found.

clinical picture. Internal abdominal hernias (both true and false) can be asymptomatic for an indefinite period of time and are first detected by intestinal obstruction in adults or older children. The possibility of acute intestinal obstruction occurring during the neonatal period cannot be ruled out. However, for internal abdominal hernias in children, the most typical symptomatology is recurrent obstruction.

X-ray examination. X-ray examination is of little help in recognizing internal abdominal hernias. In rare cases, it is possible to identify gas-filled loops of the small intestine on survey photographs, concentrated in the form of a regular round conglomerate (limited by the hernial sac).

To clarify the diagnosis, you can use a contrast study of the colon, which has an unusual position, bending around the hernial sac filled with strangulated loops of the small intestine.

Differential diagnosis. Differential diagnosis, as with other types of congenital recurrent obstruction, is carried out with diseases accompanied by abdominal pain, vomiting and intestinal discomfort.

Treatment. The operation is usually performed for urgent indications. Before the operation, the stomach is washed and intravenous drip infusion of fluid is started.

The duration of preoperative preparation is minimal - it is limited by the time necessary for drug preparation for anesthesia.

Authors: Drozdov A.A., Drozdova M.V.

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