Tuesday, November 17, 2015

ABDOMINAL WALL HERNIAS 2 ventral hernias


 ETIOLOGY

Hernias  may result from congenital weakness of the wall  or  the
weakness may develop secondarily during later life. The Secondary
hernia are usually considered to be traumatic or acquired due  to
sudden lifting of weights.

The development of a hernia in the groin, during middle life  may
also  be  because  of increased intra  abdominal  pressure.  Thus
chronic  cough,  symptoms of  genitourinary  or  gastrointestinal
tract obstruction may preceed herniation.

Some  young  male adults first discover a hernia  after  vigorous
physical exercise.

3. VENTRAL HERNIAS

Ventral  hernias are situated on the anterior abdominal wall  and
same are in the midline  and include
UMBILICAL DEFECTS

During  the  embryonic period at about the tenth  week  of  fetal
life; the viscera normally return to the abdominal cavity and the
abdominal wall closes slowly during subsequent fetal development.

At birth, many infants will show a small umbilical hernia because
this  process has not been completed (Fig. 24.8b).  In most  cases
spontaneous closure occurs within the first three years of life.

Rarely,  the  process  of  abdominal  wall  closure  is   totally
incomplete  at birth and omphalocele is present.  The  defect  at
the umbilicus is covered only by a peritoneal sac.

In a few cases, the embyrologic duct from small bowel to the yolk
sac (vitillo-intestinal duct) remains patent and attached to  the
umbilical cord at birth.

This  duct  is  likely  to be included  in  the  tie.   When  the
umbilical remanent sloughs later; a fistula into the small gut is
created.

In  other cases; the tract from the bladder; the  urachus  enters
the  umbilical arteries.  The remnant of the cephalic portion  of
the  embryonic  urinary  bladder is  usually  obliterated  before
birth;  if  it  remains patent, it may  become  involved  in  the
umbilical  cord  ligature  and a  draining  umbilical  sinus  may
present.

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