Okremі vidi infringed gryzh. Pupkov, a bile line of the abdomen, a ventral grill

Intercourse is carried out until the number of serious acceleration rates, which may occur during the period of development. There is no reason for organ health to be found in a grill bear. Such a process can be seen in the area of ​​the mouse or in the gate. A touch of yogo є the destruction of the robotic circulatory system.

Classification of restrained gryges

The medical devices see the following types of infringed griffins:

• Pervinnі obmezhennya. Such a category is designed to end up ridko, it can only be determined by a one-time zusill, as it was reported by a people. With an important mind at all є the manifestation of a new schism before the appearance of vipinny. During the period of a short, albeit signified navantazhennya mittєvo set up a grizzly, yak at a moment to be jammed in the gryzh gates. Diagnosis of such a disease is important;
• Secondary infringements of the grids. Prior to this category, there are all іnshі vipinnya. As a rule, you should be seen on the same grizzly.

In addition, you can see two forms of infringed griffins:

• Elastic type. Vona will be hosted in to a young person, Wicked to hang out with vivid physical assignments. Symptoms є painful attack, tension of a mushroom bear. The grill itself cannot be adjusted, it is nudota, suprovodzhuvana blues;
• Calovia obmezhennya gryzhі abdomen. It is possible to develop it among people in the summer and people who have been abducted, as a trivial term with the use of grids. The stench gradually grows in size, becomes irreducible.

Especially vidi obmezhennya:

• Retrograde obmezhennya. Its special feature is the presence of two intestinal loops, which do not fit into the grill. At the new one there is a vigin of the third loop, before which in the past there is a broken bloodletting. Such a kind of obmezhennya to create a little, ale counter-important;
• Parietal obmezhennya. At the same time, the intestine is roasted in a grill mouse, and only in deciduous mice. At the same time, the development of such an accelerated development occurs, such as intestinal imperfection, however, necrosis of the intestinal stink may occur. Tsei pryznovid obmezhennya nikoli does not grow up in giant griffins;
• Gryzha Lіttre. It is more convenient to visit the groin area. Such a pathology is quite similar in some way to the frontal type, but the only reason - necrosis develops in the course of development.

Photo: kalovi obmezhennya gritsa

Symptoms of the embossed grills

For pinched grizzly, characteristic є chotiri symptom. The stench is created when the form is pinched. They should be referred to:

1. Bіl sharp character, which appears in the area of ​​grizzly rosetting;
2. Vipinnya not to protrude to the right to wind in the recumbent position;
3. Sore grizzly and permanently stressed;
4. Cough mail can not be transmitted.

The most significant symptom є b_l! Vona winnyaє pіd hour of physical overstrain і doesn’t disappear when yoi podinennya. In especially important vapadas, the walls are strong, but the ailments do not die out in the stacks. At any attempt to start a shkira, a bolovy shock develops, a grip falls.

If you don’t get angry at once, then you’ll fix the development of peritonitis. The process of burning step by step spreads over the whole belly, gasping for organ etching.

diagnostics

Diagnostics of the embossed grizzly in simple cases does not become difficult for the patients and it is quick to get good at it. The first step is to review the medical history. I can help you to get a good grip, as before the bullet was right and not supervised by many views.

The offensive stage is a physical condition. Zazvychay when you look around you can see the good. It’s not knowing when the position is changing, you don’t hesitate to shave when Rusi.

Prior to the methods for diagnosing pinched grizzlies, the following should be included:

• The designation of the temperature of the shkiri in the mice of the growth of the grill;
• Delivery of extravagant analyzes: blood, slaughter, feces;
• Ultrasonic examination of a carriage empty, X-ray of a queue.

conservatively

Embossed grizzly hirurgic path! Let us single out the contraindications є the agonal stance of the patient. Be it as if trying to get the grizzy right, unacceptable through the impermissibility of getting into the empty body, which was given to the non-gripping ischemia.

Ale і z tsy rule є kіlka vinyatkіv. The stench expands on ailments, as they perebryuyut at an important camp through the appearance of additional ailments. With a lot of scrutiny, which stands in the eyes of the lykar, it can take no longer than a year. In some cases, a surgical engagement for a patient on the basis of a risikovanishe, but no attempt to fix a grizzly without an operation.

It is also possible for children to try to fix the grizzly early vik It took less than an hour to pass the time.

Preparation before the operation. anesthesia

Before the operation is visible, it is necessary to prepare the embossed grizzly. For the whole, it is necessary to cut the crankcase from the crankcase, in some cases, to sprinkle the shlunks.

For a healthy operation, you can use a mice or epidural anesthesia. The rest of the variant is seen as a bigger one.

Hirurgic involvement. go operations

The operation will take place quickly and in an extreme order. The head of the surgeon in case of tsom is to expose and fix the pinching of the organ. Only tse allow uniknuti yogo vislizannya in the empty hole.

Operations go:

Crazy, as soon as you see the plasticity of the grizzly collars, it will lead to the re-development of grizzlies. However, the main and main task of the doctor is to preserve the life of the sick. The operation for the detection of recurrent grids may have been carried out earlier, but according to the plan, without a term hospitalization.

There is a tactic to be victorious in the situation of phlegmon of a grilled bear, with a single blame for being hot.

In ailments, who are overwhelmed by an important camp, the opportunity is allowed to vicariously exteriate the pinched organ. In some situations, during anesthetic anesthesia, it is possible to develop a mushroom mouse, to fix it and to fix a patient to an organ for the first time. Gryzovy gates are being built.

Photo: vidi obmezhennya: retrograde and pristinkov

heritage

With the robotic advancement of a professional surgeon, the operation does not lead to negative inheritance. However, before happy you can add:

• relapse;
• Vidmova robots previously pinched organ;
• Osvita suppuration.

All traces, except for a relapse, begin after a short term of a surgical intervention.

come proactively

During the operation, it’s necessary to restore the period, when it’s not a good time to forget about professional come in... The stench is to allow you to cross the development of a relapse:

• Wearing a bandage or a special corset for the first time during the operation;
• Investigation of the situation at the lykar;
• View important physical items, pick up important items;
• It is recommended to crush it into pieces of porcelain. Stop etching the robot, renew the poisoning.

Do not forget to forget, as a pinching of the gruzi of the abdomen in a shid and secret hospital!

Online Test

• Shilny Ve to breast cancer? (Power: 8)

  In order to independently take a decision, it’s important for you to carry out genetic testing for the identification of mutations in the BRCA 1 and BRCA 2 genes, give an example, be we caress, for the nutrition of this test ...

Affected by the grill

Sho also The gryga is feared -

When the grizzly grizzly is wiped out, it’s a raptor’s step, or the action of a pressure on any organ of a gross emptying in the gryzhovy gates, leading to the collapse of his blood supply, in the end bag, to necrosis. They can be interconnected as well (in the small holes and defects of the walls of the wotan and the pelvic floor), as well as the internal (in the chickens of the black empty and out-versts of diaphragms).

Obezhennya grows in 8-20% of ailments with callous cranial grids. As soon as 2% of the population is stocked by “greenies”, then there are a number of ailments from the pathology to achieve great things in the practice of extreme surgery. In the middle of the patients, they handle the specimens of the elderly and the kidnapped ones. Their lethality is 10%.

Scho provokuє / Reasons for intercourse gryzhі:

From the point of view of the mechanism of determination of the quickening of grids, there are two principled types of intercourse: elastic and fecal.

more elastic winykau pis for a rapt vikhozhdennya great obsyagu in the middle of the gates through the vuzk quick advices vnutren_shnobralny vise under the injection of a strong physical tension. As soon as the organisations go, they do not independently set themselves back into the empty cell. At the same time, there is a lack of pressure (regional regulation) in a high school child of gryzhovykh vinnikak ischemia of infringement of organs, which can lead to a severe pain syndrome. In his own devil, a vicious spasm of the muses of the anterior chernaya stinka, which is aggravated by the intercourse, is a strong spasm. Non-laxative elastic intercourse leads to rapid (lasting decilkoh years, at least 2 years) necrosis of the gryzoma vstu.

at feces infringement The pressure of the grill is caused by a rapid re-equipping of the intestinal loop, which is located in the grill. The opening window of the chain of the hinge is very narrow and squeezed in the gate at the same time with the restrained breech. In such a rank, a picture of stranguly-tsії is developing in the endless rakhunka, similar to the present, as it is spared in the case of elastic intercourse. In mіsci s tim for development of intestinal necrosis with fecal impairment, we need more trivial term (kіlka dib).

An unequal mindset of the elastic duck is the presence of vuz'k gryzhovy gates, at that time it is not easy at the wide gryzhovy gates. In the case of the fecal duck, the physical zusilla has a lesser role, not in the case of elastic strangulation; the increase is more significant for the deterioration of intestinal motility, the confidence of peristalsis, which often occurs in the old and old. The order of the cym in fecal infringement is an essential role to play the hypochondria, twisting of the intestine, which is located in the Gris and the growth of the grizzly mice. In other words, if you want to be bummed, you winnicky as a slower trivially unreasonable grill.

Injury may be given to different organizations, like є Grishevim vmistom. Most often, the small intestine appears, or the great omentum, and then the intestine. Even more rarely infringe on organisms, rostasovani mesoperitoneally: slip intestine, secho-vittya michur, uterus and appendages and in. Naybіlsh is not safe for intestinal obstruction, since with a large amount of death and development of important strangulated intestinal imperfections, it can lead to a progression of intoxication due to a large shock.

Pathogenesis (how to see?)

At the moment of encirclement in the grill bear, the empty space is closed, yak to take revenge on the organ or the organ, in which bloodsteps have been destroyed. At the point of squeezing the intestinal loop, omentum and other organs, it is so called strangulyatsіyna borozna, how to get a good look at the letter of the courtesy. You can see how good it is in the area to bring and bring out the intestines, as well as in the general breeches.

As a result, the blood loss in the intestinal tract results in venous stasis, which is a nezabarom viklikє swelling of all balls of the intestinal wall. One hour a diapedesis of blood elements and plasmas is seen in the middle of the enlightenment of the pinched intestine, and in the empty gryous bear. In a closed enlightenment of the ischemic intestine, the process of expanding the intestinal cavity is repaired, which is characterized by the formation of toxins. Intestine loop is affected to finish quickly, stretching out decilkoh years (with elastic interlocking), succumb to necrosis,how to obey because of the muck, then the enemy pidslizovy ball, myazovu and in the left serous membrane. About the need for memory, assessment and life.

Ridina, a yak to accumulate when surrounded in a closed empty grill bear (for a rakhunok trans- and eksudatsії), I will name Grievous vodi. With a handful of prozora і bezbarvna (serous transudate), protesting the world with forms of mushroom elements, water acquires rheum, and sometimes it is red-brown boiled water. The intestinal wall is necrotized and ceases to serve as a bar for the microbial flora for the first time, as a result of the exudate in the end bag nasty character s colibacillary odor. Podbne gniyne zapalennya, rozvinene in in different stages obmezhennya, scho rozpovsyudzhu to navkolishnі gryzhu fabrics "Phlegmon of a mushroom bear".

When interconnected, it is not just a small part of the intestine, which is in the grill, but rather leads to the appearance of the rosette in the black empty. At the re-development of intestinal imperfections in all cases, there is accumulation of some kind of gut, which is stretching the intestine, and the wall is rapidly becoming thinner. All the changes that are characteristic for the whole pathological camp can be found.

Winikla as a result of infringement, strangulation of impassability, as vіdomo, is one of the most important types of intestinal impairment, especially with contiguous small intestine. In the end of early bagatoraz blues, it is very easy to bring the organism up to an unhealthy level, waste life-time important electrolytes and bile intrigues. In addition, the delay of the nerve elements of the breech until the diagnosis of a severe painful shock is up to the point where necrosis of the intestine and the pinched breech are not seen. The purpose of change and striking is to bring the bowel back to a certain development not only by phlegm, not by a gristle, but by a gnarly peritonitis.

Pererakhovani factories start a high rate of mortality, which is likely to occur in case of infringement of the griffins, so that it is not necessary to indicate that it is not necessary not only for early operative involvement, but for conducting an energetic therapy for corrective surgery.

In yakosti special types of chuck Razrіznyayut retrograde (W-pro growth) and parietal (Rіkhterіvske) obmezhennya, gryzhu Littre.

retrograde duck It is characterized by the fact that there are less than two intestinal loops in the grill bear at the most favorable condition, and the most arrogant is the third, the last loop, which is roasted in the black empty one. Vona is in the greatest minds of bloodstending, the spirits of the breeze, the time to get over, entering the gryzhoy mіshok and going out from the ny. A similar type of intercourse is spared infrequently, although it is less important, it is less important, since the main pathological process I develop is not in a closed ridge mouse, but at a willow black empty. In this vypadku, there is much more concern for the diagnosis of peritonitis. In case of retrograde infringement of the surgery, the hour of the operation is guilty of looking around the bowel loop, which is in the middle empty.

parietal enclosure see also in literature under the name of Richter's Gryzhi. At any given sight, the intestine is not built up to the full extent of its education, but rather than partly; In this particular category, there is no reason for me-mechanical intestinal imperfections, but there is a real problem of non-Croza of the intestinal wall due to the inheritance, but the sound of the sound is real. At the same time, the diagnosis can be done smoothly, through the visibility of the swelling pains (there is no bowel breeze). Often the small intestine suffers from a small intestine, a protean description of the intestinal infringement of the slunk and the intestine. This kind of nicholas does not occur with large grizzlies, typical for small grids with high grizzly gates (stegnova, umbilical griffins, grids of a bile line of the abdomen).

Gryzha Lіttre - tse obmezhennya Meckel's diverticulum in the groin grizzly. This pathology can be attributed to an osteoarthritic utterance with only a small drop, in conjunction with the worst minds of blood supply to vertices that are more susceptible to necrosis, lower intestinal wall.

Symptoms of grizzly hair:

When skargs on the raptus winery are pains in the abdomen (it’s more, if the stench is supravodzhuyutsya symptoms of intestinal obstruction), NIKOLI IS NOT MUCH-necessary to exclude the abdominal pain. The axis of what, when looking at a sick person, I will gostry lives next to the situation of the anatomical zone and the mobility of the genitalia.

For an obmezhennya characteristic chotiri signs:

1) a sharp bile in the area of ​​a gryzh, or for the whole belly;

2) the irreducibility of the grizzly;

4) the duration of the transmission of cough delivery.

bіl є the head symptom of bridging. Vona winikє, as a rule, at the moment of a strong physical stress and not a chill, you should be able to lean back. The floor is strong, but an ailing old man is important to see him and cry. The behavior of the patient is restless, curious to blink, the symptoms of current pain shock with tachycardia and diminution develop slowly arterial vise.

More often than not, along the course of the road; when the intestines are interconnected, it is necessary to make the airway to the center of life and intestinal diseases. In the case of a large number of vapors, it becomes more and more difficult for a long period of time to reach the moment, if necrosis of the pinched organ occurs due to the bend of the intramural nerve elements. In some cases, it can take on a variable character, which is tied to the development of intestinal imperfections.

irreducible gryzhі - signs that can be meaningful only when interconnected, previously right hand.

Gryzhov's stranglehold In order to improve the situation, it is necessary to suppress the infringement of both the right and the wrong Grisha. At the link z tsim is given a sign that is more significant for the definition-bath of the intercourse, lower the irreducibility of the gryz itself. Call vipya-chuvannya, we will not only be stressed, ale and very sick, but it is not easy to identify the ailments themselves when the grits are cleaned and trying to fix them.

Delivery rate of cough delivery in the area of ​​gryzovy vipya-chuvannya - the most important sign of the duck. Wine of dressing is from Tim, at the moment when you are surrounded by a pink bear, you will find yourself in a white black hollow and old yak bi isolated with light. At the moment of coughing, the connection with the cymus of the intracranial vise, yake of the cough, is not transmitted to the empty grill (negative symptom of coughing). This symptom is important to evaluate in case of great ventral Grisha, in which a part is significant organs... In such situations, when coughing, it is important to transfer the cough on the grill, otherwise it’s good to be healthy at once with our stomach. For the correct interpretation of the given symptom in some cases, it is necessary not to put the palm on the grizzly, but to hunt him with two hands. In cases of positive symptom of cough delivery, surgery has been found to be healthy.

Percussion over the restrained gryzviya beckon to start dulling for the gryzhovoy water (if the gut is taken into the gryzhey, then in the first year the tympanitis will become obscured).

It is not easy to be confused with one-time blues, as at first it is of a reflex nature. Nadal, in the world of development of intestinal imperfections and gangrene of the intestine, there will be a lot of problems. Bluvotnі masi swell greenish-stormy colіr with an unacceptable smell. Oskilki obmezhennya intestine (vyklyuchayuchi Rіkhter's gryzhuyu) accelerated gastrointestinal imperfection, but supervised all the characteristic symptoms.

Part of the intestine, for example, the mucous intestine in the kovzno inguinal gryzha, the symptoms of imperfection are not vicious, but it’s not a bargain, if the order is interrupted, it’s more painful to accelerate the pomp of positiveness before the defect. The parietal obmezhennya of the sectional bladder in the kovznoy gryzhi supervises with dysuric disruptions: we will accelerate the sickly sechivipus, hematuria.

In the sick of the sickly wounded, who suffer from the grudge of a lot of rock, in the wipes of the bagatore's victorious bandage, go to the house when the wicked and the sick uncommon views in the area of ​​Grisha. In such patients, as a result of the dosing, it is important to determine the nature of the pain syndrome, the moment the intensity of the pain and other non-wicked symptoms appear.

Trivale obmezhennya, as I have already said, to develop the phlegmon of a gryzhen bear. It is clinically manifested by the syndrome of the system-dark ignition reaction and characteristic muscular signs: swelling and hyperemic curve, severe pain and fluctuating action over the young.

In the end of the rakhunka, the trivial of the interconnection will end, as a rule, with the development of the poured peritonitis during the transition ignition process on the black empty, for the rakhunok perforation of the thinly stretched and thinned lead to the side of the strangulated intestine.

Vishche Bula Vikladena is a picture lured by the head of the elastic-mu infringement. Kalovi obmezhennya maє ti regularity development, ale the opposite is less boisterous. Zokrem, with fecal infringement not on the bendings of the bolovy syndrome, more and more intoxication develop, and necrosis of the pinched intestine is infused. Protest, fecal infringement is so not safe itself, as it is elastic, the splinters are the result of two types of dice of the same, so tactics with them are only one.

Okremi vidi infringed gryzh

The inguinal grill is affected. obmezhennya groin grill Achieve in 60% of vypadkiv according to the rate up to the last few drops, which corresponds to the highest frequency of groin grizzly in surgical practice. Often the groin of the groin grizzly is hampered, so as the stink passes through the entire protruding of the inguinal canal, at that time, it only passes straight through the distal part of the groin.

It is a clever picture of the infringed groin gryzha to complete the character, so that all the signs of an inferiority are easily remembered. It’s difficult to do it only when there is an interconnected canal grill in a small inner ring of the inguinal canal, as it is possible to see it only when you look carefully. Call in the first place in the comrade of the lateral inguinal fossa, respectively, the localization of the lateral inguinal fossa to protrude into the hole, to reach the sickly little bit of approval, so that additional help was established correct diagnosis.

Differentiation of the inguinal grizzly is necessary because of the inguinal lymphadenitis, hospitable orchiepididimitis, swelling and dropsy of the cell, or the family cord and pinched stigma grizzly. In the first two types of vipads, there are few anamnestic cues on the front of the head, there is no severe pain syndrome and blues, and the pain is most often supported by early temperature changes. Establishment of the correct diagnosis of additional assistance, an extraordinary physical examination, when it comes to the significance of the intact groin of the inguinal canal, on the basis of sadness, podryapin, phytology of the lower prostate problems hemorrhoid university, Yaki є the reasons for concomitant lymphadenitis. In cases of orchiepididimitis, it is likely that the appearance of a malignant sickly cell and its appendage is evident.

Oncological illnesses of the cell and the family's cord are NOT supported by the rapid appearance of clinical symptoms, which point to a restrained groin grill. Retaliation of fingers to the inguinal canal is allowed to turn on the pathological stump. The palpation of the testicle is palpable, not very humpbacked. Palpation of the gidrocele and funicular is painless in the case of a pinched grizzly.

Women do not just want to see the groin grizzled from the bicorno, especially with a small grizzly grizzly. If you have a respected and protective look around, you can stand up, so that the thighs of the grill go out from the inguinal ligament, and the outward opening of the inguinal canal is normal. However, in the preoperative diagnostics, there is no major meaning here, there are some indications of a term operation in the same vipad. Having spent an hour in hand with the help of the localization of the Grishevik vorit, they rob the general method of plastics.

As long as it is difficult to find out the difficult things in the clinical verification of the uterine ligament bone, the ailment needs to be promptly handled, since in such a difficult diagnostic situation it is possible to miss the grievous infringement.

At the time the groin grizzly is surrounded by the rosette of the skin and the subcutaneous adipose tissue (the projection of the growth of 2 cm in the food and parallel to the pu-part zv'yaztsi), the grizzly bears are seen in the area of ​​the bottom. Carefully open the wall of the yogo. It’s not a good idea to get rid of the grill if it’s close to the mice, so there’s a way to connect it to the grill.

The cultivation of the original style of the grill bear among the ailments from the right-sided neighbors can be testified about the appearance of the grill. If you unknow the wounds of the intestine, then open the thinnest part of the grill mouse on the anterior-medial surface.

As soon as the operation takes place, the meat fibers appear at the inner wall of the grill, after the catch of the cutter is perceived. Detection of dysuria in a sick person. In some situations, it is necessary to open the most thin-walled lateral part of the grill, so that the iatrogenic damage to the grill is eliminated.

Having opened the grill, they aspirate the transudate and take the seed. Fik-Sira Gryzhove in the place of his hand, rozsіkayut infringe on the ring. Name the opening of the inguinal canal. In addition, along the fibers, the aponeurosis of the external oblique abdominal meat is spread on the frontal probe in the final direction (Fig. 6.6). As soon as there is an encirclement at the inner opening of the inguinal canal, the infringement of the ring is also raised to the lateral side of the gray cord, memory, from the medial side to pass the lower supracranal judge.

If there is a need, in particular, for a resection of the small intestine or a great omentum, for a hernioleparotomy - to straighten out the posterior wall of the inguinal canal and to straighten the tendon part of the inner transverse oblique Most of the ailing have enough access, just to take a part of the small intestine and the great omentum with a glance at the resection.

Vibrations of the middling middling rise of the cranial wall are necessary in the following situations:

1) in the middle of empty bends, the adhesion process, which is the introduction of the necessary for resection of the intestine through the obvious access in the groin area;

2) it is necessary to resect the thermal end of the club intestine with the attachments of the ileotransverse anastomosis;

3) necrosis of slips and sigmoid colon;

4) the phlegmon of the mushroom bear has been detected;

5) peritonitis and intestinal obstruction were diagnosed.

Having completed the stage of seeing the grill, seeing, dressing and seeing the grill, proceed to the plastic part of the operation. Directly in the form of pinched inguinal grizzly (braid is abo straight), it is better to carry out plastic surgery of the back wall of the inguinal canal. Such a tactful decision to the choice of the operative engagement is pathogenetically correct and justifiable, so that the basis for the development of whether the groin is based on structures is the lack of transverse fascia. In the minds of extraordinary surgery, it has been possible to find the most simple and effective methods of plastic surgery of the grizzly collars. We will tell the minds Bassini method(Figure 6.7). For an hour, we lift the cord with the first three sutures, fix the edge of the straight meat of the abdomen and the resulting muscle tendon up to the pubic hump and the cooper's rings, which will grow on the upper symphysis surface. We use the edges of the inner oblique and transverse meat from the accumulated transverse fascia to the pupar joint. Vikoristovuit not get wet the seam material. Shvi put on 1 cm of one side of one. The tightness of the fabric in the plastic zone with the hanging groin gap is assimilated by the path of the development of the front wall of the moisture of the straight abdomen on the protrusion of decal centimeters. The rope is laid over the overlapping seams on the new rear wall. Then sew the sheets of the aponeurosis of the lateral oblique meat edge to edge. At the same time, the opening of the inguinal canal was molded, but it didn’t hurt the cord.

At the drop of the significant "ruinous" of the posterior wall of the inguinal canal, the victorious views of Bassini's operation are correct - methodologyPost-Tempsky. Place the inner braid and the transverse mucosa in the lateral side out of the wide opening of the inguinal canal, then move the network cord to the Verkhnyolateralnaya kuttsy rozrizu. When we carry the cord from the medial side, we get the tendon with the inner oblique and the transverse joints, and the edge of the two straight joints, push up to the pubic hump and the upper pubic joint. Before the inguinal ulcer, suture not only the overhanging edge of the mucosa and the transverse fascia with sutures, but the upper medial leaf of the aponeurosis with Kimbarovskii sutures (Fig. 6.8). The violent cord is transferred from the shkira to the pediatric fatty tissue, setting up a duplication from the lower lateral leaflet to the aponeurosis. With such plasticity, the groin canal is liquidated.

The plastic surgery of the inguinal canal in women is still quiet, overwhelmed by the eye, and received. Zm_tsnyuyut the back wall under the round uterus, or, well, it’s quite right, you’re gushing in Shvi. Weakening growth on the front wall of the straight abdominal muscle is most often not needed, so the groin period of the bends is insignificant, the inner braid and the transverse muzzle firmly adhere to the pupil ring. Close the opening of the inguinal canal tightly.

In cases of obmezhennya recurrent hernias and structural "weakness" of natural myazo-fascial-aponeurotic tissues, a synthetic sieve-patch is sewn into the groin canal with a change in the back wall of the inguinal canal.

Affected by Stegnova's Gryga to be met in the middle in 25% of vypadkіv on vіdnoshennyu until all infringements of the grids. Differential diagnosis should be carried out between patients with stegovy lymphadenitis, pinched inguinal hernia and thrombophlebitis of aneurysmal enlargement of the arm with a large pediatric vein.

The established diagnosis of the hospitable lymphadenitis will be supplemented by anamnestics of the date, which will indicate the presence of the city and the results of an active reading. I respect the beasts for the manifestation of saddens, twists and turns on the lower prints, which served as the entrance gate for infection. Protect, innocent lymphadenitis correctly diagnose for more than an hour beforehand, if in the area of ​​the pediatric ring of the femoral canal (oval fossa) there are not grizzly symptoms, but rather high growth rates The lymph vuzol didn’t go through the trickle of the firing, it didn’t mean that the trivial lymphorrhea and the destruction of the lymphocyte in the picture were lost. To complete the partial wound sutures.

The appearance of a pinched stegnum, and not an inguinal grizza, is supplemented by an extraordinary retreat physical examination of a sick person. Pomilka in diagnostics, as it has already signified vische, not by the principle, although it is shown very quickly, it is shown very quickly. Brothers should be respectful of the manifestations of intestinal imperfections, which develop when the intestines are interconnected and discouraged destructively, and the chasms of the chafing michur are enriched.

Diagnosis of varicothrombophlebitis at the level of saphenofemoral transitions in large cases of non-vicious difficulties. It is necessary to determine the presence of local signs of a thrombotic process in the lower pediatric veins (hyperemia, ailment and cord cord). The contours and the size of the palpable infiltrate does not fluctuate when the patient is shifted from the vertical position in the horizon, the cough posture comes out. With the help of precise topical diagnostics, ultrasound duplex scanning with color maps of blood flow.

The operation of the drive of the pinched stegnous grizzly is considered to be the most important in the technical business, since it is necessary to have quick access to the grizzly mouse and the proximity of important anato-links to the court.

Likvidatsiya interchange can be practically only in the medial direction for the development of lacunar (gimbernatova) connection. However, here it is necessary to be borderline respectable, since in 15% of cases the lacunar ring is pierced by the great obturator artery, abnormally appearing from the lower epicranial artery. The meaning of the anatomical variant in the old people I will call it "the crown of death", as in case of a badly wounded artery, there was severe bleeding, and it was important to fit in.

Safeguarding and respecting the communication of the connection is strictly under visual control, allowing you to eliminate in the least unpleasant acceleration. If all the wounds of the abnormal artery have become, then it is necessary to press to bleed with a swab, peel off the groin ring, see the lower epigastric artery and reconnect either the basic artery, or the obturator artery. Before the growth of the groove ring, it is also possible to go out in quiet vipadkas, if you do not let the lacunar ring go out for the rakhunok of the growth.

Bagato hirurgiv, operating ailments from the restrained stegovy gryzhey, see the way of stegovyh methods of demonstrating the vision of grizzlies and plastics. The methodology is characterized by the approach to the stegnum canal from the side of the final opening. Three numerical proponated ways to practically eliminate deprivation Bassini method, how to set up in the offensive. When you see the groin mouse, the groin ring is double-three-seamed with sutures up to the upper pubic (cooper) ring, i.e., to the sweaty oxym of the pubic cyst. In such a rank, close the inner opening of the stegovy canal. Overlay of more than three seams is not recommended, as it can lead to late laying of the so-called stegnova vene.

The main shortcomings of Bassini's way of serving are: the folds of the grizzly bear, in the connection with which the dovga of the stump is inserted; technical difficulties at the stage of removal of the steginal canal and, especially, resection of the intestine. All negative inheritances can be hati-reaped, vikoristovy and inguinal access.

Mi vvazhaєmo for a docile part vikoristovuvati way of Rudzhi-Parshopchio, in the first place when there is a tricky intercourse of the intestine, if there is a very need for a resection. To carry out the rise, like at a groove, or at a hockey key, to switch to a stiff one, so that the look of a grizzly mouse is lodged. The rest of the opening and fixing of the pinching of the organ. The name of the opening of the stegovy canal is placed on the quilted, lacunar connection from the side of the open inguinal canal. Yak and Georgian insiders into the empty space, translate the visions of the mushrooms into the groin canal, conducting them with a pupar sound. Gryzhi-voї mіshok is a little bit of a vision and a lіguvannya shyki. Applying the seamstress, having entered the stegovaya vein, between the bosom and the pupar ties. Perform plastic surgery of the inguinal canal and suturing the wound. For resection of the intestine, vikonuyut laparotomy through the inguinal canal.

The umbilical hernia is affected take part in surgical practice in 10% of the rate of incidence before all infringements of the grids.

The clichéd picture of intercourse, as the wine on the right side of the gray pan is characteristic, but it is practically important to intertwine with the other pathology. Timing an hour, it is necessary to change, so that the umbilical grids are most often unreducible, and the manifestation is transmitted by the way in the whole region, there can be more and more cases of adhesions of intestinal problems, which are not very difficult. Let us be aware of the diagnostic knowledge to serve as a manifestation, or in the presence of the transmission of cough delivery.

With small umbilical grids, it is possible to have a richer intercourse, which is kind of difficult for the development, since it is difficult to diagnose the intestine because it is not superfluous to the appearance of a gut malfunction.

Vikoristovuyut operative access to the navel, which is close to the ny may be the place of rotation of the shkiri. To cheat two to improve the growth around gryzhovoypes. At the junction of the cim-gryzhovoy mesh, the shock is opened not in the area of ​​the dome-like bottom, but in the sideways, that is, in the area of ​​the floor. The growth of the aponeurotic ring vibrates to the offense side in the horizontal or in the vertical right. Remaining preferable, some of them allow you to switch to a mid-level laparotomy for a visitor, whether you need an operative one.

In case of phlegmon of a mushroom mouse, perform the operation of Grekov (Fig. 6.9). The essence of this method of the pole is in the offensive one: the bordering rozrіz of the shkіri prod-zhayut, the spike sounds, through all the balls of the black wall, including the stalk, and in such a rank they hang the grill with a single block at once to pinch the cloth in the interiors of the healthy ones. Moving into the empty space, re-straining the pinched organ proximal to strangulation and seeing the tightness of the body, not violently. If the intestine is strangled, then there is an anastomosis and an anastomosis is applied to the patient. If there is an omentum, apply a ligature to the proximal viddil, if you can also see the gland with a single block.

The methods of plastics of the aponeurosis of the anterior cranial wall are used either by the Sapezhko method, or by the Mayo method. And in that, and in the first place, the duplication of the aponeurosis is created by means of an overlay of U-shaped and high-knot sutures.

The herringbone of the bile line of the abdomen is affected. It is a classic practice to develop a healthy lifestyle in surgical practice. More often than not, for the infringement of the grizzly, they take the preperitoneal fatty tissue, as it penetrates through the skin-like defects apo-neurosis of the bile line of the abdomen. In addition, it is necessary to create and reassign the gut loops in the grizzly mouse, most often after the Richter grizzly type.

At the connection of the cym during the operative engagement with the drive of an allowable intercourse of the green line of the abdomen, it is necessary to quickly dissect the prolapse of the defect of the white line of the abdomen, the preperitoneal fat of the abdomen. When a gryzha mouse is detected, it should be opened, revise it to be in a new organ and then visit a grizzly mouse. When there is a grizzly mouse, put a stitching ligature on the lip and display. For the plastic closure of the gryzhovy vorit zastosovuyat zyvchay simple closure of the defect apo-neurosis with okremny sutures. Ridko, with the presence of multiple herds, the plastic of the bile line of the abdomen should be stuck behind the Sapezhko method.

Affected by the operation of the ventral hernia It is admittedly boring. Unimportant on the great grizzly gates, the enclosure can be found in one of the numerous chambers of the grizzly bear on the caloric, but it’s a bit more elastic, according to the elastic mechanism. In the case of obvious great growths, changes and deformations of the intestine are not often observed in the area of ​​maloperative grids, there are pains and manifestations of adhesions of intestinal imperfections, which are usually the result There is a certain amount of pardon in diagnostics that is not of fundamental importance, although in that and in the same way it is necessary to go into an extraordinary operation.

Promptly engaging with the drive of a pinched pislyoperatsiyna gryzhi to carry out anesthesia under anesthesia, allowing the development of a sufficient revision of organs in the black emptying and to sew a defect in the wart.

The size of the shkiri vibrates the fringing, the shards of it are dwarfed over the grill vipinnyam and without the middle is grown with the grill bear, and such that the loops of the intestine are drawn. To make a rosette of a grill bear, to infringe upon a circle, to carry out a revision of this together and to burn a published organi into an empty space. Deyaki xi-Ruhr grizzly mice do not see the sign of traumatism in the process of manipulation, but they sew grizzly gates in the middle with welded seams. In case of small defects, the edge of the aponeurosis is sewn "edge to edge". With great ventral grids, including a larger part instead of a black one, especially in children of a childish age, grids are not sewn in, but they are put on the operative's wound depriving them of shkirny shvi. Foldable methods of plastic surgery, especially with respect to alloplastic materials, in such cases do not get stuck so often, a bit of the stench will push the risk of operative involvement in a large contingent of ailments.

Rosrahovuvati on the success of alloplasty is possible, only strictly adhering to the rules of asepsis. A synthetic "sieve", as if to be put in, fiksuyut in such a rank, sew over it the edge of the aponeurosis (the intestines are guilty of being "vidgorodzhenii" from a synthetic material with a part of a grill mouse or a great omentum). It’s not a matter of zrobiti, the "patch" is sewn on to the final surface of the aponeurosis. In a general order, there is a drainage of the operational wound (with active aspirations for 2-3 days). All ailments recognize antibacterial pre-Paraty wide rangeдії.

Your robotic surgeon can get in touch with intercourse Gryzhi Spiga Ліев (півмісяцевої) Лінії. The grizzly gates when they are localized on the line, where the navel from the anterior upper part of the club's brush is close to the last edge of the straight belly meat. Gryzhovy mіshok can grow as a child, so also interstitially between the inner oblique mujaz and aponeurosis. Hirurgical correction of similar grids is displayed from oblique, pararectal or transverse access.

Cross-sectional, locking, sidnichnoy gryzh and ін. Zustriv chak vkray ridko. Principles of їkh operative treatment of victories in special-tsіalnіy posіbniki.

Restrained internal grids take a modest place in urgent surgery. The health of organs can appear in the folds and intestines of the quill near the mucous intestine, in the gut of the intestine, at the Treitz's ligament, in the lesser omentum, in the area of ​​the wide ligament of the uterus and in. With diaphragmatic grids, the inner diaphragm is infringed in the openings of the diaphragm of a congenital or traumatic pacing. Most often, the gryzha should have a "gracious" character, there are some splinters of the gryzha mice.

Affected internal grizzly can be manifested by symptoms of acute intestinal imperfections (with pain in the abdomen, bloating, obstructed pain and gas, major clinical and radiological symptoms). On the edge of the collapsible preoperative diagnostics of the wall of emptying organs. Radiographically infringed on the herd by the diaphragms, it is recognized by the presence of a part of the slunk or the organ in the thoracic emptying above the diaphragm.

As a rule, a lot of different types appear before the hour of revision of the black empty, operating the ailing one with the drive of intestinal impermeability. The obsjag of a surgical involvement in such a problem is a specific anatomical "situation" and a pathological change from the side of the pinched organ. If the integrity of the diaphragms is broken, it is guilty but it has been put down. Slightly open the stitching from the transabdominal access, one by one with the knot sutures at the edge. On-Shirn diaphragm defects "close" with small grafts from the side of the pleural empty space.

Pislyaoperatsiyne a sick person

period of operation in case of a pinched grizzly, there is a large amount of respect, but not in case of planned grizzly patterns. It was thought that, from one side, the ailments come in to complete an important overbought-bath, from the other - we will kidnap all the more patients. At the connection with the cym, except for the extreme, noisy weather in the operating area, we are ailing to punish the necessary cardiotropic and pre-Paraty. To carry out adequate disintoxication therapy, it is necessary to go in to fight against the damaged water-electrolyte and kit-lot-basic balance. In case of resection of the intestine, the ailments should be transferred for 2-3 days on the outside parenteral feeding... For certificates priznachayut anti-biotics. In the region, it is important to update the peristaltic activity of the intestine.

With the help of the prevention of venous thromboembolic diseases, anticoagulants and drugs are used to reduce the rheological power of the blood. The patient is guilty of getting up from the sled, as it is possible earlier, having pulled the bandage in front of the front. An active rukhovy mode is required on the day of the operation.

Likuvannya grew faster, depending on the character. For operations that are performed without plastic surgery of the grizzly collars, re-scheduled operations are performed in 3-6 months.

Finish the chapter, and then it’s clear that it’s just a quick and efficient sanitation of grids in a planned manner to allow the reduction of the number of extraordinary entanglements. A collapsed grizzly needs to operate yakomog earlier from the moment of intercourse. Adequate surgical tactics and correct technique vikonannya of all stages of operations of methods of reducing for operational acceleration, Provide a good functional result and prevent relapse of illness.

Diagnostics of the griffoning:

Diagnostics of the infringed gryzhi in typical vipadkah not folding. It is necessary to have a first for all the history of the patient, from which it is possible to see the manifestation of a sick man, before the moment the pain of the ball appears right and painless. Slid vrahovuvati also, before the moment the chuck is preceded, as a rule, stronger physical stress: pidnimannya vagi, big, stribok, act of defecation and in.

The physical condition of a sick person is guilty of being dearly respected, so the picture of a pochiezhennya is similar to those of the Small-rims, who are hospitable to the organs of the worms. In case of pain in the abdomen, for everything, it is necessary to look at all these "weak" mice of black hair, which can serve as gryzovy in mouths. There is an inevitable need for such a glance to the fact that one should be so called the primary infringement of the grids. In the case of the witness, they turn on the grizzly, as they will collapse without the middle at the moment of their cob appear, without a prior gryzh history. Especially often, the primary infringement is given to grizzly localizations: spigelia (pivmyatsevoy) line, transverse areas, obturator canal and in.

When you look around the gryzhovoy, make sure to be kind, you don't know or change the outline when you change the position of the sick person. Palpation is very intense and heavy, especially in the area of ​​gryzhovy vorit. Transmitting cough delivery. Per-Kusi vipinannya in the early stage of intestinal intercourse can cause tympanitis, protest from time to time there is a grizzly water and tympanitis changes with a dull percussion sound. When auscultation over a pinched grill, peristalsis does not hang, it is not easy to see the peristalsis of the restrained intestine over the abdominal empty space. When you look around the abdomen, it seems like a noise, a symptom of Val and other symptoms of intestinal failure. On-the-witness of the last in the case of a grip of a gryga can also be installed with an eye-catching X-ray of a black empty, with such a blink of a good chuck in the loops of the intestines for the purchased gas.

Differential diagnosis in case of interconnected grids, it is necessary to carry out a number of pathological stamps, which were knitted with grids themselves, so that they do not have a perfect match. Obviously, in typical cases, the diagnosis of unguis is awkward, albeit due to a number of circumstances (the grizzly is primarily affected, the manifestation of concomitant pathology of organs in the worm and in.).

Persh for everything necessary to differentiate infringed on the gryzh from not-right. Ostannya, as a rule, is not stressed, not painful, good for cough delivery. In addition, in the wake of the inappropriateness of the grizzly, it will grow out of hand, invoke a part of the grizzly all the time to be restored. It is especially difficult in the differential diagnosis of wine-nutty in the case of a large chamber grill, if it is interconnected to be in one of the chambers. In general, there are some common signs of intercourse: bile, sponginess, and the duration of the transmission of cough delivery.

Practical surgery in Vinikova needs a differentiated tsar to be interconnected. coprostasis. It remains to be a head rank in case of improper griffins in persons of a childish age, in those who are physically confident in peristalsis and strength before fixing. It should lead to stagnation instead of in the intestinal loops, to be located in the gristle, or even on the view of the fecal duck during coprostasis, but not the grip of the gut. Klinichno coprostasis build-up stepwise without anterior physical on-sprains with an increased development of pain syndrome. Nicoli pains are not intense, on the first place there is a touch of style and gas, there is no pressure on the headache, the symptom of coughing is positive. Coprostasis is not a vimag of an operative treatment, for its liquidation it is necessary to use a siphon system. Tim for an hour, a mother on uvaz, but unqualified caprostasis can lead to an infringement of the grizzly.

V CLINIC PRACTICE situations occur, as it is customary to denote the term pomilkov obmezhennya. Tse witness includes a symptom complex, scho nagadu a picture of an utisku, ale viklikaniy be-yakim we will welcome ailing organs of worms empty. The meaning of the symptom complex is to serve as the reason for the grave diagnosis of the grizzly duck, at that time the spiteful nature of the sickness becomes prikhovanim. Nybilsh often diagnostics grants they are diagnosed with strangulated lesions, hemorrhagic pancreatic necrosis, peritonitis of a disease of nature, pecinous and nirkova kolki... An inappropriate diagnosis to lead to the wrong surgical tactics, the growing up to the grisly-nyu replace the necessary wide laparotomy, which is unnecessary for the grizzly-peresetina when chopping or girder rings. A guarantee of some kind of pardon to serve only a respectful look around the sick person without any omissions. I will especially respect the animals for the big pose of the grizzly.

A clinician can get lost in such a situation, if there is a lack of grit, which is the main reason for intestinal failure, to become unresponsive, and to lose heart because of the inheritance of the strangulation of the intestine. The main reason for such a pardon is a disrespectful look at a sick person. As a memory slid, if the herd is squeezed, do not wait for a glimpse, as it is good to look at the anterior abdominal wall. Zokrema, with the cob groin groin, it is necessary to infringe on the inner groin of the inguinal canal. In this kind of vipad zvnіshnіy os-motr, especially in ogryadnyh ailments, do not give any results; If you do not have a retinal palpation in the groin of the trocha, the groin can be found to be more sensitive to a small size. Do not forget about the possibility of intercourse, so there is a rare development of grids: obturator canal, spigel line, girdle, intermediate and in. Here it is dictated to the visage of the famous French clerk G. Mondor: "If there isnostі gut slіd, persh for everything, until juvati gryzhovі gatesand shukati I have been infringed on the grizzly.

Without any words, it’s just as much of a diagnosis as it’s something winter, then the stench of guilt is permissible for the corny of a pinched grill. Hirurii-gi, as a great admonition in the city of gryzh, formulates the installation by an offensive rank: “In the case of the most recent droppings, it’s very good to go to the side of intercourse and termine operuvate the sick. Mensh is not unbeatable for a sick person to be out there;

On the pre-hospital and stationary stage, you can see what you see.

Prehospital stage:

1. In case of pain in the abdomen, it is necessary to look at the sick person for the appearance of grizzly.

2. In case of intercourse grids, or if they are susceptible to a squeeze, in the case of self-imposed adjustment, a patient for an emergency hospital in a surgical hospital.

3. Not safe and unacceptable try to force the rapist to infringe upon the gryges.

4. Zastosuvannya zestlyuyuchih preparations, baths, heat or cold, we are sick with infringement of mushrooms is contraindicated.

5. The sick person is delivered to the hospital on a stretcher in the position lying on the back.

Stationary stage:

1. For the diagnosis of a pinched grill є:

a) the appearance of a stressed, sickly person and not to adjust the self-reliance of gryzhovoypes with negative cough delivery;

b) key signs Gastrointestinal imperfection abo peri-Tonita in a sick person with a grill.

2. Start: temperature and temperature in the area of ​​the greenhouse. Iakshko see signs of muscular inflammation, carry out differential diagnostics of phlegmon of a mushroom mouse and other diseases (inguinal adenophlegmon, we welcome thrombosis of a large aneurysm

3. Laboratory dosage: zagalny analiz blood, blood sugar, zagalny analysis of the slaughter and іnshі behind the show.

4.Instrumental dosage: radiography breast cancer, EKG, oglyadova roentgenography of a black empty, behind the shown - ultrasonic examination of a black empty and a gristle.

5. Consultations of a therapist and anesthesiologist, if necessary - an endocrinologist.

Lіkuvannya obmezhennya gryzhі:

surgical tactics unambiguously ordering on the need for prompt operative treatment of pinched grizzly posture of fallowing due to the type of grizzly and term of encirclement. One contraindication before the operation is the agonal camp of the ailing one. Be-yak try to fix the grill on pre-hospital stage for in the stationary it seems unacceptable-Temperament through the insecurity of moving to a black empty organ, which is given to a non-turning ischemia.

Surely, є vinyats і of the rule. It’s about the ailments that are known to the important country through the manifestation of the fellow’s ailments, which at the moment of intercourse, which stood in front of the lykar, had passed no more than 1 year. In such situations, the operation represents a significantly greater risk for the patient, but not the way to correct the hair. This can be protected. Even at the moment of intercourse, it has passed three hours, then the reduction is permissible for children, especially the early age, some of them have a myazo-aponeurotic illumination of the eccentric wall more elastic, less important for the age ...

In a number of ailments themselves, which may seem to be able to adjust their grizzly, through the overexposure operation, they are repeatedly and very roughly tried to fix the pinched grizzly in home minds. As a result, you can win the name of the so-called imaginary right, which is one of the most important quick fixes. Significantly earlier than my reduction, the result physical injection lykarya. Pererakhumo va-Rianta "imaginary right":

1. In a large-chamber grill bear, it is possible to move the restrained insides from one chamber to the inside, so that it can lie more, most often in the pre-abdominal cell.

2. It is possible to release the whole gryzhovoy mishok from the navkolishnykh fabrics and to set it at once with the entrapped gutters into the empty gutter or the klitkovin.

3. In the form of a drop, I see it from the back of a gryge, so it is from a pair-mental queue. In case of a lot of infringement, the organizers "set" empty or klitkovin into the cell.

4. Taste of a rough correction can be caused by a pinched gut.

Typical clinical symptoms of a pinched grizzly after "imaginary" repositions cease to appear. Timing by the hour, the manifestation of a sharp ailment during the investigation of an operative growth of a grudge and a stomach in the past with anamnestic information about a mali, the abuser was right to allow the wrongdoing of the wrong

In the case of the general population (irreducible griffon, baggy chamber with a griffon), nutrition is guilty of being overwhelmed by the extreme operation.

In the case of papillous intercourse syndrome, for those who suffer from surgery, for those who are ill with a grave, they need surgery, and at the same time - Hernitonoplasty, as well as during the daytime.

Particularly susceptible to surgical tactics in the case of spontaneous repositioning of the pinched grizzly. As soon as it went to the hospital: at home, in the car for a quick help on the way to the hospital, or in the near-term rest, then the ailments of the protest squads will be hospitalized in the surgery.

It’s a known fact that it’s trivial to get sick for more than 2 years, especially in the case of gastrointestinal imperfections, to serve as a demonstration before an extraordinary operation (viconuated by the way of the middle laparotomy) for a diagoscopic laparoscope. The body is pinched in the general order of knowledge and evaluation of its life.

In all types of spontaneous adjustments: 1) the term is less than 2 years old; 2) the knowledge of the reliability of the person in the middle of being surrounded - it is necessary to have a dynamic guard over the camp of a sick person. In quiet situations, if the camp is black and empty in the best possible way, there is no need to worry about the situation: there are no more problems and signs of intoxication, ailments can be abandoned in the stationary and due to the necessary conditions.

Even in the process of being cautious, the patient's temperature rises, there is a slight ailment in the abdomen, and there are symptoms of a disorder in the abdomen, nine extracts in the middle of the laparotomy and resection of the organ, as soon as before the hour of a straightforward start of anesthesia or a cob of muscle anesthesia. Uninvolved on the price, start before the operation. Take the rosette of the grill mouse (if necessary, check the gernolaparotomy), look around the adjoining organ. Having discovered the organ, which has come to be interconnected, it will be found in the wound and evaluated the life. When twisting in the jolts of the pinched organ, it is pushed in until the laparoscopy can be assisted through the arm of the cracked grill. Let us proceed with the operation and finish behind the rules adopted for the restrained gryzha.

preoperative training before surgical intervention, we wiggle out of the drive of the pinched girdle, most often it’s the smallest: ask the sick person to urinate; If necessary, empty the slunk behind the auxiliary probe.

Ailments with trivial terms of intercourse, with symptoms of rotational toxicity and important supporters bilya-reap hospitalizations in the intensive therapy unit for the overall correction of damaged homeostasis indicators for 1.5-2 years Meals about the need for special preparation of a sick person before surgery should be provided by a senior surgeon and ANESA-thesiologist. I especially respect the children of the abducted and old child with serious pathology on the side of the heart-vascular system. Regardless of the nature of the preparation for the operation, it is necessary to pіznіche first 2 years of age for hospitals), as well as for the onset of skin growth of the dead intestine. Covering an operation for a rakhunok razhennya osyagu pro-passing by a sick person is unacceptable.

Sickness. Bagato hirurg_v see the crossing of the Mistsev ANESA-tezіі. Vvazhaєtsya, scho won’t be brought up to the unprejudiced right of Gri-zhi. Tim will show for an hour that the security is clearly overdone. I am overwhelmed with any localization of a pinched grizzly, without transverse, as a result of epidural (spinal) anesthesia, or intubation endotracheal anesthesia.

Remaining insistently necessary in case of expansion of the operative engagement in connection with intestinal imperfections abo peri-Tonit.

Special features of the surgical engagement. Extra-va operation in case of pinched grizzly there are a number of principles of their definitions from the planned performance grizzly. A slide of memory, to the staff of the surgeon at a maximum speed of exposure and fixation of the pinched organ for the removal of the lick in the middle of the empty during the onset of manipulation in the area of ​​green hair. Rose should be carried out without the middle over the Gryzhovo and the third time before the location of the Gryzha. Rise a child, a child's fatty cell, and do not see the mushroom bears, the bottom of it is raised. Zazvychay when wagging zhovtuvaty or dark brown color Gris water. At the ring of cims, before opening the grill bear, it is necessary to isolate the wound with gauze servet. Immediately after the opening of the grizzly mouse, the assistant takes care of the pinching of the organ (most often a loop of the small intestine) and will fix it in the early. It is possible to continue the operation and infringement of the circle, so that the gates (Fig. 6.3). Varying the price in the most oven-free direction on the basis of the quality of the tissues and organs. The pinching of the organ can be done in two ways: the diffusion of the aponeurosis is repaired either without the middle from the side of the gryzhovykh in the mouth, or go into the protylny directly out of the invisible aponeurosis until the umbilical tissue is surrounded by the ring. In both cases, in the case of a unique device, the aponeurosis development organ needs to rotate by moving a grooved probe.

Once again, we are guessing about the possibility of a retrograde chuck. Zvyazyka z zim, if there are two or more bowel loops in the gryzhego, thenit is necessary to look around the intermediate loop, as it is placed in the black empty space.

Having strangled the gut, assess the life for the following signs:

1) normal erysipelas of the intestine;

2) the appearance of peristalsis;

3) the value of the pulsation of the Sudin Brig, received in the Strang-lyats.

As all the meanings are signs of presence, then the gut can be rendered life-long and empty. In the case of general vipads in the intestine, inject 100-150 ml of 0.25% novokain and co-greval of pinching of the dilyanka with a stretch of 10-15 minutes with servetka, soaked with warm physiological sodium chloride. As soon as I want to see one of the pererakhovannye vishche and get lost in the gut, then it’s worth serving the indications until the rezhek-tsії її in the boundaries of healthy tissues, as in large quantities of water through the vast majority of water.

The length of the pinched loop allows for a view of 30-40 cm to bring the bowel (strangulation) and 15-20 cm of the bowel (lower). Chim who has done the same, Tim has been widely guilty of butti resection. It was thought that, when the intestines were interconnected, that є on the basis of one of the types of strangulated imperfections, it’s possible to bring a message, which is known to be a pereshkodi, it’s guarded in a big step, not to see it. At the connection with the cym, the imposition of the intestinal anastomosis near the strangulated furrow is connected with the inconsistency and development of peritonitis.

The resection of the pinched small intestine is violated according to the basic chemical rules; The anastomosis can lead and lead with the help of shortcuts. In case of a sharp inconsistency of diameters, lead and lead out of the intestine until the anas-tomosis "bik u bik" is applied.

At the same time, the distal border during the resection of the club intestine is located less than 10-15 cm from the mucous membrane, then it goes into the submission of the ileoascendo - or ileotransverse anastomosis.

In some cases, the intestine itself is in its own way, the intestine is seen as a whole zhitєzdatnoy, ale little twists and turns of strangulated furrows, in some cases, local necrosis can develop. In some situations, it is possible to protrude into the circular bore strangulated grooves by means of vnodal serous-oily suture sutures, with the obligatory control of intestinal passage. In case of severe changes in the area of ​​strangulation furrows, it is necessary to resect the intestine.

It is necessary to remember that in the pinched loop of the intestine in front of the suffering mucous membrane and the mucous ball, which is not visible from the side of the serous membrane, and about the striking of which one can judge deprived of indirect signs. In the literature, there have been descriptions of the mucous membrane perforation and perforation of the small intestine, which has become known to me. Described is also cicatricial stenosis of the small intestine when obmezhennya, adhesion of її from the otchuyuchye organs, which in general led to the appearance of intestinal obstruction.

Significantly simpler than on the right with necrosis of a pinched omentum. In most cases, the necrotic part is seen, and the proximal part is set empty into the abdomen. In case of intercourse of fatty tissue, it is possible to rupture the harvesting of the intestine. To that, when making a cut, it is necessary to take a quick look around the intestinal wall and assess the life.

Surgery tactics in cases of interconnection of their organs (fallopian tube, worm-like growth and inn.) For example, when operating a patient with necrosis of the sigmoid colon, it is necessary to expand the scope of the operative engagement and vikonuvati Hartmann's operation from the pre-median midline laparotomic access.

Having bored a living or resected organ into the empty space, when it was interlaced, I would see from the navkolishnogo clit of grizzly bears, bandage it from the shyka and a little bit. Until the isse-nyu grizzly bear is blown out with great grids, among the pre-sickly viku, tight-knit fellow grieves and among children. In cich vipadkas, ligate and rewire the grill bear in the shyka, and cover the inner surface with alcohol in order to wickle the adhesion of the leaves.

At a small, fallen ground in the form of a grill, start up to plastic grill collars. At the same time, the operation is fundamentally not related to the planned vision of the grizzly, for the blame of the fact that with a pinched grizzly it is necessary to use the most simple, low-traumatic methods of hernoplasty, as it is not complicated, but it is not complicated. Until the present hour, the loosening of the tension-free method of hernoplasty from different allografts is used. In the minds of extreme surgical practice, it’s stagnant, you get sick with infringed griffins, as there are large grizzlies (recurrent groin, umbilical, pislyoperative and inn.)

The primary plasticity of the wicker wall cannot be robbed with the flog-coins of the grizzly bear and peritonitis (through the severity of the ailments and those who are not safe), great ventral grids; In the case of cich vipadkah, the application of seams to the abdomen is followed by only partial suturing of the operative wound and the application of the seams to the scruff.

The announcement and the last of the prompt engagement with the pinched grizzly drive, which called for the development of gut failure, is due to the peculiarities and difficult clinical situations.

Okremo slid zupinitsya on the principles of operational engagement with special types of pinched grizzly. viyavivshi obmezhennya kovznoy gryzhi, the surgeon is guilty of being especially respectful when assessing the life of a pinched organ in that part, as there is no serous cover. Most often it is "to scrub" and to infringe on the slap of the intestine and the sečovy mikhur. In case of intestinal necrosis, the midline laparotomy and resection of the right half of the large intestine should be performed using the ileotransverse anastomosis overlays. After the end of the stage of the operation, proceed to the plastic close of the grizzly gate. In case of necrosis of the wall of the cuticle, the operation is not less foldable, and the risk of resection must be carried out with the attachment of the procedure.

in case of prejudice Gryzhi Lіttre Meckel's diverticulum went to be in any kind of fall, right from the fact that it was renewed by his life. The need for a visible diverticulum of a viclikan tim, as well as a rudiment of delusions, as a rule, of a powerful breech, to go out from the free edge of the small intestine and to go out with blood. At the zyazyka z tsim to navit a short-hour duck is tied with insecure necrosis. For visualization of a diverticulum, a ligature-purse-string method, similar to an apendectomy, or a wedge-like resection of the intestine, this figure includes the presence of a diverticulum.

In times phlegmonic mushroom the operation should be carried out in 2 stages. With the help of anesthetic anesthesia, a midline laparotomy is performed. With a lot of accelerated pinching, the body of the floor is mintally soldered with the grizzly gate, so it is not safe to slip away into the empty gates practically every day. Have the same hour fierce fire In the area of ​​grids, I have a real problem with information about black emptying, as it is an operative to pick the grizzly mouse in a very special way.

Having made a laparotomy, go to the restrained organ from the middle. If the intestine is strangled, then її mobilize in the meantime between the gut. From the Seca and the pinched part of the intestine, which is visible to the eye, overlooking small kuksi, which is sewn tightly. If it is necessary to bring and to introduce the vital intestine, impose an anastomosis with a single intra-nodular suture. Nutrition about the method of completing the resection of the intestinal tract virishut individually. As a rule, obstructive resection with colostomy overlays is performed.

For the formation of the anastomosis, put a purse-string suture on the neck near the pinched ring (in front of the front of the neck of the mucus, fill it up to the neck), in the middle of the middle of the village. Then we sew the laparotomic wound and move to the 2nd stage without the need for the middle in the area of ​​the gristle. They open the gates, the fatty cells, the bottom of the grids are opened, and then the grids are cut over the gates, so it is possible to build up the grips and see if the body is pinched, including the gut. Likewise, they saw a lot of intestinal necrosis, drain and tampon the empty ginny. There is no way about the plasticity of the grizzly hairs in the flowers.

Naturally, from the plasticity of the gryzhovyh vіt to bring up the grizzly diva, alas, it is necessary to remember that the first task of the surgeon is to preserve the life of the sick, and the operation according to the plan can be repeated in order I will tell you a surgical tactic to stagnate in all cases of phlegmon of a gryzhny mushroom, behind the blame of a gnarly burnt on a pinched umbilical grizzly, in case of stagnating circularly, in a general way. Greco-vim. The essence of this method was lower in the distribution, assigned to the poo-pochny to the grids.

For ailments, who are in an extremely important camp, do not allow a wide laparotomy, it is permissible to go into the so-called exterioration of a pinched organ. In cich vipadkah under local anesthesia, the grizzly mouse is retarded and the gates are infringed, when the necrotic intestine has been impaired and the grizzly is locked behind the fringes of the grizzly. It is also acceptable to hang the necrotic part of the intestine and fix the intestine in the circumference of the wound like a double-barreled stomy.

Up to what kind of lіkarіv slіd zvertatyvatsya yakshcho you have a Gryzha:

gastroenterologist

Are you a turbo? Do you want to know more detailed information about the reduction of grids, the causes, symptoms, methods of treatment and prevention, how to overcome the ailments and see children from her? Why do you need to look around? You can sign up for a reception before the doctor- clinkika Eurolab wait for your services! Brush a little car to look around you, get some signs and help you see ailments behind the symptoms, consult you and give you the necessary help and supply a diagnosis. you can also viclikati likarya dodomu... clinika Eurolab vіdkrita for you tsіlodobovo.

The yak will turn to the clinic:
The phone number of our clinic in Kiev: (+38 044) 206-20-00 (broadband). The secretary of the clinic will visit you every day and hour to the doctor. Our coordinates and the scheme of the process are indicated. Wonder in more detail about all the services of the clinic at the її.

(+38 044) 206-20-00

As soon as you were before the boule viconani, Observe the results for consultation before the doctor. As soon as the viconians have not been bullied, everything that is needed in our clientele is scrutinizing, or for our colleagues in the other clientele.

You? It is imperative to go further to the camp of your health as a whole. People get too little respect symptoms in illness and do not understand that ailments can be life-threatening. Є a lot of ailments, as a few things do not manifest themselves in our body, or in the bag to appear, but, unfortunately, it’s already nice. Skin congestion has its own singing signs, characteristic signs of manifestation - so called symptoms of ailments... The diagnosis of symptoms is the first croc in diagnostics of ailments in general. For the whole, it is simply necessary to develop the passes the rigging at the lykar, It’s not just a terrible ailment, but a healthy spirit in everybody’s body in general.

If you want to give food to a likar - speed up the online consultation, you can see what you see there on your food and read please for a glance... If you want to know about books and licenses - try to know the information you need in the mailing list. Also register on medical portal Eurolab You will be constantly updated on the latest news and information on the site, which will automatically be sent to you by mail.

Інші ailments from a group Ailments of the shlunkovo-intestinal tract:

Affected by the grill we host a surgical camp, Lіkuvannya yakogo maє zdіysnyuvatisya negativno. The success of the operation in the abundance of lying in the form of pinching and freezing of the patient in the clinic.

Photo 1. In case of interconnected grids, it is necessary to have a term of victories, I will not be able to help you. Dzherelo: Flickr (eceveryshop).

Sho take Gryzha Affected

The grill is feared - greet the little bear in the gryzhovy gate... At the same time, the metabolism in the quiet structures and organs, which store a new solution, is disrupted. When there is an increase in the black wall, there is an expansion of the grill doors, in which there are internal organizations. Organi will get lost in the state of health with a ringing speedy sound.

You can be interconnected, be-like, see the grill, ale most serious for health to vvazhaєnja squeezed internal organs in the black empty.

Brutal respect! The head is not safe in the fact that a sick person can develop an inflammation of the intestine or an imperfection.

Classification of intercourse

Seeing a few types of pathology in the prevalence of reasons for the diagnosis and the nature of the pathology.

Elasticly pinched

Vinikє through physical overstrain, when a part of the internal organs go through the empty empty space. mill becoming the cause of ischemia and strong muscle spasms. Vіdmirannya fabricn vіdbuvaєte for a stretch of 1.5 - 2 years.

feces

Rise through the re-supply of intestinal loops with feces. Specialty Problem is check the health of the client, Nіzh with elastic interconnection.

Necrosis develops only after 2 minutes after pinching. The main cause of fecal disease is the deterioration of the peristalsis of the etching organs.

parietal enclosure

bowel loop welcome to chastkovo.

zmіshane obmezhennya

Get involved in the neglected stage of fecal duck, If the building element grows in size and produces the stretching of the grill collars. Stench in your chest to squeeze on the lead and lead the bowel loop.

Gryzha Lіttre

Characterized by quick wrinkles of tissue pressure... Most often it is spostering with squeezed stegnum abnormal inguinal new products. This is a kind of obmezhennya to be seen only with small grids, which can be seen at the vuzki gates. It is possible to bring it to the wall, if only one sees a greater leakage, which can lead to necrosis, some of the grizzly hairs are more likely to get worse with blood.

retrograde duck

At the gryzhovi gate, you can use the gut loops, or if it is infringed, there is only one of them.

The cause of the pathology can be the re-supply of the intestine with feces, or overwhelming physical options.

Reasons and mechanism of establishment

Mechanism of development of the pathological camp of the same for all types of grids. Vipinnya is stored from decilkoh main parts:

• the gate is an opening, which is established in weakened sounds and sounds;
• Mishechok - to empty the grill, kudi to use the meats of fabrics and internal organisms;
• gryzhove vmist - part of the organs, which penetrated through the gates of illumination.

Brutal respect! Most often, in empty grizzlies, you consume a rectum, an omentum or a sečovy mikhur. If the internal organisms are pinched, they cannot independently take the anatomically correct position.

The main reason for the affirmation is internal vise, Yake provoke a number of factors:

• stronger stress during defecation;
• trivial cough;
• pathology sechovipuskannya;
• reduction in weight;
• the importance of childbirth;
• wearing a tight dress and belts;
• gastroenterological problems.

Symptoms and signs

Omezhennya Gryzhi does not become uncommon, as it will be supervised to become a bright and classy picture. Before characteristic signs I will admit:

1. small pains, Scho vinikayut pislya press springs. Signs develop on the tlі of a sharp decrease in the arterial grip. Do not be aware of when people try to touch until the ad.
2. pinching illumination is not set on the place, Uninvolved in the distance in front of the front, adjust the grids.
3. stretching i pochervoninnya shkiri over p_densennyam.

Differentiation is a type of pathology, which is similar in symptomatology to ailments, maybe only a drug. Yaksho stan vinniklo u ditini, then ailments become restless, consuming appetite and sleep... From a trivial cry, a slight, low temperature.

All pererakhovani signs are guilty of being the cause of the innocent malignancy to the gastroenterologist, so as far as possible to lie away from the triviality of sour hunger of pressed tissues.

diagnostics of pathology

Diagnosis of pathology includes zovnishniy look around sore zone. Lykar assessing the size and widening of the diagnosis, as well as the beginning of the steps of the ailment during palpation.

Brutal respect! With a change in the position of the pinching of the fingernail, the mouse does not change the size and does not know, which is typical for other types of pidvischeny.

Likar is also a revision the presence of the transmitted cough delivery, Yaky for pinched illumination is not characteristic.

For an accurate diagnosis, it is required radiography organs of worms empty. It is instrumental to continue to allow for intestinal imperfections. For differentiation of pinched grids from other types of views, it is indicated Ultrasonic examination of internal organs.

Likuvannya pinched grill

To fight the problem only... Until the arrival of the shvidkoy ailment, take a lying position, pushing a small pillow over the head. Zaboronyaєatsya get up, collapse, progrіvati a sickly dilyanka or take a zealous zasobi. Tse to produce up to accelerated pathology and creation of a clinical picture.

Cycle and vidi of surgical engagement

Meta operations - stick the grip of the gryzhechka on navkolishnі fabrics and sounds of internal organizations from gryzhovyh collars. Tsі dії allow you to preserve the health and life of the patient. In exchange for a quick engagement, you can renew it without delay.

When carrying out anesthesia, surgery was seen in two ways:

• standard,
• laparoscopic.

Standard not surgical involvement

over the day distribute the shkira, and then the little boy himself... For the squeeze, the internal organ is fixed in the cob position. If the fabric is not shit, then the car is set back. Schoolgirls and dead children are seen at once from the grill. For the plastics of gryzhovy vіt lіkar vikoristovuє or vasnі fabrics of people.

laparoscopy

Vtuchannya mensh is traumatic, the operation is not standard. The term of rehabilitation will speed up for a rakhunok. Laparoscopy may not be stagnant in all types. Indicated before the operation: minor changes in the diagnosis, the visibility of the patient with chronic ailments and symptoms of intoxication. From the moment the soft tissues are pinched before the laparoscopy, it must take at least 3 years. Laparoscopy does not affect people with obesity and intestinal impairment for an hour of vaginoscopy.

minimally invasive surgery maє reversals before the standard reimbursement:

• in a sick person's scar on the shkiri;
• minimizutsya risik development accelerated;
• with injuries to navkolishnykh tissues

Tse is important! Laparoscopy is carried out in stages: punctures occur in the field of pre-treatment, through which small surgical instruments are introduced. The process is carried out under a visual video camera, which is equipped with tools.

Training rules

The operation is practically not a proof against recent heart attacks and infarction. Prepare before engaging in a show So a pinched herry can be healed by necrosis.

may you expedite

With unprecedented visualization of fecal duck, the sick person grows symptoms of intoxication: It is difficult to diagnose gas during defecation. Stroke blues swell the smell of feces.

bad help lethal result.

From the point of view of the mechanism of determination of the accelerated rate, there are two principally different types of intercourse: elastic and fecal.

more elastic winners of the rapture vyhogennya of the great obsyagu of the inner cores through the high school gates at the moment of the rapid movement of the inner-chested grip along with a strong physical stress. As soon as the organisations go, they do not independently set themselves back into the empty cell. In addition, the pressure (strangulation) in the vuzkiy gryzhovykh vorit is the ischemia of the infringed organs, which can lead to a swollen pain syndrome. At his own heart, a vicious spasm of muscular spasms of the anterior chernaya stinka, as if possible, has a strong spasm. Unlikvidovanimi elastichne can lead to fast (stretching decilkoh years, at least 2 years) necrosis of the grill in place.

at feces infringement The pressure of the grill instead of the wine is as a result of the rapid re-equipage of the intestine loop, which is located in the grill. The opening window of the chain of the loop is very narrow and squeezed in the gate at the same time with the adjacent brigade. In such a rank, the picture of strangulation develops in the endless rakhunka, similar to the present, as it is spared in the case of elastic intercourse. In the case of mice, for the development of intestinal necrosis in case of fecal impairment, the necessary more trivial term (kilka dib) is necessary.

With an unequal mind, the denunciation of an elastic duck є the appearance of vuz'k gryzhovy gates, at that hour, as a kalov, a contiguous vinnik is not so harsh at the wide gryzhovy gates. In the case of a fecal duck, the physical zusilla has a lesser role, but not in elastic strangulation; more significant is the loss of intestinal motility, the confidence of peristalsis, which is often seen in a kidnapped and old man. The order of z cym in case of feces infringement is the very role of playing the gut, twisting the intestines, being in the grill and growing the grill with the walls of the grill mouse. In other words, if you want to be bummed, you winnicky as a slower trivially unreasonable grill.

Injury can be reduced by growing organizations, like є gryzhovy vmistom. Most often, the small intestine appears, or the great omentum, and then the intestine. It is even more rare to be surrounded by organisms, rostasovani mesoperitoneally: intestinal slip, sechovy mihur, uterus and appendages and in. Naybіlsh is not safe for intestinal obstruction, since with a large amount of death and development of important strangulated intestinal imperfections, as well as a great shock, I will accumulate progressive intoxication.

Pathogenesis (how to see?)

At the moment of encirclement in the grill bear, the empty space is closed, yak to take revenge on the organ or the organ, in which bloodsteps have been destroyed. At the point of squeezing the intestinal loop, omentum and other organs, it is so called strangulyatsіyna borozna, how to get a good look at the letter of the courtesy. You are kindly seen as in the area to bring and to bring out the intestines, as well as in the general breeches.

As a result, as a result of the destruction of blood in the intestine, venous stasis, which is not a barnacle in the intestines. One hour, diapedesis of blood and plasma elements is seen in the middle of the enlightenment of the pinched intestine, and in the empty grill mouse. In a closed enlightened ischemic intestine, the process of expanding the intestinal cavity is repaired, which is characterized by toxins. Intestine loop is affected to finish quickly, stretching out decilkoh years (with elastic interlocking), succumb to necrosis,how to obey because of the muck, then the enemy pidslizovy ball, myazovu and in the left serous membrane. About the tse it is necessary to remember, estimate and life.

Ridina, a yak to accumulate when surrounded in a closed empty grill bear (for a rakhunok trans- and eksudatsії), I will name gryzhova water. A handful of prozor and bezbarvna (serous transudate), protects the world with forms of mushroom water to fill the roast, and sometimes it is red-brown boiled water. The necrotized intestinal wall ceases to serve as a barrier for the microbial flora for її boundary, as a result of exudate in the endocyanal bag, swelling a gnarly character with a colibacillary odor. A little more fiery, growing up in the lower stages of intercourse, how to grow on the top of the floor, the fabric is very small, but the name is not exactly called "Phlegmon of a mushroom bear".

When interconnected, it is not just a small part of the intestine, which is in the grill, but rather leads to the appearance of the rosette in the black empty. As a result, the development of intestinal imperfections in all cases accumulates in the intestine, a kind of stretching of the intestine, and a small amount of groans. All the changes that are characteristic for the whole pathological camp can be found.

The result is infringement, strangulation of the intestine, as it seems, is one of the most important types of intestinal laxity, especially when the small intestine is interconnected. In the end of early bagatoraz blues, it is very easy to bring the organism up to an unhealthy level, waste life-time important electrolytes and bile intrigues. In addition, the delay of the nerve elements of the breech until the appearance of an important painful shock right up to the moment, as long as there is no bowel necrosis and pinched breech. The purpose of the change and the striking is to bring the bowel back to a non-safe development not only of phlegmon of the mushroom mouse, but of the gnarial peritonitis.

Pererakhovani factories start a high rate of mortality, which can be caused by infringement of the griffins, so that it is necessary not only to have an early operative involvement, but to carry out an energetic therapy corrective surgery.

In yakosti special types of chuck Razrіznyayut retrograde (W-pro growth) and parietal (Rіkhterіvske) obmezhennya, gryzhu Littre.

retrograde duck It is characterized by the time that in the gryzheme there is less than two gut loops near the apparently prosperous camp, and the most famous snakes are the third, like the one out of the way, the loop is roasted in the gutter loop. Vona is in the greatest minds of bloodstending, the spirits of the breeze, the time to get over, entering the gryzhoy mіshok and going out from the ny. A similar type of intercourse is spared infrequently, although it is less important, it is less important, since the main pathological process does not develop in a closed grill, but in a willow black empty. In this vypadku, there is much more concern for the diagnosis of peritonitis. In case of retrograde infringement of the surgery, the hour of the operation is guilty of looking around the bowel loop, which is in the middle empty.

parietal enclosure see also in literature under the name of Richter's Gryzhi. At any given sight, the intestine is not built up to the full extent of its education, but rather than partly; In this context, there is no reason for mechanical intestinal imperfections, but there is a real problem of necrosis of the intestinal wall due to inheritance, but the sound is smelled with inheritance. At the same time, the diagnosis can be done smoothly, through the visibility of the swelling pains (there is no bowel breeze). Often the small intestine is affected by the small intestine; The whole kind of nicholas does not occur with large grizzlies, which are typical for small grids with high grizzly gates (stegnova, umbilical griffins, grids of a bile line of the abdomen).

Gryzha Lіttre - tse obmezhennya Meckel's diverticulum in the groin grizzly. This pathology can be attributed to an osteoarthritic urinary tract with only a small drop, in conjunction with the big minds, the blood-flowing diverticulum is more likely to suffer necrosis, but not an ulcer of the intestine.

Symptoms of grizzly hair

In case of skargs on raptus cinnamon pain in the abdomen (it is more, if the stench is supravodzhuyutsya symptoms of intestinal obstruction), it is always necessary to remove the abdominal pain. The axis of what, when looking around at any sick person, when I grow up, lives on the path of anatomical zones and a young man's life.

For an obmezhennya characteristic chotiri signs:

1) a sharp bile in the area of ​​a gryzh, or for the whole belly;

2) the irreducibility of the grizzly;

4) the duration of the transmission of cough delivery.

bіl є the head symptom of bridging. Vona winikє, as a rule, at the moment of a strong physical stress and not a chill, you should be able to lean back. The floor is strong, but an ailing old man is important to see him and cry. The behavior of the patient is unsettled, curiously curved, the manifestations of current pain shock from tachycardia and decreased arterial grip develop slowly.

More often than not, along the course of the road; when the intestines are interconnected, the intestinal tract is stimulated to the center of the abdomen and epigastric disease. In the case of a large number of vapors, it becomes too much for a long stretch of decilcox years right up to the moment, if necrosis of the pinched organ develops from the bend of the intramural nerve elements. In some cases, it can take on a variable character, which is tied to the development of intestinal imperfections.

irreducible gryzhі - signs that can be meaningful only when interconnected, previously right hand.

Gryzhov's stranglehold In order to improve the situation, it is necessary to suppress the infringement of both right and wrong grizzly. At the link z tsim is given a sign that is more meaningful for the definition of intercourse, lower itself, by itself, is the irreducibility of the gryzha. Let us say that we will not only be stressed, but rather sickly, but it is not easy to identify the ailments themselves when the grits are worn out and try to fix them.

Delivery rate of cough delivery in the field of gryzovy vipinnya - the most important sign of a chuck. Wine of dressing is from that, at the moment of cutting, the pinky bear of the rose will come together with the white black empty and old yak bi isolated with sanctification. At the moment of coughing, the connection with the cymus of the intracranial vise, yake of the cough, is not transmitted to the empty grill (negative symptom of coughing). This symptom is important to evaluate in case of great ventral grids, in which a part of the vascular organs is significant. In such situations, when coughing, it is important to transfer the cough on the grill, otherwise it’s good to be healthy at once with our stomach. For the correct interpretation of the given symptom in certain types of problems, it is necessary not to put the bowels on the head, but to hunt him with two hands. If there is a positive symptom of a cough delivery, the surgeon has a better condition.

Percussion over the restrained gryzviya, start dulling for the gryzhovoy water (if the gut is taken into the gryzhey, then in the first year the tympanitis will become obscured).

Obmezhennya is not so easy to supravodzhutsya with one-time blues, as sphattu to wear a reflex character. Nadal, in the world of development of intestinal imperfection and gangrene of the intestine, it becomes permanent. Bluvotnі masi swell greenish-storm colіr z unacceptable smell... Oskilki obmezhennya intestine (vyklyuchayuchi Rіkhter's gryzhuyu) accelerate the gastrointestinal imperfection, then supervise all characteristic symptoms.

Part of the intestine, for example, the mucous intestine in the kovzno inguinal gryzha, the symptoms of imperfection are not vicious, but it’s not a bargain, if the order is interrupted, it’s more painful to accelerate the pomp of positiveness before the defect. The parietal obmezhennya of the chaff in the kovznoy gryzhi is superfluous with dysuric disruptions: let us speed up the sore sechivipus, hematuria.

In the sick of the sickly age, who suffer from a lot of rocky rock, in the case of the bagatorial victorious bandage, it seems like a sound to the sick and inappropriate in the area of ​​the grizzly. In such patients, as a result of a dump, it is important to determine the nature of the pain syndrome, the moment of the appearance of intense pain and some uninvolved symptoms.

Trivale obmezhennya, as I have already said, to develop the phlegmon of a gryzhen bear. It is clinically manifested by the syndrome of systemic ignition reaction and characteristic muscular signs: swelling and hyperexia, severe pain and fluctuations over the young.

In the end rakhunka, the triviality of the intercourse will end, as a rule, with the development of the poured peritonitis in the event of the transition of the ignition process to the black empty, for the perforation of the thinly stretched and thinned gut.

Vishche Bula Vikladena is a picture lured by the head rank of elastic restraint. Kalovi obmezhennya maє ti regularity development, ale the opposite is less boisterous. Zokrem, with fecal infringement not on the bendings of the bolovy syndrome, more and more intoxication develop, and necrosis of the pinched intestine is infused. Protest, the kalovi obmezhennya so itself is not safe, as it is elastic, the shards of a dazzling result of two types of snaps of the same, for that the tactics with them are only one.

Okremi vidi infringed gryzh

The inguinal grill is affected. The reduction of the groin grizzly grows in 60% of the cases in terms of maturity up to the outright number of utings, which is the most common frequency of the groin grizzly in surgical practice. Often the groin of the groin grizzly is hampered, so as the stink passes through the entire protruding of the inguinal canal, at that time, it only passes straight through the distal part of the groin.

The cliché picture of the infringed groin gryzha is characteristic, as all the signs of the inferiority are easily remembered. Difficult to do only when there is an interconnected canal grill in a large internal groin of the inguinal canal, as you can only see it with a respectful eye. When you see the localization of the lateral inguinal fossa, it’s possible to make a mistake, to reach a sickly little acceptance, so that it helps to establish the correct diagnosis.

Differentiation between the groin grids is required inguinal lymphadenitis, Gostry orchiepididimita, chilli and dropsy of a small cord or pinched stegnova gryzha. In the first two cases, there are a lot of anamnestic cues on the front of the grizzly, there is not a lot of pain and blues, and the pain is most often supervised by early temperature changes. Establishment of the correct diagnosis of additional help with an extraordinary physical examination, in case of any given reason, there is no change in the groin of the inguinal canal, the appearance of sadness, podryapin, gnosis of the lower case of hemorrhage, prostatitis, proctitis, proctitis In cases of orchiepididimitis, it is likely that the appearance of a malignant sickly cell and its appendage is evident.

Oncologic disease of a yachka and a family cord is not supervised by the rapid appearance of clinical symptoms, but it can be caused by a restrained groin grill. Retaliation of fingers to the inguinal canal is allowed to turn on the pathological stump. Pukhlina yєchka palpation is sharp, not very humpbacked. Palpation of the gidrocele and funicular is painless in the case of a pinched grizzly.

Women do not just want to see the shape of the groin grizzly from the stegnova, especially with a small grizzly grizzly. If you have a very respectful and protective look, you can stand up, so that the stegov's grill go out from the groin ligament, and the last opening of the inguinal canal is good. However, the preoperative diagnostics is not of great importance here, although the term operation is shown in the first place. Having spent an hour in hand with the help of the localization of the gryzovy vorit, they rob the general method of plastics.

As soon as there are difficulties in the clinical verification of the round uterine ligament, ailment needs to be given an emergency operative task, since in such a difficult diagnostic situation it is possible to miss the grievance.

If the groin is surrounded by a groin and a small fat cell (the projection of the growth is 2 cm in food and is parallel to the pupar ring), a mushroom is seen in the bottom area. Carefully open the wall of the yogo. It’s not a good idea to get rid of the grill if it’s close to the mice, so there’s a way to connect it to the grill.

The cultivation of the original style of the grill bear among the ailments from the right-sided utterance can testify about the manifestation of the kovznoy grill. Schob will uncover a wounded intestine, then open the thinnest part of the grill mouse on the anterior-medial surface.

As soon as the operation takes place, the meat fibers appear at the inner wall of the grill, after the impression of the cutter is seen. Detection of dysuric symptoms in a sick person undergoing a dose. In some situations, it is necessary to open the most thin-walled lateral part of the grill bear, to unify the iatrogenic pockmark of the grill.

Having opened the grill, they aspirate the transudate and take the seed. Fiksuyuchi gryzhove with the hand, rozsіkayut infringe on the wrist. Call їm є zvnіshnіy opening of the inguinal canal. In addition, along the fibers, the aponeurosis on the mucous membrane of the abdomen grows onto the grooved probe in the outermost right (Fig. 6.6). As soon as there is an encirclement at the inner opening of the inguinal canal, the infringement of the ring is also raised to the lateral side from the family cord, memory, from the medial side and to pass the lower supracranial judge.

If there is a need, for an omentum, for a resection of the small intestine, or a great omentum, for a hernioleparotomy - to straighten out the posterior wall of the inguinal canal and to straighten the tendon part of the internal oblique and transversely. Most of the ailing have enough access, just to take a part of the small intestine and the great omentum with a glance at the resection.

Vibrations of the middling average growth of the cranial stem are brought about in the following situations:

1) in the middle of empty bends, the adhesion process, which is the introduction of the necessary for resection of the intestine through the obvious access to the groin area;

2) it is necessary to resect the thermal end of the club intestine with the attachments of the ileotransverse anastomosis;

3) necrosis of slips of the sigmoid colon is revealed;

4) the phlegmon of the mushroom bear has been detected;

5) peritonitis and / or intestinal imperfections were diagnosed.

Having completed the stage of seeing the grill, seeing, dressing and seeing the grill, proceed to the plastic part of the operation. Directly in the form of pinched inguinal grizzly (braid is abo straight), it is better to carry out plastic surgery of the back wall of the inguinal canal. Such a tactful decision to the choice of an operative engagement is pathogenetically correct and justifiable, so that the basis for the development of any inguinal grizzly lies in the structural inability of the transverse fascia. In the minds of the extreme surgery, the vicarists have found the most simple and superior methods of plastics of the gryzhovy vorit. We will tell the minds Bassini method(Figure 6.7). When we carry it with a rope, using three sutures, we fix the edge of the straight meatus of the abdomen and the resulting meatus tendon to the side of the pubic hump and the cooper's rings, as it grows on the upper symphysis of the surface. We use the edges of the inner oblique and transverse meat from the accumulated transverse fascia to the pupar joint. Vikoristovuit not get wet the seam material. Put on the 1 cm side of one side of one. The tightness of the fabric in the plastic zone with a high inguinal gap is assimilated by a path of development of the anterior wall of the straight abdomen on the protrusion of decile centimeters. The rope is laid over the overlapping seams on the new rear wall. Then sew the sheets of the aponeurosis of the lateral oblique meat edge to edge. At the same time, the openings of the inguinal canal were molded, but they did not squeeze the cord.

At the drop of the significant "ruinous" of the posterior wall of the inguinal canal, the victorious views of Bassini's operation are correct - methodologyPost-Tempsky. Place the inner braid and the transverse mucosa in the lateral side out of the wide opening of the inguinal canal, then move the inner cord to the Verkhnyolateralnaya kuttsy rozrizu. When we carry it with a rope from the medial side, we get the tendon of the inner oblique and the transverse ligaments and the edge of the straight muscle, push up to the pubic hump and the upper pubic ulcer of Cooper. Before the inguinal ulcer, suture not only the overhanging edge of the mucosa and the transverse fascia with sutures, but the upper medial leaf of the aponeurosis with Kimbarovskii sutures (Fig. 6.8). The violent cord is transferred from the shkira to the pediatric fatty tissue, setting up a duplication from the lower lateral leaflet to the aponeurosis. With such plasticity, the groin canal is removed.

The plastic surgery of the inguinal canal in women is still quiet, overwhelmed by the eye, and received. Zm_tsnyuyut the back wall under the round uterus, or, well, it’s quite right, you’re gushing in Shvi. The release of the opening on the anterior point of the direct abdominal muscle is most often not required, for that the groin period of bends is insignificant, the inner oblique and transverse muzzle firmly adhere to the pupil ring. Close the opening of the inguinal canal tightly.

In cases of recurrent hernia and structural "weakness" of natural myazo-fascial-aponeurotic tissues, a synthetic mesh patch is sewn into the groin canal with the help of a change in the back wall of the inguinal canal.

Affected by Stegnova's Gryga to be met in the middle in 25% of vypadkіv on vіdnoshennyu until all infringements of the grids. Differential diagnosis should be carried out if there is a stegovy lymphadenitis, a pinched inguinal hernia and thrombophlebitis of an aneurysmal enlargement of the arm of the great pediatric venia.

Anamnestic data will be added to the established diagnosis of the state of the art, so that information about the appearance of the grisha and the results of active reporting is provided. I respect the beasts for the manifestation of saddens, twists and turns on the lower prints, which served as the entrance gate for infection. Protect, inodi lymphadenitis correctly diagnose for more than an hour beforehand, if in the area of ​​the pediatric ring of the stegoval canal (oval fossa) there are not grizzly symptoms, but rather high growths The lymph vuzol didn’t go through the trickle of the firing, it didn’t mean that the trivial lymphorrhea and the destruction of the lymphocyte in the picture were lost. To complete the partial wound sutures.

The appearance of a pinched stegnum, and not an inguinal grizza, is supplemented by an extraordinary retreat physical examination of a sick person. Pomilka in diagnostics, as it has already signified vische, not by principle, for a sick person, so it is shown extra quickly in hand. Slid brothers to respect the manifestations of intestinal imperfections, which develop when the intestines and dysuric growths are interconnected, and the chasms of the chaff.

Diagnosis of varicothrombophlebitis at an early stage of the safenofemoral transition in a large number of cases is not a severe complication. It is necessary to relieve the local signs of a thrombotic process in the lower pediatric veins (hyperaemia, ailments and cords). The contour and the size of the palpable infiltrate does not change when the patient is shifted from the vertical position to the horizontal position, the cough posture appears. With the help of precise topical diagnostics, ultrasound duplex scanning with color maps of blood flow.

The operation of the drive of the pinched stegnum grizzly is considered to be the most important in the technical work due to the speed of quick access to the grizzly mouse and the proximity of important anatomical sounds of the judges:

Likvidatsiya interchange can be practically only in the medial direction for the development of lacunar (gimbernatova) connection. However, here it is necessary to be borderline respectable, since in 15% of cases the lacunar ring is pierced by a large obturator artery, it is abnormally seen in the lower supracranial artery. The meanings of the anatomical variant in the old people I will call it "the crown of death", as in case of a severe wounded artery, there was severe bleeding, and it was important to fit in.

Safeguarding and respecting the communication of the connection is strictly under visual control, allowing you to eliminate in the least unpleasant acceleration. If all the wounds of the abnormal artery have become, then it is necessary to squeeze the bleeding point with a tampon, peel off the groin ring, see the lower epigastric artery and reconnect either the main їїyuyuyu burs, or the obturator artery Before the development of the groin ligament, it is also possible to protrude from quiet vapors, if there is no lacunar ligament in the case of a rakhunok development.

Bagato hirurgiv, operating ailments from the restrained stegovy gryzhey, see the way of stegovyh methods of demonstrating the vision of grizzlies and plastics. The methodology is characterized by the approach to the stegnum canal from the side of the final opening. Three numerical proponated ways to practically eliminate deprivation Bassini method, yaky polagaє in the offensive. When you see the groin mouse, the groin ring is double-three-seamed with sutures up to the upper pubic (cooper) ring, i.e., to the sweaty oxym of the pubic cyst. In such a rank, close the inner opening of the stegovy canal. Overlay of more than three seams is not recommended, as it can lead to late laying of the so-called stegnova vene.

The main shortcomings of Bassini's way of serving are: folding the view of the shyki of the grill bear, in the connection with which the dovga yogo kuksa should be included; technical difficulties at the stage of removal of the stegnum canal, especially, resection of the intestine. All negative inheritances can be unique, vikoristic and inguinal access.

Mi vvazhaєmo for a docile part vikoristovuvati way of Rudzhi-Parshopchio, in the first place in case of trivial intercourse of the intestine, if the need for resection is necessary. To carry out the rise, like when groin grizzly, or near the hockey key, you can switch to steadily, so that the grizzly bear is lodged. Stop opening and fixing pinched organ. The name of the opening of the stegovy canal is placed on the quilted, lacunar connection from the side of the open inguinal canal. Having bored the gut into the empty space, translate the visions of the gryzhovoy into the inguinal canal, conducting it with a pupar's sound. Gryzhovoy mіshok sіs a bit fоr seeing and lіguvannya shyki. Apply seams, having entered the stegovaya vein, between the pubic and pupar bands. Perform plastic surgery of the inguinal canal and suturing the wound. For resection of the intestine, vikonuyut laparotomy through the inguinal canal.

The umbilical hernia is affected take part in surgical practice in 10% of the rate of incidence before all infringements of the grids.

The clichéd picture of intercourse, as the vine on the right side of the wall is characteristic, but it is practically important to merge with the other pathology. Timing an hour, it is necessary to be able to, so that the umbilical glands are most often unreducible, and the manifestation is transmitted by the way in the whole region, there can be more and more cases of adhesions of intestinal problems, which are not very pink. We will be aware of the diagnostic knowledge to serve as a manifestation of the transmission of cough delivery.

With small umbilical grids, it is possible to have a richer intercourse, which is kind of difficult for development, since the parietal intercourse of the intestine does not supervise the symptoms of gastrointestinal imperfections.

Vikoristovuyut operative access to the navel, which is close to the ny may be the place of rotation of the shkiri. To cheat two to improve the growth around gryzhovoypes. At the junction of the crimson mushrooms, they are not drawn in the area of ​​the dome-like bottom, but on the side, that is, in the area of ​​the floor. The growth of the aponeurotic ring is wobbled in the offending side in the horizontal or in the vertical direction. It is still more preferable, some of them will allow you to switch to a secondary midline laparotomy for a visitor of any required operational user.

In case of phlegmon of a mushroom mouse, perform the operation of Grekov (Fig. 6.9). The essence of this method of the pole is in the offensive one: the bordering rise of the shkiri prodovzhuyut, the chink sounds, through all the balls of the black stem, including the stalk, and in such a rank they hang the grill with a single block at once to pinch the rim in the inter-gut of healthy tissue. Moving into the empty space, re-straining the pinched organ proximal to strangulation and seeing the tightness of the body, not violently. If the intestine is strangulated, then it is possible to lead and to lead by means of an anastomosis, it is also known as "kinets in kinets." If there is an omentum, apply a ligature to the proximal viddil, if you can also see it with a single block.

Ways of plastics of the aponeurosis of the anterior cranial wall vikoristovuyut either Sapezhko's way, or Mayo's way. And in that, and in the first place, the duplication of the aponeurosis is created by means of an overlay of U-shaped and high-knot sutures.

The herringbone of the bile line of the abdomen is affected. It is more common to develop a healthy stomach in a surgical practice. More often than not, for the infringement of the girdle, they take over the pre-abdominal adipose tissue, as they penetrate through the thin-like defects of the aponeurosis of the bile line of the abdomen. In addition, it is necessary to create and reassign the gut loops in the grizzly mouse, most often after the Richter grizzly type.

At the connection of the cym during the operative engagement with the drive of the cannula of the white line of the abdomen, it is necessary to quickly dissect the prolapse of the defect of the white line of the abdomen, the preperitoneal fat of the abdomen. When a gryzha mouse is detected, it should be opened, revise it to be in a new organ and then visit a grizzly mouse. When the grizzly mouse is out, apply a stitched ligature on the lip and display. For a plastic closure of the grizzly collar, it is easy to suture the aponeurosis defect with thin sutures. Ridko, with the presence of multiple herds, the plastic of the bile line of the abdomen should be stuck behind the Sapezhko method.

Affected by the operation of the ventral hernia It is admittedly boring. Unimportant on the great grizzly gates, the enclosure can be found in one of the numerous chambers of the grizzly bear on the caloric, but it’s a bit more elastic, according to the elastic mechanism. In the case of obvious great growths, overgrowth and deformity of the intestine, it is not uncommon in the area of ​​maloperative grids that there are pains and manifestations of adhesions of intestinal imperfections, which are the result of intercourse. There is a certain amount of pardon in diagnostics that is not of fundamental importance, although in that and in the same way it is necessary to go into an extraordinary operation.

Promptly engaging with the drive of the pinched pislyoperatsіynoіy gryzhі to carry out anesthesia under anesthesia, allowing enough revision of organs in the black empty and sew in the defect of the wart.

The size of the shkiri vibrates the fringing, the shards of it are dwarfed over the grill vipinnyam and without the middle is grown with the grill bear, and such that the loops of the intestine are drawn. To make a rosette of a grill bear, to infringe upon a circle, to carry out a revision of this together and to burn a published organi into an empty space. Deyakіy hіrurgi gryzhovoy mіshok do not see naggingly on the traumatic nature of the process of manіpulation, and they sew grizzly gates in the middle with welded seams. In case of small defects, the edge of the aponeurosis is sewn "edge to edge". With great ventral grids, including a larger part instead of a black empty, especially for a person who is sick, grids are not sewn in, but they are put on the operative wound depriving shkirnі shvi. Folding methods of plastic surgery, especially with respect to alloplastic materials, do not stagnate so often in such cases, a bit of the stench will increase the risk of promptly getting involved in a very important contingent of ailments.

Rosrahovuvati on the success of alloplasty is possible, only strictly adhering to the rules of asepsis. A synthetic "sieve", as if to be put in, fiksuyut in such a rank, sew over it the edge of the aponeurosis (the intestines are guilty of being "vidgorodzhenii" from a synthetic material with a part of a grill mouse or a great omentum). It’s not a matter of zrobiti, the "patch" is sewn up to the last surface of the aponeurosis. In the general order, there is a drainage of the operational wound (with active aspiration for 2-3 days). We acknowledge all ailments antibacterial drugs a wide range of diy.

Your robotic surgeon can get in touch with intercourse Gryzhi Spiga Ліев (півмісяцевої) Лінії. The grizzly gates when they are localized on the line, where the navel from the anterior upper part of the club's brush is close to the last edge of the straight belly meat. Gryzhovy mіshok can grow as a child, so also interstitially between an internal oblique mouth and aponeurosis. Hirurgical correction of similar grids is displayed from oblique, pararectal or transverse access.

Cross-sectional, locking, sidnichnoy gryzh and ін. To grow in the edge. Principles of їkh operational management of victories in special instructions.

Restrained internal grids take a modest place in urgent surgery. The health of organs can appear in the folds and intestines of the quill near the mucous intestine, in the gut of the intestine, at the Treitz's ligament, in the lesser omentum, in the area of ​​the wide ligament of the uterus and in. With diaphragmatic grizzlies, the inner diaphragms are infringed in the openings by diaphragms of congenital or traumatic pacing. Most often, the gryzha should have a "gracious" character, there are some splinters of the gryzha mice.

Affected internal grizzly may be manifested by symptoms of gastrointestinal imperfections (with pain in the abdomen, bloating, covered with style and gas, and other clinical and radiological symptoms). On the edge of the collapsible preoperative diagnostics of the wall of emptying organs. Radiologically infringed on the girdle by the diaphragms, it is recognized for the appearance of a part of the slunk or the organ in the chest emptying above the diaphragm.

As a rule, a whole lot of gut malfunction appears before an hour of revision of a black empty, operating a sick person from a drive of intestinal imperfections. Obshygical involvement in such a problem is caused by a specific anatomical "situation" and pathological changes from the side of the pinched organ. If the integrity of the diaphragms is ruined, it will be guilty. Slightly open the stitching from the transabdominal access, one by one with the knot sutures at the edge. Large defects with diaphragms are "closed" with small grafts from the side of the pleural empty space.

Pislyaoperatsiyne a sick person

period of operation in case of pinched grizzly, it is significant more respect, less in case of planned grizzly appearance. It was thought that, from one side, the ailments enter to finish the important camp, from the other - we will kidnap a lot of patients. In connection with the cym, except for the extreme, noxious in the cold to the operating area, we are averse to punishing the necessary cardiotropic and other drugs. To carry out adequate disintoxication therapy, it is necessary to go in to fight against the deterioration of the water-electrolyte and acid-pool balance. In case of resection of the intestine, the ailments should be transferred for 2-3 days on the outside parenteral feeding. Antibiotics are recognized for the certificates. In the edge it is important to update the peristaltic activity of the intestine.

With the help of the prevention of venous thromboembolic diseases, anticoagulants and drugs are used to reduce the rheological power of the blood. The patient is guilty of getting up from the sled, as it is possible earlier, having pulled the bandage in front of the front. An active rukhovy mode is required on the day of the operation.

Likuvannya grew faster, depending on the character. For operations that are performed without plastic surgery of the grizzly collars, re-scheduled operations are performed in 3-6 months.

Finish the chapter, and then see that only the efficient surgical sanitation of grids in a planned manner will allow the reduction of a number of extras. A folded gryzh must be operated earlier at the moment of intercourse. Adequate surgical tactics and correct technique are used to identify all stages of operations, to reduce the speed of operations, to ensure a good functional result and to prevent relapse.

Diagnostics of the gryzhi obmezhennya

Diagnostics of the infringed gryzhi in typical vipadkah not folding. It is necessary to be persuaded for all the history of the patient, from which there is evidence of an ailment in a sick manure, before the moment the pain of the ball appears right and painless. Slid vrahovuvati also, before the moment the chuck is preceded, as a rule, stronger physical stress: pidnimannya vagi, big, stribok, act of defecation and in.

The physical condition of a sick person is guilty of being even more respectable, since the pochatkova picture of an intercourse is similar to those of the deyakyi hospitable hospitable bodies of the empty waste. At the sound of cym in case of pain in the abdomen, the first for everything, it is necessary to look at all these "weak" mice of the black wall, which can serve as a gate of the grill. There is an inevitable need for such a glance to the fact that one should be so called the primary infringement of the grids. In the case of the witness, they turn on the grids, as they will break without the middle at the moment of their cob appearance, without a prior gryzh history. Especially often, the primary infringement is caused by grizzly localizations: spigelia (pivmisyatsevoy) line, transverse areas, obturator canal and in.

When you look around the gryzhovoy, make sure to be kind, you don't know or change the outline when you change the position of the sick person. Palpation is very intense and heavy, especially in the area of ​​the grizzly gates. Transmitting cough delivery. Percussion of vipinnya in the early stage of intestinal intercourse can cause tympanitis; When auscultation over a pinched grill, peristalsis does not hang, it is not easy to see the peristalsis of the restrained intestine over the abdominal empty space. When you look around the abdomen, it seems like a noise, a symptom of Val and other symptoms of intestinal failure. The appearance of the rest in the case of a grizzly grip can also be established with an eye-catching X-ray of a black emptying, when you wake up a good wash in the loops of the intestine, to the purchased gas above them.

Differential diagnosis in case of interconnected grids, it is necessary to carry out from low pathological stanes, which are tied to the grids themselves, so that there is no need for a mediocre appearance. Obviously, in typical cases, the diagnosis of an utterance is awkward, albeit one due to a number of circumstances (the grizzly is primarily affected, the manifestation of a subtle pathology in the organs of the black emptying, etc.).

Persh for everything necessary to differentiate infringed on the gryzh from not-right. Ostannya, as a rule, is not stressed, not painful, good for cough delivery. In addition, in the wake of the inappropriateness of the grizzly, it will grow out of hand, invoke a part of the grizzly all the time to be restored. Particularly difficult in differential diagnosis can be found in the case of a large chamber grizzly, if it is interconnected to be seen in one of the chambers. In general, there are some common signs of intercourse: bile, sponginess, and the duration of the transmission of cough delivery.

Practical surgery in Vinikov needs a differentiation to be made. coprostasis. Remaining to become a head rank in case of improper griffins in individuals of a kidnapped person, in those who have a physiological confidence in peristalsis and mental strength to fixation. It should lead to stagnation instead of in the intestinal loops, to be located in the gristle, or even on the view of the fecal duck during coprostasis, but not the grip of the gut. Clinically coprostasis build-up stepwise without anterior physical stress with an increase in pain syndrome. Nicoli pains are not intense, on the first place there is a touch of style and gas, there is no pressure on the headache, the symptom of coughing is positive. Coprostasis is not a vimag of an operative treatment, for its liquidation it is necessary to use a siphon system. Tim for an hour, a mother on uvazi, but unqualified caprostasis can lead to fecal infringement of the grizzly.

Clinical practice learns situations that are accepted by the term pomilkov obmezhennya. The tse of the witness includes a symptom complex, scho a picture of an utisku, and a little viklikaniy be-a-kind of hospitality to the organs of the worms. The meaning of the symptom complex is to serve as the reason for the grave diagnosis of the grizzly duck, at that time the spiteful nature of the sickness becomes prikhovanim. Most often diagnostics are found in case of strangulated intestinal obstruction, hemorrhagic pancreatic necrosis, peritonitis of a disease of nature, hepatic and nirkova colka. An inappropriate diagnosis to lead to the wrong surgical tactics, growing up to the early stages of life replaces the necessary wide laparotomy, which is not necessary for the eyes of the young when cutting or cutting rings. A guarantee of some kind of pardon to serve only a respectful look around the sick person without any omissions. I will especially respect the animals for the big pose of the grizzly.

A clinician can get lost in such a situation, if he is confused with grit, which is the main reason for intestinal failure, to become unresponsive, and to become ill with a history of intestinal strangulation. The main reason for such a pardon is the disrespectful look of the sick person. Slide a memory, but a gryge is squeezed, do not wait for a glimpse as well as a note on the front cherevniy station. Dawn, with cob groin groin, there is an intercourse at the inner groin of the inguinal canal. In this kind of vipad, callous glance, especially among the sick people, do not give any results; If you do not have a retinal palpation in the groin of the trocha, the groin can be found to be more sensitive to a small size. Do not forget about the possibility of intercourse, rarely develop grids: obturator canal, spigel line, transverse, intermediate and in. Here it is pre-vernacular to see the names of the famous French clerk G. Mondor: "If there isnostі gut slіd, persh for everything, until juvati gryzhovі gatesand shukati I have been infringed on the grizzly.

Without any words, it’s just as much to diagnose as if it’s not possible to guess, then the stench is guilty but it’s permissible for the corny of a pinched grill. Hirurgi, who may be a great admonition in the city of gryzh, formulate the installation by the offensive rank: “In the case of the most recent fall, it’s right to get away with it, and it’s time to take care of the sick. Mensh is not unbeatable for a sick person to be married there;

On the pre-hospital and stationary stage, the slid vikonuvati takі dії.

Prehospital stage:

1. In case of pain in the abdomen, it is necessary to look at the sick person for the appearance of grizzly.

2. In case of interconnected grids, or suspicion for a squeeze, in the case of self-imposed adjustment, a patient for an emergency hospitalization in a surgical hospital.

3. Not safe and unacceptable try to force the rapist to repress the restrained grids.

4. Zastosuvannya zestlyuyuchih preparations, baths, heat or cold, we are sick with infringement of mushrooms is contraindicated.

5. The sick person is delivered to the hospital on a stretcher in the position lying on the back.

Stationary stage:

1. For the diagnosis of a pinched grill є:

a) the manifestation of a stressed, sickly person and not to be self-relieved with a negative cough delivery;

b) key signs of gastrointestinal imperfection or peritonitis in a sick person with a grill.

2. Start: temperature and temperature in the area of ​​the grill. Iakshcho reveal signs of muscular firing, carry out differential diagnostics between phlegmon of a mushroom mouse and other diseases (inguinal adenophlegmon, thrombophlebitis of an aneurizmatic enlarged girdle)

3. Laboratory dosage: out-of-body analysis of blood, blood sugar, out-of-body analysis of blood and blood tests.

4. Instrumental dosage: chest x-ray, EKG, oglyadovaya x-ray of a black empty, after shown - ultrasound of a black empty and a chest tube.

5. Consultations of a therapist and anesthesiologist, if necessary - an endocrinologist.

Lіkuvannya obmezhennya gryzhі

surgical tactics unambiguously ordering on the need for prompt operative treatment of pinched grizzly, regardless of the type of grizzly and term of encirclement. One contraindication before the operation is the agonal camp of the ailing one. Whether it be trying to get the grizzy right on the pre-hospital stage, or in the hospital it seems unacceptable through some kind of transfer to an empty organ, which is fed by a non-vortex ischemia.

Surely, є vinyats і of the rule. It’s about the ailments, as they perebayut at the edge of the important camp through the manifestation of the concomitant ailments, at the moment of intercourse, which stood in front of the lykar, not more than 1 year passed. In such situations, the operation represents a significantly greater risk for the patient, but not the way to correct the hair. This can be protected. Even at the moment of intercourse, it has passed three hours, then the reduction of the grizzly is permissible in children, especially in the early age, because they have a myazo-aponeurotic illumination of the gnarly-aponeurotic illumination of the gnarly, more elastic, less severe

In a number of ailments themselves, which may seem to be able to adjust their grizzly, through the overexposure operation, they may not be able to repeatedly and it is not easy to finish roughly trying to reposition a pinched grizzly in their home minds. As a result, you can win the name of the so-called imaginary right, are one of the most important quick fixes. Significantly more narrowly adjusted by the result of the physical injection of the liquor. Pererakhumo options "imaginary right":

1. In a large-chamber grill bear, it is possible to move the restrained insides from one chamber to the inside, so that it can lie more, most often in the pre-abdominal cell.

2. It is possible to release the whole gryzhovoy mishok from the navkolishnykh fabrics and to set it at once with the entrapped gutters into the empty gutter or the klitkovin.

3. From the bottom of the grill, and from the parietal quill. In case of a lot of infringement, the organizers "set" empty or klitkovin into the cell.

4. Taste of a rough correction can be caused by a pinched gut.

Typical clinical symptoms of a pinched grizzly when the "imaginary" right will cease to start. Timing by the hour, the manifestation of a sharp ailment when there is a further development of a grudge and a stomach in the past with anamnestic evidence of a mala, the abuser is right to allow the wrong

In the case of non-reversible grasses (irreducible grasses, large chambers for the operation of grasses), nutrition is guilty of being overwhelmed by an extraordinary operation.

In case of papillous malnutrition syndrome, who are ill-treated to surgical illnesses of organs of the deadly sparse, they must undergo an operation, and at the same time - Hernioplasty, as well as during the daytime.

Particularly susceptible to surgical tactics in the case of spontaneous repositioning of the pinched grizzly. As soon as it went to the hospital: at home, in the car for high-quality assistance on the way to the hospital or in the near-term rest, then the ailment is guilty of being hospitalized in the surgery.

It’s a clear fact that I’ve gotten sick for 2 years, especially in case of gastrointestinal imperfections, to serve as indicated before an extra operation (viconuated by a path of the middle laparotomy) for diagnostic laparoscopy. The body is pinched in the general order of knowledge and evaluation of its life.

In all types of spontaneous adjustments: 1) the term is less than 2 years old; 2) the knowledge of the reliability of the person in the middle of the situation - it is necessary to dynamically watch over the camp of the sick person. In quiet situations, if the camp is black and empty in the best possible way, there is no need to worry: there is no more pain and sign of intoxication, ailment can be abandoned in the stationary and due to the necessary conditions.

Yakscho in protsesі sposterezhennya from ailing pіdvischuєtsya temperature tіla, zberіgaєtsya bolіsnіst in zhivotі i z'yavlyayutsya symptoms podraznennya ocherevini viroblyayut ekstrenu mid laparotomіyu i resected body scho pіddavsya obmezhennya th nekrozu.Spontannoe reduction grizhі Mauger vіdbutisya Shlyakhov in operatsіynu, pid hour vstupnogo anesthesia abo cob medical anesthesia. Uninvolved on the price, start before the operation. Take the rosette of the grill mouse (if necessary, check the gernolaparotomy), look around the adjoining organ. Having discovered the organ, which has come to be interconnected, it will be found in the wound and evaluated the life. When twisting in the jolts of the pinched organ, vdajutsya until the additional laparoscopy through the throat of the open grill mouse. Let us proceed with the operation and finish behind the rules adopted for the restrained gryzha.

preoperative training before surgical interventions, we wobble from the drive of the pinched gryzhі, most often it is minimal: ask the sick person to help, or to drive the catheter behind the auxiliary catheter, clean the area of ​​the operative field and be ready to go. If necessary, empty the slunk behind the auxiliary probe.

Ailments with trivial terms of intercourse, with symptoms of abnormal toxicity and with important adversaries, should be taken to the hospital in the intensive therapy unit for the prevention of operative treatment of diseases Meals about the need for special preparation of a sick person before surgery should be given as a senior surgeon and anesthesiologist. I especially respect those who come to the patients of the abducted and old man with serious pathology on the side of the heart-vascular system. Regardless of the nature of the preparation for the operation, it is necessary to carry out a shvidsche (not for the first 2 years of hospitalization), as well as the onset of dermal growth of the intestine. Covering an operation for a rakhunok is inadmissible.

Sickness. Bagato hirurgiv provide the test of medical anesthesia. Vvazhaєtsya, scho won’t make it to the right grizzly. Tim will show for an hour that the security is clearly overdone. I am overwhelmed with any localization of a pinched grizzly, without transverse, as a result of epidural (spinal) anesthesia, or intubation endotracheal anesthesia.

Remaining insistently necessary in cases of expansion of the operative engagement in connection with intestinal laxity or peritonitis.

Special features of the surgical engagement. An operation procedure for a pinched grizzly has a number of principles of indications from the planned performance of grizzly. A slide of memory, to the staff of the surgeon at a maximum speed of exposure and fixation of the pinched organ for the removal of the lick in the middle of the empty during the onset of manipulation in the area of ​​green hair. Carry out the growth without prior notice over the gryzogo vipinnyam as long as the localization of the gryzha. They grow up to a child, to grow fat cells, and do not see the mushrooms growing up, to open their bottom. Zazvychay when wagging zhovtuvaty or dark brown kolor gryzhovogo water. At the ring of cims, before opening the grill bear, it is necessary to isolate the wound with gauze servet. Immediately after the opening of the grizzly mouse, the assistant takes care of the pinching of the organ (most often a loop of the small intestine) and will fix it in the early. It is possible to continue the operation and infringement of the circle, so that the gates (Fig. 6.3). Varying the price in the most oven-free direction on the basis of the quality of the tissues and organs. The pinching of the organ can be done in two ways: the development of the aponeurosis is repaired either directly from the side of the grizzly collars, or to go into the prototype directly from the invisible aponeurosis to the umbilical tissues that surround the wedge. In both cases, it is necessary to rotate the aponeurosis by moving a grooved probe.

Once again, we are guessing about the possibility of a retrograde chuck. Zvyazyka z zim, if there are two or more bowel loops in the gryzhego, thenit is necessary to look around and look around the loop, yak roztashevuyutsya in the black empty.

Having strangled the gut, assess the life for the following signs:

1) normal erysipelas of the intestine;

2) the appearance of peristalsis;

3) the value of the pulsation of the breech, which was received in strangulation.

As all the meanings are signs of presence, then the gut can be rendered life-long and empty. In general, in the intestinal breeze, inject 100-150 ml of 0.25% novokainu and prevent pinching of the dilyanka with a stretch of 10-15 minutes with servet, soaked with warm physiological solution to sodium chloride. If every day I would like to be one of the perekhovannyh vyshche to know and get lost in the gut, then it is worth serving the indications before resection in the boundaries of healthy tissues, as in the majority of cases it is possible to access it through

The length of the pinched loop allows for a view of 30-40 cm to bring the bowel (strangulation) and 15-20 cm of the bowel (lower). Chim who has done the same, Tim has been widely guilty of butti resection. The reason is that, when the intestines are interconnected, it’s on the day one of the types of strangulated imperfections, that it’s shown that there is a pereshkodi, it’s guarding in a greater step, not to bring it in. At the connection with the cym, the imposition of the intestinal anastomosis near the strangulated furrow is connected with the inconsistency and development of peritonitis.

The resection of the pinched small intestine is violated according to the gross surgical rules, a few steps are taken to develop the brigades and apply the ligatures on the judges, and then there is a bit of a mobile part of the intestine. The anastomosis can lead and lead in bytes more beautifully than imposing "end in end". In case of a sharp inconsistency of diameters, lead and lead out of the intestine until the anastomosis "bik to bik" is applied.

Even the distal border during the resection of the club intestine grows less than 10-15 cm from the intestine, slid in until the imposition of the ileoascendo - or ileotransverse anastomosis.

In some cases, the intestine itself is in its own way, the intestine is seen as a whole zhitєzdatnoy, ale little twists and turns of strangulated furrows, in some cases, local necrosis can develop. In some situations, vdajutsya up to circular bore strangulation furrow with vascular serous-oily suture sutures, with ligamentous control of intestinal passage. In case of severe changes in the area of ​​strangulation furrows, it is necessary to resect the intestine.

It is necessary to remember that in the pinched loop of the intestine there is a mucous membrane and a mucus ball in front of the suffering, which is not visible from the side of the serous membrane, and about the striking of which one can judge deprived of indirect signs. In the literature, there have been descriptions of the mucous membrane perforation and perforation of the small intestine, which has become known to me. Described is also cicatricial stenosis of the small intestine when it is obmezhennya, the adhesion of її from the otchuyuchye organs, which in general led to the appearance of intestinal obstruction.

Significantly simpler than on the right with necrosis of a pinched omentum. In general, the necrotic part is seen, and the proximal part is set empty into the abdomen. In case of intercourse of fatty tissue, it is possible to rupture the hardening of the intestine. To that, when making a cut, it is necessary to take a quick look around the intestinal wall and assess the life.

Surgery tactics in cases of interconnection of other organs (fallopian tube, worm-like growth and inn.) morphological changes from the side of the cich of anatomical statements. For example, when operating a patient with necrosis of the sigmoid colon, it is necessary to expand the scope of the operative engagement and vikonuvati Hartmann's operation from the pre-median midline laparotomic access.

Having bored a living or resected organ into the empty space, when it was interlaced, I would see from the navkolishnogo clit of grizzly bears, bandage it from the shyka and a little bit. Before the excision of a gryzhny mishka, it is pushed out with great grids, for individuals who are abducted, for those who are tight-knit for those who are sick and for children. In cich vipadkas, ligate and rewire the grill bear in the shyka, and cover the inner surface with alcohol in order to wickle the adhesion of the leaves.

At a small, fallen ground in the form of a grill, start up to plastic grill collars. At the same time, the operation does not fundamentally appear as a planned appearance of the gryzh, for the blame of the fact that when the grizzly is pinched, it is necessary to use the most simple, low-traumatic methods of hernoplasty, which is very difficult to speed up. Until the present hour, the breakdown of the tension-free method of hernoplasty from the back of the growing allografts. In the minds of extreme surgical practice, you get stuck, you get sick with infringed griffins, as there may be large grids (recurrent groin, umbilical, pisleoperative and in.).

The primary plastics of the warty wall cannot be robbed with phlegmon of a grizzly bear and peritonitis (due to the severity of the sick and the lack of rapidity), great ventral grids, but they have been eliminated in the sick with an important lack of fatalities. In cich vipadkah, the application of stitches on the neck is followed only by the partial stitching of the operative wound and the application of the stitch on the shoulder.

The announcement and the last of the prompt engagement with the pinched grizzly drive, which called for the development of gut failure, is due to the peculiarities and difficult clinical situations.

Okremo slid zupinitsya on the principles of operational involvement with special types of pinched grizzly. viyavivshi obmezhennya kovznoy gryzhi, the surgeon is guilty but especially respectful when assessing the life of a pinched organ in that part of the body, as there is no serous cover. Most often, "look" and shrink the gut and the grain of the grain. In case of intestinal necrosis, the midline laparotomy and resection of the right half of the large intestine should be performed using the ileotransverse anastomosis. After the end of the stage of the operation, proceed to the plastic close of the grizzly gate. In case of necrosis of the wall of the cuticle, the operation is not less foldable, and the risk of resection must be carried out with the attachment of the procedure.

in case of prejudice Gryzhi Lіttre Meckel's diverticulum went to be in any kind of fall, right from the fact that his life was renewed. The need for a visible diverticulum of a viclican thymus, as a rule, a rudiment of additions, as a rule, of a powerful breech, to go from the vital edge of the small intestine and to be disgustingly supplied with blood. At the zyazyka z tsim to navit a short-hour duck is tied with insecure necrosis. For the visualization of the diverticulum, vikoristovuyut abo ligaturny-purse-string method, similar to apendectomy, or vikonuyut cuneiform resection of the intestine, which figure includes the subdivision of the diverticulum.

In times phlegmonic mushroom the operation should be carried out in 2 stages. With the help of anesthetic anesthesia, a midline laparotomy is performed. With a lot of accelerated pinching, the body of the floor is mintally soldered with the grizzly gate, so it is not safe to slip away into the empty gates practically every day. At the same hour, the appearance of a grizzly lightning in the area of ​​a gryzha has a real problem of information about a grudge, which is an operation of picking a grizzly mouse in an extravagant way.

Having made a laparotomy, go to the restrained organ from the middle. If the intestine is strangled, then її mobilize in the meantime between the gut. I see and end the pinched part of the intestine, but I can see it, there are not too many cups, which are sewn tightly. If it is necessary to bring and to introduce the vital intestine, impose an anastomosis with a single-row intra-nodular suture. Nutrition about the method of completing the resection of the intestinal tract virishut individually. As a rule, obstructive resection with colostomy overlays is performed.

For the formation of the anastomosis, put a network suture on the neck near the pinched circle (in front of the intestine, the cups are covered with the neck), so that the gnar is in the middle of the empty hole. It is possible to sew the laparotomic wound and move up to the 2nd stage without intermittently in the area of ​​the hryocyst. They open the bottom of the grill, and then they cut the grill gates, so that it is possible to see if the body is pinched, including the cases of the small intestines. Likewise, they see intestinal necrosis, drain and tampon the empty ginny. There is no way about the plasticity of the grizzly hairs in the flowers.

Naturally, it’s possible to bring about a recurrence of the pain in the form of plastic surgery, but it’s necessary to remember that the surgeon’s task is to preserve the life of the sick, and the operation of the plan to drive the recurrent pain in the order is possible. I will say a surgical tactic to stagnate in all cases of phlegmon of a gryzhi, behind the blame of a gnarly firing of a restrained umbilical grizzly, in case of a stagnation in a circular manner, visible to a grizzly, and proponations I. Grekov. The essence of this method is lower in the distribution, assigned to the umbilical griffins.

For ailments, who are in the middle of an important camp, they do not allow Yushchem a wide laparotomy, it is permissible to go in to the so-called exterioration of a pinched organ. In cich vipadkah under muscle anesthesia, the grizzly bears are retarded and the gates are impaired, when the necrotic intestine is impaired and the grids are squeezed. It is also acceptable to hang the necrotic part of the intestine and fix the intestine in the circumference of the wound like a double-barreled stomy.

I insist that everybody knows, and it’s a lot of Russians to go to see me for a place. We will not take over the nobility, as we will seize ourselves from the bites of the claws. The temperature regime in the environment with the activation of insecure comas ...

Medical statistics

Ophthalmology is one of the most dynamically developing galuseum of medicine. Usually, there are technologies and procedures that allow you to trim the result, which is 5-10 times more than it would be possible to achieve. For example, on the cob of the XXI century of love vіkovoі distant growth the boil was ill-advised. The maximum, for a moment of rozrahovuvati lіtnіy patient, is the price ...

As many as 5% of the more evil chicks store sarcomas. The stench comes out with high aggressiveness, quick expansion of hematogenous path and slenderness before relapses during treatment. Deyaki sarcomas develop in rocks, they do not show themselves to themselves ...

Viruses do not just hang out in the twilight, but they can eat on the handrails, sit and on the surface, while retaining their activity. To that, in trips, or in huge mіstsyah, bazhano isn’t just wicked to wicked people together, ale and unique ...

Turn a good view and say goodbye to the eyepieces every time contact lenses- the world of bagatokh people. Infection can be done quickly and indefinitely. The new possibilities of laser correction will lead to the emergence of the contactless technique of Femto-LASIK.

- the collapse of the gryzhovy mishka in the gryzhovy gates, which will cause the destruction of blood and necrosis to fix the gryzhovo in the place of organs. The defect is characterized by a severe pain, a pain and malaise, an inappropriate defect. Diagnostics of gryzhenny gryzhі primed on anamnesis and physical condition, observational X-ray examination of the grubby emptying. For an hour to see the grizzly from the drive of the pinched grizzly, it is not necessary to carry out resection of the necrotized intestine.

Country houses

Abdominal grids are the most frequent and slower abdominal grids. Injured by gryzhi є we are hospitable to the surgical camp, but we are not obliged to get involved, and to act for the frequency of accusations of only the hospitable appendicitis, the hospitable cholecystomy and the hostile pancreatitis. In operative gastroenterology, gryzha is diagnosed in 3-15% of cases.

The encirclement of the grizzly is tied to the rapid pressure instead of the girdle (omentum, small intestine and in. Organ) in the grizzly gates (defects of the anterior cervical wall, open the diaphragms, the colonies of the grubby empty). Injury can be made to be abdominal grids: groin (60%), stegnov (25%), umbilical (10%), earlier - grizzled bile lines of the abdomen, stravohid aperture of diaphragms, pislyoperative. The intercourse of the grizzly is tied to the necrotic development of the necrosis of the compressed organs, intestinal laxity, peritonitis.

See mebezhennya gryzhі

Fallen from the crushed in the gryzhovy gate, the organ develops the grizzly from the intestine, omentum, slunk, chaff, uterus and appendages. The step of reversing the illumination of an empty organ in case of interconnected grizzly can be different (parietal) or more. In some cases, for example, when Meckel's diverticulum is interconnected or a worm-like outgrowth, the re-education of the organ is not spared. Behind the peculiarities of development, there is antegrade, retrograde, pomilkov (uyavne), rapt (in the case of a daily history of a gryzh), an antegrade grizzly.

There are two mechanisms for combining hairs: elastic and calovy. Elastic intercourse to develop at once at once through the university gates of the great obsyagu gryzhovy vmistu. Internal organi, Put it in the gryzhok mіshok, you can not go into the empty chapel on your own. If the grizzly collars are surrounded by a high ring, it will lead to the development of ischemia, a severe pain syndrome, a stiff gristle spasm, the grizzly collars become even more heavier.

The bowels grow up in the case of a sharp re-education to bring the intestinal loops, which were consumed in the mushroom, intestinal cavity. At the same time, the gut can be impaired and impaired in the grizzly gates at once from the breech. Kalovi obmezhennya often develops in case of unrepentant griffins.

Interchangeable grizzlies can be both first and second. The first thing to do is to grow up and out on the smallest one-time supra-high-pitched zusill, as a result of which one can see it overnight, but before that it didn’t disappear. Secondly, it will be seen at the only obvious earlier than the Gryzha cherevnoy stinka.

Causes of the gryzhі

The main mechanism of intercourse grizzly is to serve at once or periodically to repeat the development of an intracranial vise, which can be associated with overwhelming physical diseases, constipation, cough (with bronchitis, prostate, pneumonia) The development of that infringement of the grizzly syndrome, the weakness of the muscles of the abdominal wall, intestinal atony in people with abdominal pain, traumatic abdominal abdominal problems, prompt engagement, Skudnennya.

For normalization of the internal grip of the grizzly gates, it changes in size and surrounds the grips behind the grizzlies between the grids. At the same time, the chuck does not lie in the diameter of the grizzly collars and the size of the grizzly.

Symptoms of grizzly hair

An encircling gryzh is characterized by offensive signs: a sharp local abdominal pain, unhappiness to fix grizzly, stress and ailing grizzly symptoms, a symptom of "cough posture."

The head signal of the intercourse of the gryzh is to serve as a bil, to develop at the height of the physical zusill, or to spur and not to calm down. The bed is intense, but the patient often cannot get through the stacks; Your behavior becomes restless. In the active status, the blindedness of the curvatures is determined, the manifestation of painful shock - tachycardia and hypotonia.

It can be seen in the epigastric dilyantsi, the center of the abdomen, groin, stiffly. When intestinal imperfections are diagnosed, they are spastic in nature. Pain syndrome, as a rule, bends with a stretch of decilcox years, until quietly, until necrosis of the pinched organ develops and the bend of nerve elements does not occur. With feces, infringement of the bolovy syndrome and intoxication of the swelling is weaker, more and more intestinal necrosis develops.

In case of intercourse grizzly, there can be a single-use bloat, which can be combined with a reflex mechanism. With the development of intestinal imperfections, the bloating becomes persistent and swollen in character. Situations of a small-sized encirclement of a gryzhi have an imperviousness, as a rule, do not be found. In general vipadku, in case of pain, may turbuvati tenesmus, clogging of gases, dysuric disorders (accelerated illnesses, hematuria).

It’s trivial to get rid of the grizzly, it can lead to the phlegmon of the grizzly bear, to understand the characteristic symptoms of the muscle: the swelling and hyperemia of the grizzly crooks, the ailments of the grizzly symptoms, and the fluke. Tsey stan supravodzhutsya zagalny symptomatology - high fever, To the power of intoxication. The result of the not-so-pissed-off gryzhi to serve as a spilled peritonitis, viklikaniy transition zapalennya to the neck or perforation of the stretched viddil of the restrained intestine.

Diagnostics of the gryzhi obmezhennya

With the presence of a grizzly anamnesis and typical diagnostics clinics, the grizzly grizzly does not represent folding. With a physically fit patient, I respect the manifestation of a stressed, sickly gryzhovoypine, as I didn’t know it when the body was changed. The pathognomonic sign of the encircling of the grizzly is to serve as the visibility of the transmitted cough delivery, which is tied to the common grizzly bears from the black empty places to infringe on the gingerbread. Peristalsis over the pinched grill is not audible; In some cases, symptoms of intestinal obstruction are indicated (Valya's symptom, splashing noise, etc.). Frequently, abdominal asymmetry and positive peritoneal symptoms are observed.

With the presence of intestinal imperfections, an oglyad radiography of the black emptying appears in the Kloyber bowl. I met differential diagnostics ultrasound examination of organs of empty empty ones is carried out. Sharing the stegovy and inguinal grids followed by the form of tissue fabrics, for the addition of synthetic prostheses).

The most significant moment of the operation is an assessment of the health of a pinched intestinal loop. Criteria for the intestinal health to serve for the improvement of the tone and physiological conditions of the intestine, for the soundness from the surrounding cells, the smoothness and blistering of the serous membrane, the appearance of the pulsation of the strangulation, on the apparent fright When all the meanings are evident, the gut will be seen as life-style and will become empty.

In general, in case of intercourse grids, it is necessary to perform a resection of the intestine with an anastomosis "end to end". In case of ill-feeling of resection of the necrotic intestine, an intestinal fistula (enterostomy, colostomy) is superimposed. Carrying out the primary plasty of the cranial stem is suggested for peritonitis and phlegmon of the mushroom mouse.

Forecast and prevention of gryzhny intercourse

The mortality rate in case of intercrossing of the middle of the patients of the kidnapped person reaches 10%. As soon as possible for medical assistance and try to make self-cleaning of the gryzas to diagnostics and tactful pardons, it is significant to destroy the results of the treatment. Reduced operations with the drive of the grizzly may be necrosis of the altered intestinal loop in case of improper assessment of life, inability of intestinal anastomosis, peritonitis.

Prevention of obmezhennya polyagaє in the planned treatment of any emerging abdominal grids, as well as the prevention of obstavin, as well as the development of grids.