the protrusion of internal organs or deep tissues from the cavities normally occupied by them into intermuscular tissue or under the skin, without violating the integrity of the integuments. Hernias in man are most frequently abdominal; more rarely, they involve the brain or muscles. Hernias may be classified, according to their origin, as congenital or acquired (for example, postoperative or posttraumatic).
Abdominal hernias are classified, according to the place of exit, as inguinal, femoral, umbilical, hernias of the linea alba and the intersectiones tendineae of the rectus abdominus muscle, sciatic, perineal, and internal (diaphragmatic and omental). Peculiarities of anatomical structure (for example, enlarged inguinal or umbilical rings) and anomalies in the development of the abdominal wall lead to the formation of hernia. When there is a combination of these factors in the region of a weak section or scar of the abdominal wall (the hernial ring), a portion of the parietal peritoneum begins to protrude, forming a hernial sac; afterward the various organs of the abdominal cavity—most often the small intestine and the omentum—may descend into the hernial sac. When organs located in the retroperitoneal space or partly covered by the peritoneum prolapse, the hernial sac is absent. External hernias are diagnosed by the elastic consistency of the protrusion, which is covered by unaltered skin. When the patient is lying down, this hernial protrusion often disappears either independently or upon light pressure, descending into the abdominal cavity. The hernial protrusion gradually enlarges and, sometimes attaining considerable dimensions, may cause discomfort during movement. Organs in the hernial sac and those located immediately under the skin are easily injured. Prolonged presence of organs in the hernial sac leads to the formation of adhesions between the organs themselves or with the hernial sac, which hinders correction of the hernia, and an irreducible hernia is formed—that is, the hernial protrusion does not return to the abdominal cavity when the patient changes position.
A serious complication of hernia is strangulation. During coughing, exertion, or other physical strain intestinal loops may slip into the hernial sac and strangulate in the hernial ring. In such cases attempts to reduce the hernia may lead to serious consequences; these hernias require surgical operation.
The treatment of hernia is surgical only. Trusses support the hernia temporarily, but they do not prevent strangulation. Prolonged wearing of a truss, producing constant pressure on the tissues, leads to their atrophy, subsequent weakening of the abdominal wall, and the development of adhesions. To avoid complications, all hernias should be treated surgically. Physical exercise and the treatment where necessary of chronic cough, constipation, emaciation, or obesity help in the prevention of hernia. It is recommended that pregnant women wear a binder to prevent stretching of the abdominal wall and that the abdomen be massaged after delivery.
V. R. TARASOV