Abdominal eventration is a protrusion or displacement of (abdominal) viscera through a defect in the abdominal wall.
The layers of the abdominal wall are, from the outside to the inside, the following:
- The skin.
- The subcutaneous cellular tissue or subcutaneous fat.
- Aponeurosis (a variety of tendon).
- Muscle layer (layer 1).
- Aponeurosis (layer 2).
- Preperitoneal fatty tissue and peritoneum (a membrane that covers most of the organs in the abdomen).
In certain areas, layers 1 and 2 may vary in number or be missing, with only one of the two aponeurotic layers, which occurs precisely in the midline of the anterior abdominal wall or linea alba.
The defect of the musculo-aponeurotic layers produces the exit of a hernial sac formed by peritoneum through the hernial orifice (the musculo-aponeurotic defect), which produces a hernia visible from the outside.
Causes of eventration
Eventration, also called ventral hernia or incisional hernia, occurs after a history of penetrating trauma to the abdominal wall or surgery. The incidence of eventrations varies between 1 and 16%, although this percentage may be higher depending on the type of surgery.
The appearance of these eventrations is also related to the presence of risk factors such as obesity or overweight, contaminated surgery, diabetes, immunosuppression or other underlying diseases, surgical technique (surgeon-dependent factors) and the appearance of infection in the initial surgical wound on which the eventration will appear.
Symptoms of eventration
The symptoms that produce the patient are the presence of a lump or deformity of the abdominal wall at the level of the scar or close to it, which is usually accompanied by pain or discomfort to a greater or lesser degree. Sometimes, depending on the morphotypical characteristics of the patient and the hernia itself, pain may be the only symptom.
On some occasions, the presence of intestine inside the hernia sac with adhesions to it can cause intestinal transit disorders that manifest as episodes of intestinal occlusion more or less manifest.
However, all eventrations are subject to the possibility of suffering episodes of incarceration, i.e. the trapping of the viscera in a narrow orifice, such as a hernia; and even strangulation. These conditions usually cause intense and sustained pain and inflammation in the area of the eventration, which can lead to disseminated abdominal pain and even fever.
Strangulation of the hernia involves the appearance of vascular compromise of the hernial contents with consequent ischemia of the contents. If the content is an intestinal loop or colon and ischemia is maintained over time, it can lead to perforation of the intestine.
Treatment of eventration
When one of these complications occurs, the hernia must be treated urgently by means of general surgery. However, surgery is always elective, i.e., the patient’s own choice. The surgical approach can be by open or laparoscopic surgery and always involves the anatomical correction of the defect as far as possible and reinforcement by the placement of the mesh.
There are many types and brands of mesh or wall prostheses on the market today and the surgeon will choose them according to the type of hernia, the conditions of the repair (presence of infection, position of the mesh in relation to the planes of the abdominal wall), the approach (open or laparoscopic) and his or her surgical experience.
If you need more information about eventrations, ask for an appointment with a medical specialist in this pathology.