A. ANATOMY
Generally hernia is a protussion the content of the cavity through defect or the weakness of the cavity wall in question. On abdominal hernia, abdomenal content protunding through a defect or weakness of the musculo-aponeurotik layer of the abdominal wall. Based on the occurance, congenital hernia or hernia are divided into congenital and acquired hernia. Hernia are named according to its location, eg diaphragm, inguinal, umbilical and femoral
By their very nature, can be called a hernia hernia when the hernia contents can reponibel jeluar entry. Out when standing or straining, and came back when sleeping or pushed into the stomach. When the contents of the bag can not be repositioned back into the abdominal cavity, called a hernia hernia ireponibel. This is usually caused by adhesions in the peritoneal pouch bag hernia. This is called a hernia hernia accreta. There is no pain or signs of intestinal obstruction.
Inkarserata called hernia or hernia strangulate when it squashed by the hernia ring so that the bag can not be caught and returned to the abdominal cavity. As a result, frequent passage or vascular disorders. Inkarserata hernia clinically more intended for hernia ireponibel with passage disturbance, whereas vascular disorder known as Strangulated hernia.
External hernia is an abnormal protrusion of intra-abdominal organs through the abdominal wall defect in the fascia. Hernia which often happens is inguinal, femoral, umbilical, and paraumbilikal.
Inguinal hernia is the protrusion viscus (organ) from the peritoneal cavity into the inguinal canal.
All hernia occurs through slit weak or potential weakness in the abdominal wall that is triggered by an increase in intra-abdominal pressure that repeated or continuous.
Seventy-five percent of all abdominal hernias occur in the inguinal (groin). Others may occur in the umbilicus (navel) or other abdominal area. Inguinal hernias are divided into two, namely the medial inguinal hernia and inguinal hernia lateralis. If the bag reaches the lateral inguinal hernia scrotum (testicles), called a hernia hernia skrotalis. Lateral inguinal hernia occurs more frequently than the medial inguinal hernia with a ratio of 2:1, and among men it was 7-fold more frequently affected than women. The more we age, the greater the possibility of a hernia. This is influenced by the strength of abdominal muscles that have been weakening.
Hernias that arise in the crease and the inguinal hernia abdominokrural is arising below the fold is a femoral hernia. Inguinal canal is an oblique line passing through the lower anterior abdominal wall. This channel allows the structures to pass to and from the testis to the abdomen in the male. In women, the channel is crossed by ligaments rotundum uteri, magi from the uterus to the labium. In addition, the channel is bypassed Ilioinguinalis nerve in both sexes.
The length of the inguinal canal in adults is approximately 4 cm, formed from the profundus inguinal annulus / annulus inguinali internal to the superficial / external. Inguinal canal is located parallel to and just above the inguinal ligament. In neonates, the internal inguinal annulus is located almost directly posterior to the external inguinal annulus so that the inguinal canal is very short at this age. Then, the internal annulus moves toward the lateral growth effect.
Internal inguinal annulus is an oval hole in the fascia transversalis, located about 3 cm above the inguinal ligament, midway between the Messiah and symphisis pubis.Medial to the internal annulus there is av. inferior epigastric. Edge of the annulus is the origin of the internal spermatica fascia in the male or the inner wrapper rotundum uteri rotundum ligaments in women.
Externa is an annular shaped defect in the inguinal triangle (Hesselbach's triangle) on the aponeurosis. Obliquus externus abdominis and essentially formed by the crista pubica. Edge of the annulus is the origin of the fascia spermatica externa. Lateral boundary is the inferior epigastric artery, the medial border of the m. rectus abdominis lateral part, and the inferior border of the inguinal ligament.
Inguinal canal is formed on the wall of the anterior, posterior, superior, and inferior.Anterior wall formed by the aponeurosis m. Obliquus externus abdominis is amplified at 1/3 by the lateral fibers of m. Obliquus internus abdominis. The entire length of the posterior wall of the inguinal canal is formed by the fascia transversalis tendon reinforced cojoint in 1/3 medial. Cojoint tendon is the tendon insertion combined m. Obliquus internus abdominis and m. transversus abdominis is attached to the crista pubica and linea pectinea. Basic or inferior wall of the inguinal canal is formed by the inguinal ligament, while the roof is formed by m. Obliquus abdominis internus abdominis and m.transversus.
Figure 1. Hesselbach's triangle
Inguinal hernias can be directly (direct) and can also indirectly (indirect). Indirect inguinal hernia bag of walking through the deep inguinal ring, lateral to the inferior epigastric vessels, and finally towards the scrotum. Pockets of directors inguinal hernia protruding directly through the base of the inguinal canal, medial to the inferior epigastric vessels, and rarely go down towards the scrotum. Femoral hernia is almost always seen as a mass irredusibel, although pockets more kososng, because fat dam of femoral canal lymph nodes around the bag. Single, enlarged lymph nodes can mimic femoral hernia very quickly.
Indirect hernia bag is actually a process vaginalis persistently dilated. Hernia was walking through the deep inguinal ring and follow the sheath into the scrotum. At the deep ring, bag filling anterolateral side of the cord. Properitoneal fat pockets often associated with indirect and is known as a lipoma of the cord, although the fat is not a tumor.
Retroperitoneal organs such as the sigmoid colon, cecum and ureter can be slipped into a pocket indirect. In the bag, these organs become part of the pouch wall and are susceptible to injury during repair.
Inguinal hernia pouch directors come from the bottom of the inguinal canal, the Hesselbach triangle; protruding hernia bag directly and does not contain obliqus externus muscle aponeurosis. Only in rare circumstances, the hernia is so intense that it pushes out through the annulus superficial and descend into the scrotum. The bladder is often a component of the bag is empty hernia director.
Bags from the femoral hernia femoral canal through a defect on the medial side of the femoral sheath (femoral sheath). Femoral canal contains one or two lymph nodes, which are scattered called Cloquet. Lymph-nodes are pushed out of the femoral canal by a protrusion of peritoneal and often form a palpable mass.
