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Surgery.(General 1).Hernia > 13. Complications of Hernia > Flashcards

13. Complications of Hernia Flashcards

1
Q

Complications of Hernia

A
  • Common

* Rare

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2
Q

Common Complications of Hernia

A
  1. Irreducibility

2- Obstruction

  1. Strangulation
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3
Q

Rare Complications of Hernia

A
  1. Inflammation
  2. Rupture
  3. Hydrocele of the hernial Sac
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4
Q

Irreducibility in Common Complications of Hernia

A
  • DEFINITION
  • CAUSES
  • CLINICAL PICTURE
  • COMPLICATIONS
  • Treatment
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5
Q

DEFINITION of Irreducibility in Common Complications of Hernia

A

failure to return the contents into the abdomen

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6
Q

CAUSES of Irreducibility in Common Complications of Hernia

A

Adhesions between the contents and the sac

or

Adhesions between the contents themselves.

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7
Q

Pathogenesis of Adhesions in CAUSES of Irreducibility in Common Complications of Hernia

A

Chronic irritation )> fibrous tissue )> Adhesions

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8
Q

Pathogenesis of Adhesions between the contents themselves in CAUSES of Irreducibility in Common Complications of Hernia

A

Forms one mass larger than the defect

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9
Q

CLINICAL PICTURE of Irreducibility in Common Complications of Hernia

A
  • No symptoms of intestinal obstruction

* The best person to reduce the hernia is the patient himself, failure to do so, it is considered irreducible

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10
Q

COMPLICATIONS of Irreducibility in Common Complications of Hernia

A

Irreducibility predisposes to obstruction and strangulation

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11
Q

Treatment of Irreducibility in Common Complications of Hernia

A

Urgent surgery.

Reduction by Taxis is contraindicated

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12
Q

Reduction by Taxis is contraindicated in Treatment of Irreducibility in Common Complications of Hernia

A
  • Meaning of Reduction by Taxis

* The reason why it’s contraindicated

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13
Q

Meaning of Reduction by Taxis in Reduction by Taxis is contraindicated in Treatment of Irreducibility in Common Complications of Hernia

A

Manual Reduction of hernia

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14
Q

The reason why it’s contraindicated in Reduction by Taxis is contraindicated in Treatment of Irreducibility in Common Complications of Hernia

A

As it may lead to

  1. Reduction of strangulated loop to the abdomen.
  2. Reduction en bisac
  3. Rupture of the hernia.
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15
Q

Reduction en bisac in The reason why it’s contraindicated in Reduction by Taxis is contraindicated in Treatment of Irreducibility in Common Complications of Hernia

A

Reduction of the sac between the layers of the abdominal wall

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16
Q

Obstruction in Common Complications of Hernia

A
  • Incidence
  • DEFINITION
  • CLINICAL PICTURE
  • COMPLICATIONS
  • Investigations
  • Treatment
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17
Q

Incidence of Obstruction in Common Complications of Hernia

A

In cases of Enterocele only

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18
Q

DEFINITION of Obstruction in Common Complications of Hernia

A
  • Occlusion of the intestinal lumen from without or from within
  • without affecting its blood supply.
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19
Q

Meaning of from without in DEFINITION of Obstruction in Common Complications of Hernia

A

All causes of intestinal obstruction regardless the hernia such as F.B

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20
Q

Meaning of from within in DEFINITION of Obstruction in Common Complications of Hernia

A

Obstructing adhesions

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21
Q

Meaning of lncarcerated hernia

A

Obstructed hernia by faeces

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22
Q

CLINICAL PICTURE of of Obstruction in Common Complications of Hernia

A

The 4 Cardinal symptoms of Intestinal Obstruction

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23
Q

The 4 Cardinal symptoms of Intestinal Obstruction in CLINICAL PICTURE of Obstruction in Common Complications of Hernia

A
  1. Vomiting.
  2. Abdominal distension.
  3. Abdominal colics.
  4. Absolute constipation.
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24
Q

COMPLICATIONS of Obstruction in Common Complications of Hernia

A

predisposes to strangulation

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25
Q

Investigations of Obstruction in Common Complications of Hernia

A
  1. Serum electrolytes (Na & K)
  2. KFTs & LFTs
  3. CBC
  4. ABGs
  5. Plain x-Ray abdomen erect & supine
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26
Q

CBC in Investigations of Obstruction in Common Complications of Hernia

A

Normal

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27
Q

Pathogenesis of Leucocytosis in CBC in Investigations of Obstruction in Common Complications of Hernia

A

if intestinal bacteria translocate into the bloodstream, causing the systemic inflammatory response syndrome or sepsis.

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28
Q

ABGs in Investigations of Obstruction in Common Complications of Hernia

A

Hypokalemic, hypochloremic metabolic alkalosis

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29
Q

Pathogenesis of Hypokalemic, hypochloremic metabolic alkalosis in Investigations of Obstruction in Common Complications of Hernia

A

due to severe emesis and loss of HCl

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30
Q

Plain x-Ray abdomen erect & supine in Investigations of Obstruction in Common Complications of Hernia

A

Multiple fluid levels & distended loops.

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31
Q

Treatment of Obstruction in Common Complications of Hernia

A

Urgent surgery.

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32
Q

Most serious complication of Hernia

A

Strangulation

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33
Q

Strangulation in Common Complications of Hernia

A
  • INCIDENCE
  • CAUSES
  • PATHOLOGY
  • CLINICAL PICTURE
  • Investigations
  • Treatment
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34
Q

INCIDENCE of Strangulation in Common Complications of Hernia

A
  • The most common hernia liable to strangulate
  • The most common hernia seen strangulated
  • It is the most common cause of Intestinal Obstruction in developing countries.
  • It’s the most serious complication of Hernia
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35
Q

The most common hernia liable to strangulate in INCIDENCE of Strangulation in Common Complications of Hernia

A

femoral hernia then paraumbilical hernia

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36
Q

The most common hernia seen strangulated in INCIDENCE of Strangulation in Common Complications of Hernia

A

oblique inguinal hernia as it is the commonest form

of hernia.

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37
Q

The most common cause of Intestinal Obstruction in developing countries

A

Strangulation of Hernia

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38
Q

CAUSES of Strangulation in Common Complications of Hernia

A
  1. Presence of a constricting agent
  2. Narrowing of the neck of the sac by adhesions.
  3. It may follow other complications as irreducibility or obstruction.
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39
Q

Presence of a constricting agent in CAUSES of Strangulation in Common Complications of Hernia

A
  • Examples

* Pathogenesis

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40
Q

Examples in Presence of a constricting agent in CAUSES of Strangulation in Common Complications of Hernia

A
  • Deep or superficial inguinal ring in Oblique Inguinal Hernia
  • Sharp edge of lacunar ligament in femoral hernia.
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41
Q

Pathogenesis of Presence of a constricting agent in CAUSES of Strangulation in Common Complications of Hernia

A
  • Constriction of the contents leading to interruption of their blood supply.
  • If the Constriction is not relieved, gangrene occurs in few hours.
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42
Q

Pathology of Strangulation in Common Complications of Hernia

Very important

A
  • The sequelae that The strangulated loop will suffer

* Note

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43
Q

The sequelae that The strangulated loop will suffer in Pathology of Strangulation in Common Complications of Hernia

A

1- Pressure on the veins & impeded venous congestion

2- Pressure on the arteries & impeded arterial supply

  1. Gangrene occurs at the site of constriction

4- Perforation and peritonitis are the terminal events

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44
Q

Pathogenesis of Pressure on the veins & impeded venous congestion in The sequelae that The strangulated loop will suffer in Pathology of Strangulation in Common Complications of Hernia

A
  • The strangulated loop becomes congested and distended with gas & fluid.
  • increased congestion causes haemorrhage in the wall & lumen of the affected loop
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45
Q

Pathogenesis of Pressure on the arteries & impeded arterial supply in The sequelae that The strangulated loop will suffer in Pathology of Strangulation in Common Complications of Hernia

A
  • Ischemia & infarctions of the mucosa )> Ulceration
  • Mucosal barrier failure
  • Bacterial translocation occurs & predisposes to septic shock.
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46
Q

Mucosal barrier failure in Pathogenesis of Pressure on the arteries & impeded arterial supply in The sequelae that The strangulated loop will suffer in Pathology of Strangulation in Common Complications of Hernia

A
  • The devitalized loop exudates its contents (fluid, blood & bacteria) into the hernial sac which now contains Sero sanguinous highly toxic fluid.
  • At this point the strangulated loop is still viable
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47
Q

Note on Pathology of Strangulation in Common Complications of Hernia

A

Strangulated hernia is categorized as Mixed strangulation ( obstruction of both blood supply and intestinal lumen)

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48
Q

CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  • Symptoms

* Examination

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49
Q

Symptoms in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

1- Acute pain in the hernia.

2- Sudden enlargement of the hernia.

3- Irreducibility.

4- Symptoms of intestinal obstruction

5- Finally perforation occurs with generalized abdominal pain of peritonitis.

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50
Q

Pathogenesis of Acute pain in the hernia in Symptoms in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Due to Inflammatory reaction

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51
Q

Symptoms of intestinal obstruction in Symptoms in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  1. Vomiting.
  2. Abdominal distension.
  3. Abdominal colics.
  4. Absolute constipation.
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52
Q

Note on Absolute constipation in Symptoms of intestinal obstruction in Symptoms in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Absolute constipation is absent in cases of

1- Strangulated omentum.

2- Littre’s hernia

3- Richter’s hernia

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53
Q

Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  • General
  • Abdominal
  • Local
  • Clinical differentiation between obstruction and strangulation
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54
Q

General Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  1. Fever.

2. Shock in neglected cases

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55
Q

Shock in neglected cases in General Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  • Hypovolemic Shock

* Septic shock

56
Q

Pathogenesis of Hypovolemic Shock in shock in neglected cases in General Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Vomiting or intra luminal hge

57
Q

Pathogenesis of Septic shock in shock in neglected cases in General Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

due to Bacterial translocation

58
Q

Abdominal Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
59
Q

Inspection in Abdominal Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Abdominal distension.

60
Q

Palpation in Abdominal Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Abdominal rigidity in cases of perforation & peritonitis

61
Q

Percussion in Abdominal Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Hyper-resonance

62
Q

Auscultation in Abdominal Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

1st there are accentuated intestinal sounds

Later there is silent abdomen.

63
Q

Local Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

The hernia is :

1- Irreducible.

2- Tender

3- Tense

4- Giving no expansile impulse on cough.

  1. Showing signs of acute inflammation.
64
Q

Sure sign of strangulated hernia in Local Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  1. Tense

2. Giving no expansile impulse on cough , if no. one is not found in the choices of MCQ

65
Q

Pathogenesis of Giving no expansile impulse on cough in Local Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

As defect of hernia became very narrow

And hernia is tense

66
Q

Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  • It’s difficult Thus it is safer to consider any obstructed hernia as strangulated hernia until proved otherwise
  • Difference between obstructed and strangulated Hernia
67
Q

Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A
  • General Examination
  • Local Examination
  • Ryle insertion
  • Investigations
68
Q

General Examination in obstructed Hernia in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

69
Q

General Examination in strangulated Hernia in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Toxic “ Feverish “

70
Q

Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Expansile impulse

Consistency

Overlying signs of inflammation

Percussion of intestine in the sac

Auscultation of intestine in the sac

71
Q

Expansile impulse in obstructed Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Present but difficult to be elicited

72
Q

Expansile impulse in strangulated Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

73
Q

Consistency in obstructed Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

74
Q

Consistency in strangulated Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

75
Q

Overlying signs of inflammation in obstructed Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

76
Q

Overlying signs of inflammation in strangulated Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

77
Q

Percussion of intestine in the sac in obstructed Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

78
Q

Percussion of intestine in the sac in strangulated Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

79
Q

Auscultation of intestine in the sac in obstructed Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Accentuated intestinal sounds

80
Q

Auscultation of intestine in the sac in strangulated Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

81
Q

Pathogenesis of Silent intestinal sounds in Auscultation of intestine in the sac in strangulated Hernia in Local Examination in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Due to dec blood supply )> paralytic ileus

82
Q

Ryle insertion in obstructed Hernia in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Relives pain as Suction of fluids relieves colics

83
Q

Ryle insertion in strangulated Hernia in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Doesn’t Relive pain as As the pain is ischemic not colic

84
Q

Investigations in obstructed Hernia in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Normal CBC

85
Q

investigations in strangulated Hernia in Difference between obstructed and strangulated Hernia in Clinical differentiation between obstruction and strangulation in Examination in CLINICAL PICTURE of Strangulation in Common Complications of Hernia

A

Leucocytosis

86
Q

Investigation of Strangulation in Common Complications of Hernia

A
  1. Serum electrolytes (Na & K),
  2. KFTs & LFTs
  3. CBC :
  4. ABGs
  5. Plain x-Ray abdomen erect & supine
87
Q

CBC in Investigation of Strangulation in Common Complications of Hernia

A

Leucocytosis

88
Q

ABGs in Investigation of Strangulation in Common Complications of Hernia

A

Metabolic acidosis.

89
Q

Plain x-Ray abdomen erect & supine in Investigation of Strangulation in Common Complications of Hernia

A

Multiple fluid levels & distended loops.

90
Q

TREATMENT of Strangulation in Common Complications of Hernia

A
  • Urgent surgery after resuscitation
  • Preoperative preparation “resuscitation”
  • Operative management
91
Q

Preoperative preparation “resuscitation” in TREATMENT of Strangulation in Common Complications of Hernia

A
  1. NPO & nasogastric tube suction
  2. I.V fluids & correction of any electrolytes disturbance.
  3. I.V antibiotics
  4. I.V. H2 blockers
  5. Fluid chart.
92
Q

Benefits of NPO & nasogastric tube suction in Preoperative preparation “resuscitation” in TREATMENT of Strangulation in Common Complications of Hernia

A

decreases distension and vomiting.

93
Q

I.V antibiotics in Preoperative preparation “resuscitation” in TREATMENT of Strangulation in Common Complications of Hernia

A

3rd generation cephalosporins & metronidazole.

94
Q

I.V. H2 blockers in Preoperative preparation “resuscitation” in TREATMENT of Strangulation in Common Complications of Hernia

A

to avoid stress peptic ulcer.

95
Q

Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  1. The incision must explore the neck & the fundus of the sac.
  2. Dissection & opening the sac, at the fundus
  3. Evacuation of the toxic fluid.
  4. Holding the contents & division of the constriction ring on your finger or hernia director.
  5. Delivering the loop outside
  6. Dealing with the contents according to viability.
  7. Finally herniorrhaphy using prolene sutures but mesh is contraindicated.
96
Q

The reason of Dissection & opening of the sac, at the fundus in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

To avoid escape of the toxic fluid to the peritoneal cavity.

97
Q

The reason of Delivering the loop outside in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

to avoid strangulated inner loop in cases of Maydle’s hernia.

98
Q

Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

a. Dealing with Omentum

b. Dealing with Intestinal loop

99
Q

Dealing with Omentum in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Must be resected as viability can’t be guaranteed.

100
Q

Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  • Difference between Viable and non-viable loop
  • Management of Viable loop
  • Management of Doubtful loop
  • Management of Gangrenous loop
101
Q

Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  • Luster
  • Color
  • Mesenteric arteries
  • Response to pricking or pinching
102
Q

Luster of Viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Normal luster

103
Q

Luster of non-viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Lusterless

104
Q

Color of Viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

105
Q

Color of non-viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Grey or black

106
Q

Mesenteric arteries of Viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Pulsating mesenteric arteries

107
Q

Mesenteric arteries of non-viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Not pulsating ,thrombosed

108
Q

Response to pricking or pinching of Viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Contracts if pricked or pinched

109
Q

Response to pricking or pinching of non-viable loop in Difference between Viable and non-viable loop in Dealing with Intestinal loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

No response

110
Q

Management of Viable loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Return the viable loop to abdomen

111
Q

Management of Doubtful loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  1. Hot packs are applied for maximum 10-15 minutes
  2. ask the anesthesiologist to increase pure oxygen inhalation for few minutes
  3. see if it is viable or not.
112
Q

Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  • Management of Small intestine Gangrenous loop
  • Management of Gangrenous Right colon and caecum
  • Management of Gangrenous Left colon
113
Q

Management of Small intestine Gangrenous loop in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Resection and 1ry anastomosis

114
Q

The reason why 1ry anastomosis can be done in Management of Small intestine Gangrenous loop in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  1. Good blood supply of the small intestine.
  2. Small intestine is less contaminated.
  3. Has complete serosa & musculosa
115
Q

Management of Gangrenous Right colon and caecum in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  • The reason why they are managed as one unit

* Principle

116
Q

The reason why they are managed as one unit in Management of Gangrenous Right colon and caecum in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

both having the Same blood supply

117
Q

Principle of Management of Gangrenous Right colon and caecum in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Right hemicolectomy and ileo transverse anastomosis

118
Q

Management of Gangrenous Left colon in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  1. Exteriorization resection
  2. Wait for 3 months ( till improvement of general condition)
  3. Colonic preparation and secondary anastomosis
119
Q

Principle of Exteriorization resection in Management of Gangrenous Left colon in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A
  1. The gangrenous part is excised.
  2. The proximal segment is exteriorized
    as colostomy.
  3. The distal segment is closed (Hartman’s pouch) or sutured to the skin (mucus fistula).
120
Q

Colonic preparation in Management of Gangrenous Left colon in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

2 days Preparation : to dec bacterial load and stools by

  1. Castor oil to induce diarrhea
  2. Enema
121
Q

the reason why it’s secondary anastomosis in Management of Gangrenous Left colon in Management of Gangrenous loop in Dealing with the contents according to viability in Operative management in TREATMENT of Strangulation in Common Complications of Hernia

A

Secondary anastomosis as it’s after a month has passed

122
Q

Rare Complications of Hernia

A
  1. Inflammation
  2. Rupture
  3. Hydrocele of the hernial Sac
123
Q

Inflammation in Rare Complications of Hernia

A

Contents as inflamed appendix or Meckel’s diverticulum.

124
Q

Rupture in Rare Complications of Hernia

A

Common in patients with CLD & ascitis.

125
Q

Hydrocele of the hernial Sac in Rare Complications of Hernia

A
  1. Predisposing factor
  2. ETIOLOGY
  3. CLINICAL PICTURE
  4. TREATMENT
126
Q

Predisposing factor of Hydrocele of the hernial Sac in Rare Complications of Hernia

A

Use of Truss

127
Q

ETIOLOGY of Hydrocele of the hernial Sac in Rare Complications of Hernia

A

Due to fluid accumulation in an empty hernial sac which has been shut off from the peritoneal cavity by omentum or by adhesions

128
Q

CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A
  1. Symptoms

2. Examination

129
Q

Symptoms in CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A
  1. There is history of a hernia.

2. Later, there is an irreducible pyriform swelling in the upper part of the cord.

130
Q

Examination in CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A

Swelling with the following characters

  1. Consistency
  2. Special characters
131
Q

Consistency of swelling in Examination in CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A

The swelling is cystic

132
Q

Special characters of the swelling in Examination in CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A
  1. Translucency

2. Mobility

133
Q

Translucency of swelling in Special characters of the swelling in Examination in CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A

The swelling is translucent

134
Q

Mobility of swelling in Special characters of the swelling in Examination in CLINICAL PICTURE of Hydrocele of the hernial Sac in Rare Complications of Hernia

A
  1. The swelling is mobile from side to side but not from above downwards.
  2. Gentle traction on the testis does not alter the mobility of the swelling.
135
Q

Treatment of Hydrocele of the hernial Sac in Rare Complications of Hernia

A

Like that of the hernia

Surgery.(General 1).Hernia (13 decks)

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