Professional Documents
Culture Documents
Hernia is
A rupture ( Latin word)
Penonjolan bagian organ atau jaringan
melalui lubang abnormal (kamus
kedokteran Dorland)
An abnormal protrusion of an organ or
tissue through a defect in its surrounding
walls (Sabiston)
An area of weakness or complete
disruption of the fibromuscular tissues of
the body wall (Mangiots)
Tiga komponen:
1. Defek ~ Cincin
2. Kantong hernia
(peritoneum)
3. Isi
1.
2.
3.
4.
5.
6.
7.
Intestine
Colon
Omentum
Buli
Ovarium
Uterus
Appendiks
Cause
Faktor Etiologi:
Kelemahan dinding
abdomen
Faktor Pencetus:
Excessive straining
LUTS
BPH
Urethral stricture
Chronic cough
Constipation
Lift/push weight
Ventral Hernia
TYPES
INGUINO-SCROTAL
REGION
Hesselbachs Triangle
Hesselbachs Triangle
Hesselbachs Triangle
Direct Hernia
Groin Hernia
Inguinal Hernia VS
Femoral Hernia
Inguinal Hernia VS
Femoral Hernia
Inguinal
Hernia
Femoral
Hernia
Above inguinal
ligament
Mostly
Defect:
deep inguinal ring or
Hesselbachs triangle
Below
inguinal
ligament
Mostly
Defect:
femoral ring
PHYSICAL EXAMINATION
Digital Examination
Digital
Examination
3 Fingers Examination
Hernias
TERMINOLOGY
Terminology
Reducible/Reponible
Isi kantong dapat keluar-masuk
Irreducible/Irreponible
Isi kantong tidak dapat masuk kembali, namun tidak
ada gejala dan tanda strangulata
Incarcerate ???
Strangulate
Isi kantong hernia terjepit sehingga menyebabkan
gangguan
Sirkulasi iskemiknyeri
Pasase ususobstruksi usus mekanik
Irreduci
ble
Inguino-scrotal Hernia
STRANGULATE!
Mechanical Bowel
Obstruction
Trias obstruksi:
1. Perut semakin membuncit
2. Muntah setiap makan-minum
3. Tidak bisa flatus maupun BAB
PF regio abdomen:
I: distention, bowel contour, bowel movement
P: NT
P: hypertympanic
A: hyperperistaltic, metallic sound
RT: ampula recti kolaps
Mechanical Bowel
Obstruction
Abdominal radiograph
is it NECESSARY?
Strangulated Scrotal
Hernia
4T
1.Tense
2.Tender
3.Temperature
4.Tone
(Hyperemia)
Proses strangulasi
Vaskularisasi intestine/colon
terganggu
Mucosal slough
Klinis: hematoschezia
Spontaneously Reduce
Strangulated Scrotal Hernia En Masse
Reduction en-masse of inguinal hernia, means
reduction/migration of a hernial sac along with
the incarcerated bowel into the properitoneal
space and is likely produced by forcible attempts
at reduction
Occasionally, it can also be spontaneous
There is usually a history of difficult reductions,
the last one being especially difficult, after which
the symptoms of intestinal obstruction occur
The hernia appears to have been reduced but
the signs of bowel obstruction persist
Spontaneously Reduce
Strangulated Scrotal Hernia En Masse
Reduction en-masse of
inguinal/femoral hernia can be
defined as reduction of the hernial
sac together with its intestinal
contents so that the bowel still
remains incarcerated
It has been quoted by Pearse to occur
in approximately 1 of 13,000 hernias
Spontaneously Reduce
Strangulated Scrotal Hernia En Masse
Casten and Bodenheimer postulated that reduction
en masse can occur only if there is a relatively
unyielding neck of the sac and a lax internal ring
Fibrosis is probably produced by recurrent trauma
from difficult reductions
Pearse concluded that a preformed space between
the parietal peritoneum and anterior abdominal
wall, the properitoneal sac, or diverticulum was
present in many cases
Millard suggested that such a sac was equally likely
to be produced by forcible attempts at reduction
Spontaneously Reduce
Strangulated Scrotal Hernia En Masse
Hernia
Type
Sliding Hernia
Littres Hernia
Richters Hernia
Amyands Hernia
Spigelian Hernia
Interstitial Hernia
Supravesical Hernia
Lumbar Hernia
Maydls Hernia
Differential
Diagnosis for
Scrotal
Enlargement
DD/: Hidrocele
DD/: Orchitis
Pemeriksaan Fisik
Hernia
Benjolan keluar
masuk
Hidrokel
Benjolan yang
menentap dan
semakin membesar
Tumor
Testis
Benjolan yang
menentap dan
semakin membesar
Orkhitis
Gejala-gejala proses
inflamasi (nyeri,
demam)
Torsio
Testis
Riwayat trauma
When to
Operation Timing
Elective
Reducible
Irreducible
Emergency
Strangulate
Hernioplasty
Tension:
Bassini plasty
Shouldice
Nyhus
Condon
Stoppa
Tension-free:
Lichtenstein
Perfix mesh plug (Rutkow-Robbins)
Kugel
Laparascopic
Bassini plasty
Lichtenstein
Mesh
Mesh
Complication after
Herniorraphy
Pain
Wound infection
Orchitis
Seroma/hematoma in distal hernia
sac
Inguinodynia
Recurrent
Inguinodyna
Chronic groin pain or
neuropathic pain
Debilitating pain with
prolonged suffering and
distress
Characterized by
hyperesthesia along the
corresponding dermatome,
and exquisite pain at the site
of a neuroma or trapped
nerve; and contact
dysesthesia
Patient describing as painful
exacerbations similar to an
electric shock, paroxysms of
burning and shooting
pains
community by
operating on hernia
cases,
and seeing that is
recurrence rate is
lower,
than he can by
operating on cases-Wakelyof
Hernia Permagna
Hernia Permagna
Tipe hernia yang apabila isi kantung
hernia dikembalikan ke rongga
peritoneum dapat menimbulkan
keadaan abdominal compartment
syndrome
Abdominal Compartment
Syndrome
Peningkatan tekanan intraabdomen
Thank
You.