patologia de pared abdominal-hernias
TRANSCRIPT
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USMP Dr. César Rotta GarcíaOctubre 2009
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Generalidades
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Protrusion o salida, ocasional o permanente, de una víscera o tejido a traves de un orificio o defecto de la pared abdominal, anatómicamente constituido.
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Factores Predisponentes
Factores Desencadenantes◦ Disnea.◦ Tos.◦ Constipación.◦ Trabajo forzado.◦ Embarazo.◦ Hiperplasia prostática.
Edad.Sexo.Herencia.Obesidad.
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Envoltura Saco Herniario
Contenido.◦ Habitualmente las visceras más próximas y con
mayor movilidad.
Cuello.Cuerpo.Fondo.
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Reductible
Irreductible
Coercibles
Incoercible
Crónicas
Agudas Atascadas
EstranguladasDeslizadas
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Interrogatorio. Clínica. Examén Físico. Intraoperatorio.
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Toda hernia debe ser tratada quirúrgicamente.◦ Tratamientodel saco◦ Tratamiento del contenido.◦ Plastia de la pared
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Combinación de factores pre disponentes y desencadenantes.
Edad.Sexo.Herencia.Obesidad.
Disnea.Disnea. Tos.Tos. Constipación.Constipación. Trabajo forzado.Trabajo forzado. Embarazo.Embarazo. Hiperplasia Hiperplasia
prostáticaprostática
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• Hernias voluminosas de la variedad intrainguinal.•Pared del saco está formada por la víscera.• Representan alrrededor 3 %.•Contenido: cólon, trompa y ovario.•Hernias directas: vejiga.•Mecanismo: por tracción del peritoneo parietal.•Tipos: parasacular, intrasacular, extrasacular.
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N. AbdominogenitalN. Genitocrural
ANT. POST.
Oblicuo mayor
Oblicuo menor
Transverso
Arcada inguinalLig Poupart
Fasciatransversalis
Conductodeferente
Plexo venoso
A. FunicularA. Espermática
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Oblicuo mayor
Oblicuo menor
Transverso
Arcada inguinalLig Poupart
Fasciatransversalis
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Oblicuo mayor
Oblicuo menor
Transverso
Arcada inguinalLig Poupart
Conductodeferente
Plexo venoso
A. FunicularA. Deferencial
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Hernia que reaparece en la región inguinal operada.
Debe ser del mismo tipo anatomopatológico que la primaria.
Diagnóstico intraoperatorio.
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Hernia Crural. Hernia irreductible:
◦ Hidrocele◦ Hematocele ◦ Adenitis ◦ Lipomas.
Hernia reductible:◦ Varicocele.◦ Hidrocele congenito.
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Irreductibles.
Atascadas o incarceradas.
Estranguladas.
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Tratamiento del saco. Tratamiento del contenido. Plástica de la pared.
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Tratamiento del saco y su contenido.
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A traves del anillo crural, por debajo del ligamento inguinal.
Sexo femenino 5:1. En segunda decada de la vida. Etiopatogenia:
◦ Origen congenito.◦ Favorecido por factores desencadenantes.
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Existen diversas vías de acceso para su reparación:◦Vía Inguinal◦Vía Crural◦Vía Preperitoneal
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Debido a la estrechez y riguidez del orificio de salida su complicación es un hecho muy frecuente.
Se complican 10 veces más que las hernias inguinales.
Se complican en un 50%.◦ Atascamiento.◦ Estrangulación.
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Se producen en la línea media supraumbilical.
Protrusión a través del entrecruzamiento de las fibras de la línea alba.
Frecuencia 1-4%. Predomina en hombres. 3era. – 4ta. década. Factor predisponente:
◦ Orificio de entrada de vasos y ramas perforantes.
Factor desencadenante:◦ Aumento presión intraabdominal.
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Hernia de Spiegel. Hernias lumbares. Hernia obturatríz. Hernia izquiática. Hernias internas.
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Es la protusión o salida del contenido abdominal a través de un defecto adquirido de la pared abdominal.
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Factores Predisponentes
◦Dependientes del Paciente.
◦Dependientes del tipo de cirugía.
◦Dependientes de la técnica quirúrgica.
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Es la apertura durante el postoperatorio inmediato de los planos laparotómicos que fueron cerrados.
◦ Completa (evisceración) Se abren todos los planos.
◦ Incompleta Se abre solo la aponeurosis.
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Es la salida de las visceras de la cavidad abdominal a través de una herida dehiscente.
Puede ser de 3 grados:◦ I) la viscera no alcanza el plano cutáneo.◦ II) el borde antimesentérico de la viscera alcanza el
plano cutáneo.◦ III) el borde mesentérico de la viscera alcanza el
plano cutáneo.
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Grado I
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Grado II
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Grado III
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Tratamiento◦ Dehiscencia incompleta o evisceración grado I
Tratamiento Conservador. Faja de Montgomery.
◦ Evisceración grado II-III o anteriores en buen estado general Cirugía
Se pueden dar puntos capitonados de refuerzo.
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Tratamiento Puntos Capitonados
Intraperitoneales Extraperitoneales
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