Incisional Hernia: Pathogenesis and clinical findings
Penetration of abdominal wall from prior surgery, in combination with:
Dead and injured cells from incision
Small blood vessels rupture
Plasma seeps out of vessels and collects together
Nutritional deficiency
↓ absorption of fat soluble vitamins
Chronic illness
Cirrhosis
Diabetes
Malignancy
Immuno- suppressive therapy
Ascites
Heavy lifting
Multiple complex mechanisms (including hyper- glycemia & immune dysfunction) that ↑ risk of infection
Post-op wound Infection
Obesity
Chronic constipation
Chronic cough Pregnancy
↓ clotting factors
Vigorous cough
Severe Hypertension
Seroma
Post-op hematoma Bulging fluid separates High risk
Sutures unsuitable Poor surgical for tension technique
↑ intraabdominal pressure
Fascial Incision separates
Notes:
fascial incision
surgeries* High Risk Surgeries*
Connective tissue disorder
Suboptimal fascial closure
• • •
Emergency surgeries Midline incisions
Acute abdominal surgeries
↓ wound healing/collagen synthesis
Fascial defect at previous incision site
Incisional Hernia:
Protrusion of tissues through prior fascial incision
• Deep wound infection = most common cause of incisional hernias
• Diagnosis on physical exam +/- CT scan if patient is obese
• Treatment = surgery
Bulge at prior incision site
Palpable fascial defect
Bowel and other abdominal contents protrude through defect
Mechanical bowel obstruction (see relevant slide)
Constipation /obstipation
Contents unable to be pushed back through defect (incarceration)
Vascular supply is compromised to herniated contents
Contents become ischemic (strangulated)
Prolonged pressure on skin & bowel over time
Ulceration & ischemia
↓ blood flow to skin layers
Discoloration of skin
Bulge ↑ with coughing/straining
Ulcers extend through bowel wall
Authors: Karly Nikkel Meaghan Ryan Reviewers Michael Blomfield Tony Gu Yan Yu* Edwin Cheng* *MD at time of publication
Colo-enteric fistula
Bowel Perforation
Abdominal Pain
Abdominal Distension
Nausea/ Vomiting
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published November 13, 2019 on www.thecalgaryguide.com