SEARCH RESULTS FOR: Incisional-Hernia

Incisional-Hernia

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

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hernia-incisional-patogenesis-y-hallazgos-clinicos