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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
(Mangiot’s)
Tiga komponen:
1. Defek ~ Cincin
2. Kantong hernia
(peritoneum)
3. Isi
1. Intestine
2. Colon
3. Omentum
4. Buli
5. Ovarium
6. Uterus
7. Appendiks
Cause
• Faktor Etiologi: • Faktor Pencetus:
Kelemahan dinding Excessive straining
abdomen – LUTS
• BPH
• Urethral stricture
– Chronic cough
– Constipation
– Lift/push weight
Ventral Hernia
TYPES
Abdominal Wall Layers
INGUINO-SCROTAL REGION
Hesselbach’s Triangle
Hesselbach’s Triangle
Hesselbach’s Triangle
The Myopectineal Orifice of Fruchaud
Female Ingiunal Canal = Canal of Nuck
Inguinal Hernia >< Scrotal Hernia
PHYSICAL EXAMINATION
Digital Examination
Digital Examination
• The examiner should place
the tip of the index finger at
the most dependent part of
the scrotum, direct it into the
external inguinal ring
• The patient is then asked to
strain
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
Irreducible
Inguino-scrotal Hernia
STRANGULATE!
What is the Diagnose?
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
4C
1. Consistency
2. Color
3. Capillary
4. Contractility
~ Peristaltic
Proses strangulasi
Vaskularisasi intestine/colon terganggu
Lapisan mukosa yang paling menderita
(o.k. letaknya paling profunda,
paling jauh dari pembuluh darah)
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
• Reduction en-masse of hernia should be
considered as a cause of acute intestinal
obstruction in patients with persistent bowel
obstruction following reduction of
inguinal/femoral hernias!!!
A hernial sac is seen containing
incarcerated bowel loop between
the parietal peritoneum and anterior
abdominal wall, the properitoneal sac
(a) CT scan of the abdomen
demonstrating dilated small
bowel loops suggestive of bowel
obstruction
(b) The hernial sac [arrow] containing
thickened bowel loop and
mesenteric fat [arrowhead] is seen
in the properitoneal space,
superior to the left inguinal region
(c) A fibrous constriction band is seen
around the neck of the hernial sac
[arrow]. Note enhancement of
bowel wall [arrowhead]
(d) The inferior aspect of the hernial
sac containing bowel [arrow]
(e) Fluid in the hernial sac [arrow].
Wall enhancement of the bowel
loop and fluid in the hernial sac
suggest incarceration and
strangulation
Hernia Type
Sliding Hernia