Incarcerated hernia, ICD code 10. Postoperative ventral hernia, ICD code

Includes: paraumbilical hernia

Included:

• hernia of the opening of the diaphragm (esophageal) (sliding)
• paraesophageal hernia

Excludes: congenital hernia:

• diaphragmatic (Q79.0)
• hiatal opening of diaphragm (Q40.1)

Included: hernia:

• abdominal cavity, updated NEC localization
• lumbar
• obturator
• female external genitalia
• retroperitoneal
• ischial

Included:

• enterocele [intestinal hernia]
• epiplocele [omental hernia]
• hernia:
  • NOS
  • interstitial
  • intestinal
  • intra-abdominal

Excludes: vaginal enterocele (N81.5)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is accepted as a unified normative document to account for morbidity, the reasons for the population's appeals to medical institutions of all departments, and the causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

K40-K46 Hernias

• acquired hernia
• congenital hernia (other than diaphragmatic or esophageal opening of the diaphragm)
• recurrent hernia

Note: a hernia with gangrene and obstruction is classified as a hernia with gangrene

• inguinal hernia (unilateral) without gangrene: causing obstruction, strangulated, irreducible, strangulation

• femoral hernia (unilateral) without gangrene: causing obstruction, strangulated, irreducible, strangulation

Hernia of the spine according to microbial 10

Code of intervertebral hernia of the spine according to ICD 10

A hernia of the spine receives the ICD 10 code in strict accordance with the type of damage to the cartilaginous intervertebral discs and the place of their localization. Thus, pathologies not associated with trauma, located in cervical region, are placed in a separate division and are indicated in the official medical records code M50. This designation can be affixed to the diagnosis field on a temporary disability sheet, a statistical reporting sheet, some types of referrals to instrumental methods control.

An intervertebral hernia located in the thoracic, lumbar and sacral region in ICD 10 is indicated by the code M51. There is the designation M51.3, which denotes severe degeneration (protrusion of a hernia) of the cartilaginous disc without spinal syndromes and neurological signs. With radiculopathy and severe pain during an exacerbation, a hernia can be indicated by the code M52.1. Code M52.2 stands for severe degeneration (destruction) of the cartilage disc with instability of the position of the bodies of the vertebrae located next to it.

Nodes or intervertebral hernia of Schmorl has an ICD code - M51.4. In the event that the diagnosis is not specified and additional differential diagnosis is required laboratory diagnostics in official medical documents, the code M52.9 is affixed.

To decrypt such data, a special table is used. Usually it is of interest to employees of the medical institution, employees of the social security department and representatives of the human resources department. All the necessary information is in the public domain and can be studied by anyone who has an interest in this. If you have any difficulties, you can contact our specialist. He will tell you everything about that disease of the spine, which is encrypted as an intervertebral hernia according to the ICD 10 code.

Trubnikov Vladislav Igorevich

Candidate of Medical Sciences

Neurologist, chiropractor, rehabilitologist, specialist in reflexology, physiotherapy exercises and therapeutic massage.

Saveliev Mikhail Yurievich

manual therapist the highest category, has over 25 years of experience.

He owns the methods of auriculo and corporal reflexology, pharmacopuncture, hirudotherapy, physiotherapy, exercise therapy. Perfectly applies osteopathy in both adults and children.

Signs of a spinal hernia in the lumbar region

A herniated disc is a degenerative disease intervertebral disc characterized by a violation of its integrity and structure

A herniated lumbar spine is a protrusion or protrusion of fragments of the intervertebral disc in spinal canal. ICD disease code - 10 #8212; M51 (damage to the intervertebral discs of other departments). Occurs with injuries or osteochondrosis, leads to compression of the nerve structures.

A hernia in the lumbar region occurs with a frequency of 300:100 thousand of the population, mainly in men from 30 to 50 years old.

Hernia localization - L5-S1 (mainly) and L4-L5. In rare cases, a hernia of the lumbar spine is found L3-L4 and with severe injuries of the upper lumbar discs.

Systematization (according to the degree of penetration into the spinal canal):

According to the location of the hernia in the frontal plane: lateral, median, paramedian hernia.

Main clinical picture

At the very beginning of the disease, patients complain of back pain. Radicular and vertebral syndromes appear much later, in some cases, the "experience" of pain is several years.

At this stage, the root is compressed and the disc herniation is formed: lumbalgia (pain in the lumbar region). Initially - fickle and aching. Over time, the severity of pain increases, more often due to stretching of the posterior longitudinal ligament and overstrain of the ligamentous apparatus and muscles. The patient feels increased pain with any muscle tension, coughing, sneezing and lifting weights. Lumbalgia is characterized by repeated exacerbations that continue for many years.

A spinal hernia can occur in almost any part of the spine.

1. tension of the paravertebral muscles prevents the full straightening of the back and causes pain;
2. limited mobility of the lumbar;
3. smoothing of the lumbar lordosis (often there is a transition to kyphosis);

With a median and paramedian hernia, scoliosis is observed, open to the diseased side (less stretching of the posterior longitudinal ligament). With lateral hernia (decrease in compression of the nerve root), scoliosis is observed, open in the opposite direction.

Radicular syndrome (radiculopathy):

• pain sensations occur in the zone of innervation of one or more roots, spread to the buttock, and below - along the anterior, posterior (posterior) surface of the leg and thigh (sciatica). By nature, the pain is aching or shooting;
• pain most often occurs due to injury, with an unsuccessful turn of the body or when lifting weights;
• changes occur in the zone of innervation of the nerve root;
• muscles become weak, hypotonia is observed, atrophy (sometimes fasciculations) develops. The patient feels numbness, paresthesias occur;
• "cough symptom". When straining (coughing, sneezing), a shooting pain or its sharp increase appears in the innervation zone of the compressed root;
• loss of proprioceptive reflexes.

1. pain occurs even with a slight lifting of the leg;
2. pain appears in the lower back and in the dermatome of the affected root. The patient may feel numbness or "goosebumps" when lifting the straightened leg up;
3. pain lessens (disappears) when bending the leg in knee joint, but increases with dorsiflexion of the foot.

Hernia of the lumbar spine most often occurs against the background of osteochondrosis

Cauda equina pathology (acute root compression):

• reason: large median hernia, pain occurs with significant physical effort and heavy load on the spine (sometimes during a manual therapy session). Signs: urinary retention (impaired sensitivity in the anogenital region), lower flaccid paraparesis.

Caudogenic intermittent claudication syndrome:

• there is pain when walking in the lower extremities (due to transient compression of the cauda equina). The patient has to stop frequently while moving.

Diagnostic measures

When making a diagnosis, it is important to take into account all the symptoms that “talk” about the presence of a hernia of the lumbar spine. Spinal hernia is recognized by the following diagnostic methods:

• lumbar puncture (moderate increase in protein);
• radiography of the spinal column;
• MRI and myelography, sometimes followed by high-resolution CT;
• electromyography (the ability to differentiate peripheral neuropathy from root compression).

Differential Diagnosis

It is important to exclude when differentiating from a lumbar hernia: tumors and metastases to the spine, Bechterew's disease, tuberculous spondylitis, metabolic spondylopathies, circulatory disorders in the additional spinal artery of Desproges-Gotteron, diabetic neuropathy.

Timely diagnosis and treatment started can restore the intervertebral disc completely. With late treatment, all therapeutic measures, unfortunately, are aimed only at reducing the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative-dystrophic changes in the spine

Degenerative changes in the spine consist of three main options. These are osteochondrosis, spondylosis, spondylarthrosis. Various pathological variants can be combined with each other. Degenerative-dystrophic changes in the spine by old age are observed in almost all people.

Osteocondritis of the spine

ICD-10 code: M42 - Osteochondrosis of the spine.

Osteochondrosis of the spine is a decrease in the height of the intervertebral disc as a result of dystrophic processes without inflammatory phenomena. As a result, segmental instability develops (excessive degree of flexion and extension, sliding of the vertebrae forward during flexion or backward during extension), and the physiological curvature of the spine changes. The convergence of the vertebrae, and hence the articular processes, their excessive friction will inevitably lead to local spondylarthrosis in the future.

Osteochondrosis of the spine is an x-ray, but not a clinical diagnosis. In fact, osteochondrosis of the spine simply states the fact of the aging of the body. Calling back pain osteochondrosis is illiterate.

Spondylosis

ICD-10 code: M47 - Spondylosis.

Spondylosis is characterized by the appearance of marginal bone growths (along the upper and lower edges of the vertebrae), which on x-rays look like vertical spikes (osteophytes).

Clinically, spondylosis is insignificant. It is believed that spondylosis is an adaptive process: marginal growths (osteophytes), disc fibrosis, ankylosis of the facet joints, thickening of the ligaments - all this leads to immobilization of the problematic spinal motion segment, expansion of the supporting surface of the vertebral bodies.

Spondylarthrosis

ICD-10 code. M47 - Spondylosis Inclusions: arthrosis or osteoarthritis of the spine, degeneration of the facet joints

Spondylarthrosis is an arthrosis of the intervertebral joints. It has been proven that the processes of degeneration in the intervertebral and peripheral joints do not fundamentally differ. That is, in fact, spondylarthrosis is a type of osteoarthritis (therefore, chondroprotective drugs will be appropriate in the treatment).

Spondylarthrosis is the most common cause back pain in the elderly. In contrast to discogenic pain in spondylarthrosis, the pain is bilateral and localized paravertebral; increases with prolonged standing and extension, decreases with walking and sitting.

3. Protrusion and herniation of the disc

ICD-10 code: M50 - Damage to the intervertebral discs of the cervical region; M51 - Damage to the intervertebral discs of other departments.

Protrusion and herniation of the disc are not a sign of osteochondrosis. Moreover, the less pronounced degenerative changes in the spine, the more the disk is active (that is, the more likely the occurrence of a hernia). That is why disc herniations are more common in young people (and even children) than in older people.

Schmorl's hernia is often considered a sign of osteochondrosis, which has no clinical significance (there are no back pains). Schmorl's hernia is a displacement of disc fragments into the spongy substance of the vertebral body (intracorporeal hernia) as a result of a violation of the formation of the vertebral bodies during growth (that is, in fact, Schmorl's hernia is dysplasia).

The intervertebral disc consists of the outer part - this is the fibrous ring (up to 90 layers of collagen fibers); and the inner part is the gelatinous nucleus pulposus. In young people, the nucleus pulposus is 90% water; in the elderly, the nucleus pulposus loses water and elasticity, fragmentation is possible. Disc protrusion and herniation occur as a result of dystrophic changes disk, and due to repeated increased loads on the spine (excessive or frequent flexion and extension of the spine, vibration, trauma).

As a result of the transformation of vertical forces into radial forces, the nucleus pulposus (or its fragmented parts) shifts to the side, bending the fibrous ring outward - disc protrusion develops (from Latin Protrusum - push, push). The protrusion disappears as soon as the vertical load stops.

Spontaneous recovery is possible if fibrotization processes extend to the nucleus pulposus. Fibrous degeneration occurs and protrusion becomes impossible. If this does not happen, then as the protrusions become more frequent and repeated, the fibrous ring becomes more and more entangled and, finally, ruptures - this is a disc herniation.

A disc herniation can develop acutely or slowly (when fragments of the nucleus pulposus come out in small portions into the rupture of the fibrous ring). Disk herniations in the posterior and posterior-lateral direction can cause compression of the spinal root (radiculopathy), spinal cord(myelopathy) or their vessels.

Most often, disc herniation occurs in the lumbar spine (75%), followed by the frequency of cervical (20%) and thoracic spine (5%).

• The cervical region is the most mobile. The frequency of hernias in the cervical spine is 50 cases per 100,000 population. The most common disc herniation occurs in the C5-C6 or C6-C7 segment.
• The lumbar region bears the greatest load, holding the entire body. The frequency of hernias in the lumbar spine is 300 cases per 100,000 population. Most often, disc herniation occurs in the L4-L5 segment (40% of all herniations in the lumbar spine) and in the L5-S1 segment (52%).

Disc herniation should be clinically confirmed, asymptomatic disc herniations, according to CT and MRI, occur in 30-40% of cases and do not require any treatment. It should be remembered that the detection of a herniated disc (especially small ones) on CT or MRI does not exclude another cause of back pain and cannot be the basis of a clinical diagnosis.

Contents of the file Dorsopathy and back pain:

Degenerative-dystrophic changes in the spine. Protrusion and herniation of the disc.

The most common cause of ventral hernias is an abdominal operation, after which a hernia defect is formed in the area of ​​the postoperative wound.

It could be a defect surgical suture or rupture of the aponeurosis in the immediate vicinity of the formed scar. To date, this problem remains relevant because, given the availability of modern suture material, up to 15% of all abdominal operations are complicated by ventral hernia.

Reasons for education

• Technically incorrect suturing by a doctor after surgery,
• Inflammation, and as a result, suppuration of the wound,
• Suture material of poor quality,
• Obesity,
• Atrophied abdominal muscles
• Excessive physical activity after surgery,
• Weak immunity,
• Tendency to constipation
• Various complications that appeared after the operation, etc.

Most often it can form after removal of the gallbladder, surgery for peritonitis, removal of appendicitis. There are cases of the appearance of this pathology after the removal of the kidney.

Quite often a bulge internal organs associated with the need for urgent surgical intervention, without the possibility of carrying out a number of preparatory procedures.

In a patient, the normal functioning of the gastrointestinal tract or respiratory organs may be disrupted, which leads to a risk of increasing intra-abdominal pressure and, as a result, to a negative effect on scar formations.

Diastasis rectus abdominis

Divergence of the rectus muscles is the most common patient misconception about the presence of a hernia of the anterior abdominal wall. This pathology is also manifested by a protrusion, but it is always located between the xiphoid process and the navel, the white line of the abdomen retains its integrity, the abdominal organs are in their place, there are no hernia gates, there are no complications.

A herniated disc is one of the most dangerous pathologies of the musculoskeletal system. This phenomenon is very common, especially among patients 30–50 years of age. With a hernia of the spine, the ICD code 10 is put in the patient's medical record. Why is it necessary? Turning to the hospital, the doctor will immediately see what diagnosis the patient has. A herniated disc belongs to the thirteenth class, which contains all the pathologies of bones, muscles, tendons, lesions of the synovial membranes, osteopathy and chondropathy, dorsopathy and systemic lesions of the connective tissue. ICD 10 is a reference network designed for the convenience of clinicians. The Medical Information Guide has the following objectives:

• formation of conditions for the purpose of comfortable exchange and comparison of data acquired in different states;
• to make it more comfortable for doctors and other medical staff to store information about patients;
• comparison of data in one hospital in different periods.

Thanks to the International Classification of Diseases, it is convenient to count deaths and injuries. Also, the ICD 10th revision contains information about the causes of spinal hernia, symptoms, course of the disease and pathogenesis.

The main types of protrusion

A herniated disc is a degenerative pathology resulting from a protrusion of the intervertebral disc and pressure on the spinal canal and nerve roots. There are the following types of hernias depending on the localization:

• cervical;
• chest;
• lumbar;
• sacral.

Most often, the disease occurs in the cervical and lumbar region, somewhat less often the pathology affects the thoracic region. The human spine consists of transverse and spinous processes, intervertebral discs, costal articular surfaces, intervertebral foramina. Each section of the spinal column has a certain number of vertebrae, between which there are intervertebral discs with the presence of a pulpous nucleus inside. Consider the sections of the spine and the number of segments in each of them

1. The cervical region consists of the atlas (1st vertebra), axis (2nd vertebra). Then the numbering continues from C3 to C7. There is also a conditionally occipital bone, it is designated C0. The cervical part is very mobile, so a hernia often affects it.
2. The thoracic spine has 12 segments, denoted by the letter "T". Between the vertebrae are disks that perform a shock-absorbing function. Intervertebral discs distribute the load on the entire spine. ICD 10 indicates that in the thoracic region, a hernia is more often formed between the T8-T12 segments.
3. The lumbar part consists of 5 vertebrae. The vertebrae in this area are denoted by the letter "L". Often a hernia affects this particular department. Unlike the cervical, it is more mobile, more likely to be injured.

The sacral section is also distinguished, consisting of 5 fused segments. Less commonly, the disease is found in the thoracic and sacral regions. Each section of the spine is associated with different organs of the patient. This should be taken into account, this knowledge will help to make a diagnosis.

How is a protrusion in the cervical region indicated on the patient card? What organs are affected by the disease with this localization?

ICD code 10 is set in accordance with the type of damage to the cartilaginous intervertebral discs. With a hernia in the cervical spine, the patient's medical record is coded M50. The defeat of the intervertebral segments according to the International Classification of Diseases is divided into 6 subclasses:

• M50.0;
• M50.1;
• M50.2;
• M50.3;
• M50.8;
• M50.9.

Such a diagnosis means a temporary disability of the patient. With a hernia in the cervical region, the patient experiences the following symptoms:

• headache;
• memory impairment;
• hypertension;
• blurred vision;
• hearing loss;
• complete deafness;
• pain in the shoulder muscles and joints;
• facial numbness and tingling.

As you can see, a degenerative disease affects the functioning of the eyes, pituitary gland, cerebral circulation, forehead, facial nerves, muscles, vocal cords. If left untreated, a cervical hernia leads to complete paralysis. The patient remains disabled for life. Pathologists use X-ray, CT or MRI for diagnosis.

Classes with damage to the intervertebral discs in the thoracic, lumbar and sacral region

With thoracic, lumbar or sacral hernia of the spine, the ICD class M51 is assigned. It refers to damage to the intervertebral discs of other departments with myelopathy (M51.0), radiculopathy (M51.1), lumbago due to displacement of the intervertebral segment (M51.2), as well as specified (M51.8) and unspecified (M51.9) lesions intervertebral disc. There is also a code in the ICD 10 M51.3. M51.3 is a degeneration of the intervertebral disc that occurs without spinal and neurological symptoms.

This sheet is typically required for doctors, nurses and other health care workers, social security officers, and human resources representatives. Information can be obtained by anyone, it is in the public domain.

Symptoms of the disease in the thoracic, lumbar and sacral region in the form of a table

The human spine has certain curves, in fact it is not a column, although in many sources you can find the name "vertebral column". Physiological bends are not a sign of a pathological process in the body, there are certain norms and deviations in various pathologies. A hernia of the spine in the thoracic region causes a person to stoop, so pain is less manifested, thus, kyphosis or lordosis may occur. To prevent the disease from leading to such complications, you should recognize the symptoms of the pathology in time and consult a doctor. Let's look at the signs of a degenerative disease depending on the location. Everything is detailed in the table, even an unknowing person will be able to make a preliminary diagnosis in order to know which doctor to make an appointment with.

A spinal hernia in the sacral region most often occurs between the L5-S1 segments. In this case, there is pain that radiates to the buttocks, lower limbs, lumbar, numbness in the foot, lack of reflexes, change in sensitivity, sensation of "goosebumps", tingling, "cough push" (when coughing or sneezing, the patient strikes sharp pain).

How are Schmorl nodes designated in official documents?

The international classification of diseases designates Schmorl's hernia with the M51.4 code. Schmorl's nodes - this is a pushing of the cartilage tissue of the end plates in spongy bone segment. This disease disrupts the density of the cartilage of the intervertebral disc and mineral metabolism. As a result, there may be a decrease in the density of the vertebrae, the elasticity of the intervertebral ligaments. There is a deterioration in depreciation properties, the growth of fibrous tissue at the location of Schmorl's nodes and the formation of intervertebral pathology.

Ruled out: lumbar sciatica NOS (M54.1)

Lumbago due to displacement of the intervertebral disc

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Hernia of the spine according to microbial 10

A hernia of the spine receives the ICD 10 code in strict accordance with the type of damage to the cartilaginous intervertebral discs and the place of their localization. Thus, pathologies not associated with trauma, located in the cervical region, are placed in a separate unit and are indicated in the official medical documentation by the M50 code. This designation can be affixed in the diagnosis field on a temporary disability sheet, statistical reporting sheet, some types of referrals to instrumental control methods.

Trubnikov Vladislav Igorevich

Candidate of Medical Sciences

Neurologist, chiropractor, rehabilitologist, specialist in reflexology, physiotherapy exercises and therapeutic massage.

Saveliev Mikhail Yurievich

A chiropractor of the highest category, has over 25 years of experience.

He owns the methods of auriculo and corporal reflexology, pharmacopuncture, hirudotherapy, physiotherapy, exercise therapy. Perfectly applies osteopathy in both adults and children.

Signs of a spinal hernia in the lumbar region

Intervertebral hernia is a degenerative disease of the intervertebral disc, characterized by a violation of its integrity and structure.

A hernia of the lumbar spine is a protrusion or protrusion of fragments of the intervertebral disc into the spinal canal. ICD disease code - 10 #8212; M51 (damage to the intervertebral discs of other departments). Occurs with injuries or osteochondrosis, leads to compression of the nerve structures.

A hernia in the lumbar region occurs with a frequency of 300:100 thousand of the population, mainly in men from 30 to 50 years old.

Hernia localization - L5-S1 (mainly) and L4-L5. In rare cases, a hernia of the lumbar spine is found L3-L4 and with severe injuries of the upper lumbar discs.

Systematization (according to the degree of penetration into the spinal canal):

According to the location of the hernia in the frontal plane: lateral, median, paramedian hernia.

Main clinical picture

At the very beginning of the disease, patients complain of back pain. Radicular and vertebral syndromes appear much later, in some cases, the "experience" of pain is several years.

At this stage, the root is compressed and the disc herniation is formed: lumbalgia (pain in the lumbar region). Initially - fickle and aching. Over time, the severity of pain increases, more often due to stretching of the posterior longitudinal ligament and overstrain of the ligamentous apparatus and muscles. The patient feels increased pain with any muscle tension, coughing, sneezing and lifting weights. Lumbalgia is characterized by repeated exacerbations that continue for many years.

A spinal hernia can occur in almost any part of the spine.

1. tension of the paravertebral muscles prevents the full straightening of the back and causes pain;
2. limited mobility of the lumbar;
3. smoothing of the lumbar lordosis (often there is a transition to kyphosis);

on palpation of the paravertebral muscles and interspinous processes, pain is observed;

there is a pronounced change in posture (forced position) to reduce pain;

call symptom. Tapping the interspinous space, which corresponds to the localization of the hernia, leads to shooting pain in the leg;

vegetative manifestations (marbling of the skin, sweating).

With a median and paramedian hernia, scoliosis is observed, open to the diseased side (less stretching of the posterior longitudinal ligament). With lateral hernia (decrease in compression of the nerve root), scoliosis is observed, open in the opposite direction.

Radicular syndrome (radiculopathy):

• pain sensations occur in the zone of innervation of one or more roots, spread to the buttock, and below - along the anterior, posterior (posterior) surface of the leg and thigh (sciatica). By nature, the pain is aching or shooting;
• pain most often occurs due to injury, with an unsuccessful turn of the body or when lifting weights;
• changes occur in the zone of innervation of the nerve root;
• muscles become weak, hypotonia is observed, atrophy (sometimes fasciculations) develops. The patient feels numbness, paresthesias occur;
• "cough symptom". When straining (coughing, sneezing), a shooting pain or its sharp increase appears in the innervation zone of the compressed root;
• loss of proprioceptive reflexes.

1. pain occurs even with a slight lifting of the leg;
2. pain appears in the lower back and in the dermatome of the affected root. The patient may feel numbness or "goosebumps" when lifting the straightened leg up;
3. the pain weakens (disappears) when the leg is bent at the knee joint, but increases with the dorsiflexion of the foot.

Hernia of the lumbar spine most often occurs against the background of osteochondrosis

Cauda equina pathology (acute root compression):

• reason: large median hernia, pain occurs with significant physical effort and heavy load on the spine (sometimes during a manual therapy session). Signs: urinary retention (impaired sensitivity in the anogenital region), lower flaccid paraparesis.

Caudogenic intermittent claudication syndrome:

• there is pain when walking in the lower extremities (due to transient compression of the cauda equina). The patient has to stop frequently while moving.

Diagnostic measures

When making a diagnosis, it is important to take into account all the symptoms that “talk” about the presence of a hernia of the lumbar spine. Spinal hernia is recognized by the following diagnostic methods:

• lumbar puncture (moderate increase in protein);
• radiography of the spinal column;
• MRI and myelography, sometimes followed by high-resolution CT;
• electromyography (the ability to differentiate peripheral neuropathy from root compression).

Differential Diagnosis

It is important to exclude when differentiating from a lumbar hernia: tumors and metastases to the spine, Bechterew's disease, tuberculous spondylitis, metabolic spondylopathies, circulatory disorders in the additional spinal artery of Desproges-Gotteron, diabetic neuropathy.

Timely diagnosis and treatment started can restore the intervertebral disc completely. With late treatment, all therapeutic measures, unfortunately, are aimed only at reducing the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative-dystrophic changes in the spine

Degenerative changes in the spine consist of three main options. These are osteochondrosis, spondylosis, spondylarthrosis. Various pathological variants can be combined with each other. Degenerative-dystrophic changes in the spine by old age are observed in almost all people.

Osteocondritis of the spine

ICD-10 code: M42 - Osteochondrosis of the spine.

Osteochondrosis of the spine is a decrease in the height of the intervertebral disc as a result of dystrophic processes without inflammatory phenomena. As a result, segmental instability develops (excessive degree of flexion and extension, sliding of the vertebrae forward during flexion or backward during extension), and the physiological curvature of the spine changes. The convergence of the vertebrae, and hence the articular processes, their excessive friction will inevitably lead to local spondylarthrosis in the future.

Osteochondrosis of the spine is an x-ray, but not a clinical diagnosis. In fact, osteochondrosis of the spine simply states the fact of the aging of the body. Calling back pain osteochondrosis is illiterate.

Spondylosis

ICD-10 code: M47 - Spondylosis.

Spondylosis is characterized by the appearance of marginal bone growths (along the upper and lower edges of the vertebrae), which on x-rays look like vertical spikes (osteophytes).

Clinically, spondylosis is insignificant. It is believed that spondylosis is an adaptive process: marginal growths (osteophytes), disc fibrosis, ankylosis of the facet joints, thickening of the ligaments - all this leads to immobilization of the problematic spinal motion segment, expansion of the supporting surface of the vertebral bodies.

Spondylarthrosis

ICD-10 code. M47 - Spondylosis Inclusions: arthrosis or osteoarthritis of the spine, degeneration of the facet joints

Spondylarthrosis is an arthrosis of the intervertebral joints. It has been proven that the processes of degeneration in the intervertebral and peripheral joints do not fundamentally differ. That is, in fact, spondylarthrosis is a type of osteoarthritis (therefore, chondroprotective drugs will be appropriate in the treatment).

Spondylarthrosis is the most common cause of back pain in the elderly. In contrast to discogenic pain in spondylarthrosis, the pain is bilateral and localized paravertebral; increases with prolonged standing and extension, decreases with walking and sitting.

3. Protrusion and herniation of the disc

ICD-10 code: M50 -; M51 - Damage to the intervertebral discs of other departments.

Protrusion and herniation of the disc are not a sign of osteochondrosis. Moreover, the less pronounced degenerative changes in the spine, the more active the disc is (that is, the more likely the occurrence of a hernia). That is why disc herniations are more common in young people (and even children) than in older people.

Schmorl's hernia is often considered a sign of osteochondrosis, which has no clinical significance (there are no back pains). Schmorl's hernia is a displacement of disc fragments into the spongy substance of the vertebral body (intracorporeal hernia) as a result of a violation of the formation of the vertebral bodies during growth (that is, in fact, Schmorl's hernia is dysplasia).

The intervertebral disc consists of the outer part - this is the fibrous ring (up to 90 layers of collagen fibers); and the inner part is the gelatinous nucleus pulposus. In young people, the nucleus pulposus is 90% water; in the elderly, the nucleus pulposus loses water and elasticity, fragmentation is possible. Protrusion and herniation of the disc occur both as a result of dystrophic changes in the disc, and as a result of repeated increased loads on the spine (excessive or frequent flexion and extension of the spine, vibration, trauma).

As a result of the transformation of vertical forces into radial forces, the nucleus pulposus (or its fragmented parts) shifts to the side, bending the fibrous ring outward - disc protrusion develops (from Latin Protrusum - push, push). The protrusion disappears as soon as the vertical load stops.

Spontaneous recovery is possible if fibrotization processes extend to the nucleus pulposus. Fibrous degeneration occurs and protrusion becomes impossible. If this does not happen, then as the protrusions become more frequent and repeated, the fibrous ring becomes more and more entangled and, finally, ruptures - this is a disc herniation.

A disc herniation can develop acutely or slowly (when fragments of the nucleus pulposus come out in small portions into the rupture of the fibrous ring). Posterior and posterolateral disc herniations can cause compression of the spinal root (radiculopathy), the spinal cord (myelopathy), or their vessels.

Most often, disc herniation occurs in the lumbar spine (75%), followed by the frequency of cervical (20%) and thoracic spine (5%).

• The cervical region is the most mobile. The frequency of hernias in the cervical spine is 50 cases per 100,000 population. The most common disc herniation occurs in the C5-C6 or C6-C7 segment.
• The lumbar region bears the greatest load, holding the entire body. The frequency of hernias in the lumbar spine is 300 cases per 100,000 population. Most often, disc herniation occurs in the L4-L5 segment (40% of all herniations in the lumbar spine) and in the L5-S1 segment (52%).

Disc herniation should be clinically confirmed, asymptomatic disc herniations, according to CT and MRI, occur in 30-40% of cases and do not require any treatment. It should be remembered that the detection of a herniated disc (especially small ones) on CT or MRI does not exclude another cause of back pain and cannot be the basis of a clinical diagnosis.

Spinal hernia according to ICD 10th revision

This disease is very dangerous and insidious, take care

A herniated disc is one of the most dangerous pathologies of the musculoskeletal system. This phenomenon is very common, especially among patients 30–50 years of age. With a hernia of the spine, the ICD code 10 is put in the patient's medical record. Why is it necessary? Turning to the hospital, the doctor will immediately see what diagnosis the patient has. A herniated disc belongs to the thirteenth class, which contains all the pathologies of bones, muscles, tendons, lesions of the synovial membranes, osteopathy and chondropathy, dorsopathy and systemic lesions of the connective tissue. ICD 10 is a reference network designed for the convenience of clinicians. The Medical Information Guide has the following objectives:

• formation of conditions for the purpose of comfortable exchange and comparison of data acquired in different states;
• to make it more comfortable for doctors and other medical staff to store information about patients;
• comparison of data in one hospital in different periods.

Thanks to the International Classification of Diseases, it is convenient to count deaths and injuries. Also, the ICD 10th revision contains information about the causes of spinal hernia, symptoms, course of the disease and pathogenesis.

The main types of protrusion

A herniated disc is a degenerative pathology resulting from a protrusion of the intervertebral disc and pressure on the spinal canal and nerve roots. There are the following types of hernias depending on the localization:

Most often, the disease occurs in the cervical and lumbar region, somewhat less often the pathology affects the thoracic region. The human spine consists of transverse and spinous processes, intervertebral discs, costal articular surfaces, intervertebral foramina. Each section of the spinal column has a certain number of vertebrae, between which there are intervertebral discs with the presence of a pulpous nucleus inside. Consider the sections of the spine and the number of segments in each of them

1. The cervical region consists of the atlas (1st vertebra), axis (2nd vertebra). Then the numbering continues from C3 to C7. There is also a conditionally occipital bone, it is designated C0. The cervical part is very mobile, so a hernia often affects it.
2. The thoracic spine has 12 segments, denoted by the letter "T". Between the vertebrae are disks that perform a shock-absorbing function. Intervertebral discs distribute the load on the entire spine. ICD 10 indicates that in the thoracic region, a hernia is more often formed between the T8-T12 segments.
3. The lumbar part consists of 5 vertebrae. The vertebrae in this area are denoted by the letter "L". Often a hernia affects this particular department. Unlike the cervical, it is more mobile, more likely to be injured.

The sacral section is also distinguished, consisting of 5 fused segments. Less commonly, the disease is found in the thoracic and sacral regions. Each section of the spine is associated with different organs of the patient. This should be taken into account, this knowledge will help to make a diagnosis.

How is a protrusion in the cervical region indicated on the patient card? What organs are affected by the disease with this localization?

ICD code 10 is set in accordance with the type of damage to the cartilaginous intervertebral discs. With a hernia in the cervical spine, the patient's medical record is coded M50. The defeat of the intervertebral segments according to the International Classification of Diseases is divided into 6 subclasses:

Such a diagnosis means a temporary disability of the patient. With a hernia in the cervical region, the patient experiences the following symptoms:

• headache;
• memory impairment;
• hypertension;
• blurred vision;
• hearing loss;
• complete deafness;
• pain in the shoulder muscles and joints;
• facial numbness and tingling.

As you can see, a degenerative disease affects the functioning of the eyes, pituitary gland, cerebral circulation, forehead, facial nerves, muscles, vocal cords. If left untreated, a cervical hernia leads to complete paralysis. The patient remains disabled for life. Pathologists use X-ray, CT or MRI for diagnosis.

Classes with damage to the intervertebral discs in the thoracic, lumbar and sacral region

With thoracic, lumbar or sacral hernia of the spine, the ICD class M51 is assigned. It refers to damage to the intervertebral discs of other departments with myelopathy (M51.0), radiculopathy (M51.1), lumbago due to displacement of the intervertebral segment (M51.2), as well as specified (M51.8) and unspecified (M51.9) lesions intervertebral disc. There is also a code in the ICD 10 M51.3. M51.3 is a degeneration of the intervertebral disc that occurs without spinal and neurological symptoms.

This sheet is typically required for doctors, nurses and other health care workers, social security officers, and human resources representatives. Information can be obtained by anyone, it is in the public domain.

Symptoms of the disease in the thoracic, lumbar and sacral region in the form of a table

The human spine has certain curves, in fact it is not a column, although in many sources you can find the name "vertebral column". Physiological bends are not a sign of a pathological process in the body, there are certain norms and deviations in various pathologies. A hernia of the spine in the thoracic region causes a person to stoop, so pain is less manifested, thus, kyphosis or lordosis may occur. To prevent the disease from leading to such complications, you should recognize the symptoms of the pathology in time and consult a doctor. Let's look at the signs of a degenerative disease depending on the location. Everything is detailed in the table, even an unknowing person will be able to make a preliminary diagnosis in order to know which doctor to make an appointment with.

A spinal hernia in the sacral region most often occurs between the L5-S1 segments. At the same time, there is pain radiating to the buttocks, lower limbs, lumbar, numbness in the foot, lack of reflexes, a change in sensitivity, a feeling of "goosebumps", tingling, "cough push" (when the patient coughs or sneezes, a sharp pain strikes).

How are Schmorl nodes designated in official documents?

The international classification of diseases designates Schmorl's hernia with the M51.4 code. Schmorl's nodes are the pushing of the cartilaginous tissue of the end plates into the cancellous bone of the segment. This disease disrupts the density of the cartilage of the intervertebral disc and mineral metabolism. As a result, there may be a decrease in the density of the vertebrae, the elasticity of the intervertebral ligaments. There is a deterioration in depreciation properties, the growth of fibrous tissue at the location of Schmorl's nodes and the formation of intervertebral pathology.

Herniated disc

A herniated disc is a morphofunctional condition of the spine, in which intervertebral disc extends beyond the annulus fibrosus. It is a sign of pronounced degenerative-dystrophic changes in the spine, may be the result of a spinal injury.

Many people think that a disc prolapse of less than 6 millimeters is a protrusion, while a disc prolapse of 6 millimeters or more is a herniation.

By itself, a disc herniation cannot be considered as a separate independent disease and, rather, is a consequence of osteochondrosis, trauma. Disc herniation can be considered within the framework of various syndromes, which differ depending on the location, involvement in the process of the roots or the very substance of the spinal cord.

More often than other localizations there are localizations of intervertebral hernias at the level of the LV-SI segment. It is at this level that the transition of one mobile section of the spine to another fixed one occurs and the load on the intervertebral segments is greatest.

Information for doctors. In ICD 10, there are several codes under which it is customary to code discogenic lesions of the spine. Under the code M50.0, the defeat of the cervical intervertebral discs is encrypted. Under the code M51.1, the localization of a hernia in the lumbar, thoracic. The third digit zero means the presence of myelopathy, 1 - radiculopathy, 2 - another specified lesion, 3 - other disc degenerations.

Symptoms

The symptomatology of the disease depends on the localization of the process, the size of the hernia, its localization directly in the intervertebral segment. So, a herniated disc that has fallen out anteriorly cannot lead to either root infringement or compression of the spinal cord and is asymptomatic. Whereas a hernia that clamps the root of the spinal cord can lead to radiculopathy. Then the symptoms of a hernia will be weakness in the leg or arm, impaired sensitivity in it, convulsions, limitation of limb movements. In the later stages of radiculopathy, muscle hypotrophy develops.

Large hernias can lead to compression of the spinal cord. In the case of localization in the lumbosacral region, the patient may develop pelvic disorders, caudogenic intermittent claudication syndrome. Also, compression of the spinal cord threatens the development of myelopathy, in which the neuromuscular transmission is disturbed, the path of nerve impulses from the brain to the spinal cord suffers.

Disability in hernias is determined in patients with severe functional impairment. So, disability can be assigned to a person with radiculopathy, to patients after a neurosurgical operation, in the presence of myelopathy.

Diagnostics

A hernia can only be diagnosed with a high-resolution neuroimaging study. Such studies are MSCT or MRI. At the same time, it should be taken into account that MRI in general, especially those performed on devices latest generations(3 Tesla or more) much more accurately. MSCT cannot always determine the presence of a hernia with localization in the cervical region.

It is impossible to determine a disc herniation with “hands”, using a conventional X-ray examination. One can only assume the probable presence of damage to the intervertebral disc.

Neurological examination reveals signs of tension of the spinal roots, to identify reflex muscle spasm. Also, the loss of reflexes, a change in the sensitivity of the radicular type, a decrease in the strength of the muscles of the limbs suggest the presence of radiculopathy.

Video from the author

Treatment

All treatment of herniated discs can be divided into several stages - conservative treatment, carrying out blockades, neurosurgical treatment.

At the first stage, drug treatment is standard for vertebrogenic pain syndromes. Non-steroidal anti-inflammatory drugs, centrally acting muscle relaxants, B vitamins are used. Often, treatment is supplemented vasoactive drugs(for example, trental). In protracted pain syndrome, the use of anticonvulsants, such as pregabalin, gabapentin, is considered to be evidence-based.

In the presence of radiculopathy, additional neuroprotective therapy (thioctic acid preparations) can be used. Also additionally used are medications, like prozerin, contributing to the improvement of the conduction of a nerve impulse.

Sometimes, especially in cases of moderate pain, protracted nature of the process, emotional changes in the patient, they resort to antidepressant therapy. Many drugs are used as an antidepressant, the choice is made based on the financial capabilities of the patient, the presence of somatic pathology and other criteria.

In addition to drug treatment use manual influences, physiotherapy, exercise therapy, general preventive recommendations. Massage at an easy pace additional remedy relieving muscle spasm and pain can be prescribed to almost all patients, provided there are no direct contraindications to massage. The question of manual therapy is less clear.

Manual therapy can be prescribed only in a small number of cases. Contrary to popular belief, manual therapy is unable to "set" herniated discs and save the patient from the disease. I myself love very manual therapy, I resort to various manual techniques in many situations, but it is impossible to remove a hernia. In order to understand why, you just need to carefully re-examine the pathogenesis of the process. You can’t get to the place of localization of the hernia with your fingers, you won’t be able to “set” the intervertebral disc inward either, as well as “darn” the fibrous ring. But once again it is possible to displace the existing hernia, causing additional compression of the roots or the spinal cord itself. Therefore, with the threat of such a process, with the localization of a hernia at the cervical level, manual therapy is contraindicated.

Of the physiotherapeutic effects, in the absence of contraindications, DDT, electrophoresis with various drugs, and magnetotherapy are most often used. Course treatment is required, at least 5-10 procedures.

Exercise therapy classes are best done after consulting an exercise therapy instructor. Specific exercises for localizing the process at a certain level are given in the Rehabilitation section, exercise therapy subsection. To strengthen the muscle corset, relieve spasm, and prevent exacerbations, regular (and ideally daily) performance is recommended.

With the ineffectiveness of all the above methods of treatment, they proceed to the next stage - the blockade method. Blockades are mainly divided into the following types: paravertebral, epidural, facet joint blocks. Paravertebral - the simplest of all blockades - in fact, they are intramuscular injection in the long muscles of the back medicines. The doctor finds the most painful points and injects various drugs that reduce pain.

Facet joint blocks are rarely used for herniated discs. They are aimed at reducing pain in spondylarthrosis of the facet intervertebral joints. Epidural blockades are a method of drug delivery to the epidural space of the spinal cord and have a pronounced anti-inflammatory and analgesic effect. The blockade course usually consists of three procedures, the most commonly used drugs such as kenalog, diprospan in combination with local anesthetics, vitamin B12.

Neurosurgical intervention is indicated in case of insufficient effectiveness of the above treatments, severe muscle hypotrophy in radiculopathic conditions, pelvic disorders, manifestations of myelopathy, as well as the threat of developing caudal intermittent claudication syndrome. Laminectomy interventions with removal of a herniated disc are usually used, strengthening of the herniated site can be carried out by transpedicular fixation. The patient after the operation is not recommended to sit for 3-6 months, due to the high load on the vertebrae in the sitting position.

Also, all patients are shown compliance with general preventive measures. These include: restriction of lifted weights, work in an incline. When using elevators, public transport, it is recommended to lean against the wall with your back to reduce possible loads due to acceleration. It is necessary to sleep on a firm bed, avoiding uncomfortable positions.

Code of intervertebral hernia of the spine according to ICD 10

A hernia of the spine receives the ICD 10 code in strict accordance with the type of damage to the cartilaginous intervertebral discs and the place of their localization. Thus, pathologies not associated with trauma, located in the cervical region, are placed in a separate unit and are indicated in the official medical documentation by the M50 code. This designation can be put in the "diagnosis" field in the temporary disability sheet, statistical reporting sheet, some types of referrals to instrumental control methods.

An intervertebral hernia located in the thoracic, lumbar and sacral region in ICD 10 is indicated by the code M51. There is the designation M51.3, which denotes severe degeneration (protrusion of a hernia) of the cartilaginous disc without spinal syndromes and neurological signs. With radiculopathy and severe pain during an exacerbation, a hernia can be indicated by the code M52.1. Code M52.2 stands for severe degeneration (destruction) of the cartilage disc with instability of the position of the bodies of the vertebrae located next to it.

Nodes or intervertebral hernia of Schmorl has an ICD code - M51.4. In the event that the diagnosis is not specified and additional differential laboratory diagnostics is required, the code M52.9 is affixed in official medical documents.

To decrypt such data, a special table is used. Usually it is of interest to employees of the medical institution, employees of the social security department and representatives of the human resources department. All the necessary information is in the public domain and can be studied by anyone who has an interest in this. If you have any difficulties, you can contact our specialist. He will tell you everything about that disease of the spine, which is encrypted as an intervertebral hernia according to the ICD 10 code.

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Description and treatment of disc herniation microbial 10

The most severe and dangerous diseases of the musculoskeletal system are herniated discs. According to international classification diseases of the 10th revision (ICD-10), they have the code M51. The disease is diagnosed in every 3 out of 1000 people. Flying men are usually diagnosed with a herniated disc ICD10. Infantile hernias are associated with congenital pathology spine.

Description

When a herniated disc is formed, the discs of the spine fall out (prolapse) or protrude (protrusion), and the nerve endings of the spinal cord are pinched. In the first place are hernias, which are formed during the transition of the mobile spine to the stationary one. The next most common are herniated L3-4 discs. The most rare hernia of the intervertebral disc of the upper lumbar spine. They usually occur in patients who have suffered severe trauma.

Determine the presence of a hernia in a patient by results neurological examination it is forbidden.

And since the symptoms intervertebral hernia of the lumbar disc depend on the location, size and stage of the disease, then the only correct way to make a diagnosis is MRI or MSCT.

Symptoms of the disease

At the initial stage of the disease, while the intervertebral disc herniation is small, the root is not pinched, and the patient does not experience severe pain. Usually at this stage, the pain is dull in nature and appears periodically:

In some cases, in the initial stage of the disease, a herniated disc is accompanied by bouts of lumbago. As the hernia grows, pinching of the spinal cord root and lesions of the intervertebral discs are observed. This leads to the manifestation of vertebral and radicular syndromes. If there is no abrupt breakthrough of the lumbar disc herniation, then several years pass between the initial stage of the disease and the appearance of syndromes.

With vertebral syndrome, the mobility of the lumbar spine is limited, while the paravertebral muscles are tense all the time, because of which the patient experiences severe pain and cannot straighten his back. A patient with this syndrome often has scoliosis, and in some cases kyphosis. Patients experience heavy sweating, and the skin has a marbled tint. When tapping at the location of the hernia, the patient experiences a sharp shooting pain in the leg.

With radicular syndrome, shooting and aching pain radiates to the buttock and thigh, and in some cases to the lower leg. As the disease progresses, the patient experiences numbness of the limbs, severe muscle weakness, which, without proper treatment, turns into atrophy. Usually pain occurs with a sharp movement of the trunk, falling. One of the symptoms of lumbar radicular syndrome is sudden severe pain that occurs when sneezing or coughing.

Patients with intervertebral hernia of the lumbar region experience pain when raising the leg even to a small height, while the pain decreases or disappears when the leg is bent at the knee and becomes stronger when the foot is bent.

Sometimes even large enough hernias may not cause pain. If the loss occurred in front, then there is no pinching of the spine. However, even a small disc herniation, if it pinches the spinal cord root, can cause severe pain. With a median disc herniation, there may be problems with stools, incontinence or urinary retention, impotence.

Methods of treatment

Depending on the stage of the disease and the size of the disc herniation, treatment is carried out conservatively or surgically. To surgical treatment herniated discs are resorted to only when conservative, severe muscle weakness is ineffective or in emergency cases with acute compression of the spinal cord root.

Traditional treatments for a herniated disc include:

• traction of the spine;
• novocaine or lidocaine blockade;
• taking anti-inflammatory drugs and vitamins;
• physiotherapy;
• massage.

With an intervertebral hernia of the lumbar disc, manual therapy is not recommended.

How to cure joints and get rid of back pain forever - home method

Have you ever tried to get rid of joint pain on your own? Judging by the fact that you are reading this article, the victory was not on your side. And of course you know firsthand what it is:

• with pain and creaking, bend your legs and arms, turn, bend down.
• wake up in the morning with a feeling of ache in the back, neck or limbs
• for any change of weather to suffer from what twists and twists the joints
• forget what free movement is and every minute be afraid of another attack of pain!

Intervertebral hernia

Intervertebral hernia (herniated disc, ICD code 10 M51.2) is the terminal stage of spinal osteochondrosis, which is a degenerative-dystrophic disease. Recently, the frequency of this pathological condition getting higher.

An intervertebral hernia is a disease in which the intervertebral disc protrudes outward or inward from the spinal column due to instability of the ligamentous apparatus and other fixing structures.

Symptoms of an intervertebral hernia are primarily determined by the presence of compression of the nerve roots as a result of subsidence of the intervertebral disc and a decrease in the spaces between the vertebrae. Therefore, the main clinical manifestations herniated discs are as follows:

• Pain that can be constant or intermittent, and they increase with a change in the position of the human body (tilts to the side, for example)
• Symptoms of irritation of the nerve roots that appear hypersensitivity, pain along the nerve, tingling and goosebumps
• Chronic compression of the nerve root can lead to atrophy of the skin and muscles in the zone of its innervation, since the nervous tissue has a trophic function
• Violation of motor activity and sensitivity with the loss of certain zones of innervation with the loss of its ability to self-service.

The most reliable causes of the development of an intervertebral hernia have not been finally established. There are a number of predisposing factors that increase the likelihood of developing this disease. These include the following:

Thus, the main mechanism for the development of an intervertebral hernia is the excess of the compensatory-adaptive mechanisms of the fixing apparatus over the load experienced by the spine.

Diagnostic search for suspected intervertebral hernia includes the following studies:

• X-ray examination that allows you to see the protrusion between certain vertebrae
• Computed tomography (MRI, PET-CT, NMRI)
• Electroneuromyography, which allows you to assess the degree of involvement of one or another nerve root in the pathological process.

Absence timely treatment intervertebral hernia can lead to the development of certain complications that affect the quality of life of the patient. These include the following:

• Paresis and paralysis
• chronic pain syndrome
• Urinary and fecal incontinence and some others that are associated with compression of the nerve roots responsible for the innervation of the internal organs.

Treatment of an intervertebral hernia can be both operative and conservative. However, given that this is the last stage of osteochondrosis, conservative therapy is of low efficiency. The operation is intended to restore normal anatomical structure and strengthen the spine to prevent re-bulging of the intervertebral disc.

Physiotherapeutic treatment has a certain effectiveness. These techniques improve microcirculation in the connective tissue, which somewhat strengthens the spinal column.

The risk group includes the following categories of patients:

• With burdened heredity
• Overweight
• involved professional activity, which is associated with hard physical labor (for example, weightlifters, loaders).

Preventive measures are aimed at the possible elimination of predisposing factors. If the patient is in a high-risk group, he needs to undergo preventive examinations neurologist, including mandatory X-ray or tomographic examination of the spine. In addition, it is recommended to adhere to the following recommendations:

• Apply dosed physical activity
• Avoid overeating and hypodynamia.

• Avoiding excessive physical activity
• Wearing a special orthopedic corset
• Regular follow-up with a neurologist
• Nutrition has practically no restrictions, except for the use of high-calorie foods, since excess weight leads to the progression of the disease.

• back hurts
• Lower back pain
• lower back pain radiates to the leg
• lower back pain
• pain in the upper back
• pain in the lumbar region
• lower back pain is aggravated by bending, lifting and twisting the torso.
• Pain in the lower back

Catad_tema Surgical diseases - articles

Standard medical care sick with strangulated hernia

November 26, 2007 The Ministry of Health approved protocols for the diagnosis and treatment of strangulated hernia.

Strangulated hernia(ICD - 10 K40.3 - K 45.8) - sudden or gradual compression of the contents of the hernia in its gates.

Infringement is the most frequent and dangerous complication hernia disease. The lethality of patients increases with age, varying between 3.8 and 11%. Necrosis of strangulated organs is observed in at least 10% of cases.

The forms of infringement are different. Among them are distinguished:
1) elastic infringement;
2) fecal infringement;
3) parietal infringement;
4) retrograde infringement;
5) Litre's hernia (infringement of Meckel's diverticulum).

By frequency of occurrence are observed:
1) disadvantaged inguinal hernia
2) strangulated femoral hernias;
3) disadvantaged umbilical hernia;
4) strangulated postoperative ventral hernias;
5) strangulated hernias of the white line of the abdomen;
6) strangulated hernias of rare localizations.

A strangulated hernia may be accompanied by acute intestinal obstruction, which proceeds according to the mechanism of strangulation intestinal obstruction, the severity of which depends on the level of strangulation.
With all types and forms of strangulated hernia, the severity of disorders is directly dependent on the time factor, which determines the urgent nature of diagnostic and treatment measures.

Protocols for diagnosing strangulated hernias in the emergency department (AEMP)

Patients admitted to the AEMC with complaints of abdominal pain, symptoms of acute intestinal obstruction, should be purposefully examined for the presence of hernial protrusions in their typical places.

Based on complaints, anamnesis of the clinical picture and objective examination data, patients with strangulated hernias should be divided into 4 groups:
group 1 - uncomplicated strangulated hernia;
Group 2 - complicated strangulated hernia

With a complicated strangulated hernia, 2 subgroups are distinguished:
a) strangulated hernia complicated by acute intestinal obstruction;
b) strangulated hernia, complicated by phlegmon of the hernial sac.
group 3 - reduced strangulated hernia;

Uncomplicated strangulated hernia;

Criteria for diagnosing uncomplicated strangulated hernia in OEMT:

A strangulated uncomplicated hernia is recognized by:
- sudden onset pain in the area of ​​a previously reduced hernia, the nature and intensity of which depends on the type of infringement, the affected organ and the age of the patient;
- the impossibility of repositioning a previously freely reduced hernia;
- an increase in the volume of hernial protrusion;
- tension and pain in the area of ​​hernial protrusion;
- lack of transmission of "cough push";

Symptoms and signs of acute intestinal obstruction in uncomplicated strangulated hernia are absent.

Laboratory research:
- clinical analysis blood,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

- ECG

Therapist's consultations

Protocols of preoperative preparation for uncomplicated strangulated hernia in OEMT

Protocols of surgical tactics for uncomplicated strangulated hernia.

1. The only method of treating patients with an incarcerated uncomplicated hernia is an emergency operation, which should be started no later than 2 hours from the moment the patient enters the OEMP. There are no contraindications to surgery for a strangulated hernia.
2. The main tasks of the operation in the treatment of uncomplicated strangulated hernias are:
- elimination of infringement;
- examination of the restrained organs and appropriate interventions on them;
- hernial ring plasty.
3. An incision of sufficient size is made in accordance with the localization of the hernia. The hernial sac is opened and the organ strangulated in it is fixed. Dissection of the restraining ring before opening the hernial sac is unacceptable.
4. In case of spontaneous reduction into the abdominal cavity of the strangulated organ, it should be removed for examination and assessment of its blood supply. If it cannot be found and removed, wound expansion (herniolaparotomy) or diagnostic laparoscopy is indicated.
5. After dissection of the restraining ring, the state of the restrained organ is assessed. The viable intestine quickly takes on a normal appearance, its color becomes pink, the serous membrane is shiny, the peristalsis is distinct, the vessels of the mesentery pulsate. Before repositioning the intestine into the abdominal cavity, it is necessary to introduce 100 ml of a 0.25% solution of novocaine into its mesentery.
6. If there are doubts about the viability of the intestine, 100-120 ml of a 0.25% solution of novocaine should be injected into its mesentery and the doubtful area should be warmed with warm swabs soaked in 0.9% NaCl. If doubts remain about the viability of the bowel, the bowel should be resected within healthy tissue.
7. Signs of the non-viability of the intestine and indisputable indications for its resection are:
- dark color of the intestine;
- dull serous membrane;
- flabby wall;
- lack of intestinal peristalsis;
- lack of pulsation of the vessels of her mesentery;
8. Resection is subject, in addition to the strangulated section of the intestine, the entire macroscopically altered part of the adductor and efferent colon, plus 30 - 40 cm of the unchanged section of the adductor intestine and 15 - 20 cm of the unchanged segment of the efferent colon. The exception is resections near the ileocecal angle, where these requirements are allowed to be limited with favorable visual characteristics of the intestine in the area of ​​the proposed intersection. In this case, control indicators are necessarily used for bleeding from the vessels of the wall at its intersection and the state of the mucous membrane. It is also possible to use transillumination or other objective methods for assessing blood supply. During resection of the intestine, when the level of anastomosis is placed on the most distal ileum - less than 15 - 20 cm from the caecum, one should resort to imposing an ileoascendo - or ileotransverse anastomosis.
9. If there are doubts about the viability of the intestine, especially over its large extent, it is permissible to postpone the decision on resection using a programmed laparoscopy after 12 hours.
10. In cases of parietal infringement, a bowel resection should be performed. Immersion of the altered area into the intestinal lumen is dangerous and should not be performed, since this may lead to divergence of the immersion sutures, and immersion of a large area within the unchanged sections of the intestine can create a mechanical obstruction with impaired intestinal patency.
11. Restoration of the continuity of the gastrointestinal tract after resection is carried out:
- with a large difference in the diameters of the lumen of the sutured sections of the intestine by anastomosis "side to side";
- if the diameters of the lumen of the sutured sections of the intestine coincide, it is possible to apply an anastomosis "end to end".
12. If the omentum is infringed, indications for its resection are given if it is edematous, has fibrinous deposits or hemorrhages.
13. Surgical intervention ends with plasty of the hernia orifice, depending on the location of the hernia.

Protocols of postoperative management of patients with uncomplicated strangulated hernia

2. All patients are prescribed intramuscular injection of painkillers (analgin, ketarol) 3 times a day for 3 days after surgery; broad-spectrum antibiotics (cefazolin 1 g x 2 r / day) for 5 days after surgery.

Complicated strangulated hernia

Strangulated hernia complicated by acute intestinal obstruction

Criteria for diagnosing a strangulated hernia complicated by intestinal obstruction in OEMT:

Symptoms of acute intestinal obstruction join the local symptoms of infringement:
- cramping pains in the area of ​​hernial protrusion
- thirst, dry mouth,
- tachycardia > 90 bpm in 1 min.
- recurring vomiting;
- a delay of an otkhozhdeniye of gases;
- during the examination, bloating, increased peristalsis are determined; m.b. "splash noise";
- on the survey radiograph, Kloiber's bowls and small intestinal arches with transverse striation are determined, the presence of an "isolated loop" is possible;
- during ultrasound examination, dilated intestinal loops and "pendulum-like" peristalsis are determined;

Examination protocols in OEMP

Laboratory research:
- clinical blood test,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

Instrumental research:
- ECG
- Plain radiography of organs chest
- Survey radiography of the abdominal cavity.
- Abdominal ultrasound.

Therapist's consultations

Protocols for preoperative preparation of a strangulated hernia complicated by intestinal obstruction in OEMT

1. Before the operation, it is mandatory to put gastric tube and gastric contents are evacuated.
2. Emptying in progress Bladder and hygienic preparation of the surgical intervention area and the entire anterior abdominal wall.
3. The presence of expressed clinical signs general dehydration and endotoxicosis is an indication for intensive preoperative preparation with the placement of a catheter into the main vein and infusion therapy (intravenous 1.5 liters of crystalloid solutions, 400 ml of Reamberin, 10 ml diluted with 400 ml of 5% glucose solution. Antibiotics are administered in this case 30 minutes before surgery intravenously.

Protocols of surgical tactics for strangulated hernia complicated by intestinal obstruction.

1. An operation for a complicated strangulated hernia is always performed under anesthesia by a three-medical team with the participation of the most experienced surgeon on duty or a responsible surgeon on duty no later than 2 hours from the moment the patient enters the OEMP.
2. The main objectives of the operation in the treatment of strangulated hernia complicated by intestinal obstruction are:
- elimination of infringement;
- determination of the viability of the intestine and determination of indications for its resection;
- establishing the boundaries of the resection of the altered intestine and its implementation;
- determination of indications and method of drainage of the intestine;
- sanitation and drainage of the abdominal cavity
- hernial ring plasty.

3. The initial stages of the operation to eliminate the strangulated hernia, complicated by intestinal obstruction, correspond to the provisions set forth in paragraphs. 5 - 12 surgical tactics for uncomplicated strangulated hernia.
4. Indication for drainage small intestine serves as an overflow with the contents of the leading intestinal loops.
5. The preferred method of drainage of the small intestine is nasogastrointestinal intubation from a separate midline laparotomy.
6. Surgical intervention ends with drainage of the abdominal cavity and plasty of the hernia ring, depending on the location of the hernia.

Protocols of postoperative management of patients with strangulated hernia complicated by intestinal obstruction

1. Enteral nutrition begins with the appearance of intestinal peristalsis by introducing glucose-electrolyte mixtures into the intestinal probe.
2. Extraction of the nasogastrointestinal drainage probe is carried out after the restoration of stable peristalsis and independent stool for 3-4 days. The drainage tube, installed in the small intestine through the gastrostomy or retrograde according to Velch-Zhitnyuk, is removed a little later - on the 4th - 6th day.
3. In order to combat ischemic and reperfusion injuries of the small intestine, infusion therapy is carried out (intravenously 2-2.5 liters of crystalloids solutions, Reamberin 400 ml, 10.0 ml diluted with 400 ml of 0.9% sodium chloride solution, trental 5, 0 - 3 times a day, kontrykal - 50,000 units / day, ascorbic acid 5% 10 ml / day).
4. Antibacterial therapy in the postoperative period should include either II-III aminoglycosides, III generation cephalosporins and metronidazole, or II generation fluoroquinolones and metronidazole.
5. To prevent the formation of acute gastrointestinal ulcers, therapy should include antisecretory drugs.
6. Complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.
Laboratory studies are performed according to indications and before discharge. An extract from the uncomplicated course of the postoperative period is made for 10-12 days.

Strangulated hernia complicated by phlegmon of the hernial sac

Criteria for diagnosing a strangulated hernia complicated by phlegmon of the hernial sac in OEMT:
- the presence of symptoms of severe endotoxicosis;
- the presence of fever;
- hernial protrusion is edematous, hot to the touch;
- hyperemia of the skin and swelling of the subcutaneous tissue, extending far beyond the hernial protrusion;
- possible presence of crepitus in the tissues surrounding the hernial protrusion.

Examination protocols in OEMP

Laboratory research:
- clinical blood test,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

Instrumental research:
- ECG
- Plain chest x-ray
- Survey radiography of the abdominal cavity.

Therapist's consultations

Protocols for preoperative preparation of a strangulated hernia complicated by phlegmon of the hernial sac in the OEMT

1. Before the operation, a gastric tube is necessarily placed and the gastric contents are evacuated.
2. The bladder is emptied and the operative area and the entire anterior abdominal wall are hygienically prepared.
3. Intensive preoperative preparation is indicated with the placement of a catheter into the main vein and infusion therapy (intravenous 1.5 liters of crystalloid solutions, Reamberin 400 ml,
4. Be sure to administer broad-spectrum antibiotics (III generation cephalosporins and metronidazole) 30 minutes before surgery intravenously.

Protocols of surgical tactics for strangulated hernia complicated by phlegmon of the hernial sac.

1. An operation for a complicated strangulated hernia is always performed under anesthesia by a three-doctor team with the participation of the most experienced surgeon on duty or a responsible surgeon on duty no later than 2 hours from the moment the patient enters the OEMP.
2. Operative intervention begins with a median laparotomy. If the loops of the small intestine are infringed, its resection is performed with the imposition of an anastomosis. The question of how to complete the resection of the colon is decided individually. The ends of the intestine to be removed are sutured tightly. Then a purse-string suture is applied to the peritoneum around the inner ring of the hernial ring. The intra-abdominal phase of the operation is temporarily suspended.
3. Herniotomy is performed. The strangulated necrotic part of the intestine is removed through a herniotomy incision with simultaneous tightening of the purse-string suture inside the abdominal cavity. Wherein Special attention is given to prevent the ingress of inflammatory purulent-putrefactive exudate of the hernial sac into the abdominal cavity.
4. Primary hernioplasty is not performed. In the herniotomy wound, necrectomy is performed, followed by its loose packing and drainage.
5. According to indications, drainage of the small intestine is performed.
6. The operation ends with drainage of the abdominal cavity.

Protocols of postoperative management of patients with strangulated hernia complicated by phlegmon of the hernial sac.

1. Local treatment of a herniotomy wound is carried out in accordance with the principles of the treatment of purulent wounds. Dressings are daily.
2. Detoxification therapy includes intravenous administration 2-2.5 liters of crystalloid solutions, reamberin 400 ml, 10.0 ml diluted with 400 ml of 0.9% sodium chloride solution, trental 5.0 - 3 times a day, countercal - 50,000 units / day, ascorbic acid 5 % 10 ml/day.
3. Antibacterial therapy in the postoperative period should include either II-III aminoglycosides, III generation cephalosporins and metronidazole, or II generation fluoroquinolones and metronidazole.
4. To prevent the formation of acute gastrointestinal ulcers, therapy should include antisecretory drugs.
5. Complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.
Laboratory studies are performed according to indications and before discharge.

Reduced strangulated hernia.

Criteria for diagnosing a reduced strangulated hernia of the OEMP:

The diagnosis of "incarcerated hernia, condition after incarceration" can be made when there are clear indications of the patient himself about the fact of infringement of the previously reduced hernia, the time interval of its non-reduction and the fact of its independent reduction.

A reduced strangulated hernia should also be considered a hernia, the fact of self-reduction of which occurred (and is recorded in medical documents) in the presence of medical personnel (at prehospital stage- in the presence of the ambulance staff, after hospitalization - in the presence of the OEMP surgeon on duty).

Examination protocols in OEMP

Laboratory research:
- clinical blood test,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

Instrumental research:
- ECG
- Plain chest x-ray
- Survey radiography of the abdominal cavity.

Therapist's consultations

Protocols for preoperative preparation of a reduced strangulated hernia in OEMP

1. Before the operation, a gastric tube is necessarily placed and the gastric contents are evacuated.
2. The bladder is emptied and the operative area and the entire anterior abdominal wall are hygienically prepared.

Protocols of surgical tactics for reduced strangulated hernia.

1. When the strangulated hernia is reduced and the duration of the strangulation is less than 2 hours, hospitalization in the surgical department is indicated, followed by dynamic observation for 24 hours.
2. If during the dynamic observation there are symptoms of deterioration in the general condition of the observed, as well as peritoneal symptoms, diagnostic laparoscopy is indicated.
3. With self-reduction of a strangulated hernia before hospitalization, if the fact of infringement is beyond doubt, and the duration of the infringement is 2 or more hours, diagnostic laparoscopy is indicated.

Protocols for the management of patients with reduced strangulated hernia.

Postoperative management of patients after diagnostic laparoscopy determined by diagnostic findings and the extent of surgical intervention in them.

Strangulated postoperative ventral hernia

Criteria for diagnosing a strangulated postoperative ventral hernia of OEMT:
- the clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are fecal and elastic infringement.
- with fecal infringement, a gradual onset of the disease is observed. Constantly existing pains in the area of ​​the hernial protrusion increase, become cramping in nature, and subsequently the symptoms of acute intestinal obstruction join - vomiting, gas retention, lack of stool, bloating. Hernial protrusion in the supine position does not decrease, acquires clear contours.
- elastic infringement is typical for hernias with small hernial orifices. There is a sudden onset of pain due to the introduction of a large segment of the intestine into the hernial sac through a small defect in the anterior abdominal wall. Subsequently, the pain syndrome intensifies and symptoms of intestinal obstruction join.
- the main symptoms of strangulated postoperative ventral hernia are:
- pain in the area of ​​hernial protrusion;
- irreducible hernia;
- sharp pain on palpation of the hernial protrusion;
- with a long term infringement, clinical and radiological signs intestinal obstruction.

Examination protocols in OEMP

Laboratory research:
- clinical blood test,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

Instrumental research:
- ECG
- Plain chest x-ray
- Survey radiography of the abdominal cavity.

Therapist's consultations

Protocols for preoperative preparation of a strangulated postoperative ventral hernia in OEMT.

1. Before the operation, a gastric tube is necessarily placed and the gastric contents are evacuated.
2. The bladder is emptied and the operative area and the entire anterior abdominal wall are hygienically prepared.
3. In the presence of intestinal obstruction, intensive preoperative preparation is indicated with the placement of a catheter in the main vein and infusion therapy (intravenous 1.5 liters of crystalloid solutions, Reamberin 400 ml, 10 ml diluted with 400 ml of 5% glucose solution) for 1 hour, or on the operating table, or in OHR.

Protocols of surgical tactics for strangulated postoperative ventral hernia.

1. Treatment of a strangulated postoperative ventral hernia consists in performing an emergency laparotomy within 2 hours from the moment of admission to the hospital.
2. Tasks surgical treatment with strangulated postoperative ventral hernia:
- a thorough revision of the hernial sac, taking into account its multi-chamber nature and the elimination of the adhesive process;
- assessment of the viability of an organ strangulated in a hernia;
- if there are signs of non-viability of the strangulated organ - its resection.
3. When large multi-chamber postoperative ventral hernias of the abdominal wall are infringed, the operation ends with the dissection of all fibrous septa and suturing only the skin with subcutaneous tissue.
4. With an extensive hernial defect more than 10 cm in diameter, in order to prevent abdominal compartment syndrome, it is possible to close the hernial orifice with a mesh explant.

Protocols of postoperative management of patients with strangulated postoperative ventral hernia.

1. Treatment of patients with strangulated postoperative ventral hernia until stabilization of hemodynamics and restoration of spontaneous breathing is carried out in the OCR.
2. Therapeutic measures in the postoperative period should be aimed at:
- suppression of infection by prescribing antibacterial agents;
- the fight against intoxication and violation of metabolic processes;
- treatment of respiratory complications cardiovascular systems;
- restoration of the function of the gastrointestinal tract.

Strangulated hernia complicated by peritonitis

Criteria for diagnosing a strangulated hernia complicated by peritonitis in OEMT:
- general condition is severe;
- symptoms of severe endotoxicosis: confused consciousness, dry mouth, tachycardia > 100 beats. in 1 min., hypotension 100 - 80/60 - 40 mm. Hg;
- periodic vomiting of stagnant or intestinal contents;
- during the examination, bloating, lack of peristalsis are determined, positive symptom Shetkin-Blumberg;
- on the survey radiograph, multiple levels of fluid are determined;
- during ultrasound examination, dilated intestinal loops are determined;

Examination protocols in OEMP

Laboratory research:
- clinical blood test,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

Instrumental research:
- ECG
- Plain chest x-ray
- Survey radiography of the abdominal cavity.

Therapist's consultations
Examination of the resuscitator

Protocols for preoperative preparation of strangulated hernia complicated by peritonitis in OEMT

1. Preoperative preparation and diagnostics are carried out under OCR conditions.
2. A gastric tube is placed and the gastric contents are evacuated.
Intensive preoperative preparation is indicated with the placement of a catheter into the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, Reamberin 400 ml, 10 ml diluted with 400 ml of 5% glucose solution) for 1 hour either on the operating table or in OHR.
3. Be sure to administer broad-spectrum antibiotics (III generation cephalosporins and metronidazole) 30 minutes before surgery intravenously.
4. The bladder is emptied and the operative area and the entire anterior abdominal wall are hygienically prepared.

Protocols of surgical tactics for strangulated hernia complicated by peritonitis.
1. An operation for a complicated strangulated hernia is always performed under anesthesia by a three-doctor team with the participation of the most experienced surgeon on duty or a responsible surgeon on duty.
2. Operative intervention begins with a median laparotomy.

Attempts to reduce a strangulated hernia are contraindicated.

The diagnosis of a reduced incarcerated hernia can be made when there are clear indications of the patient himself about the fact of infringement of a previously reduced hernia, the time interval of its non-reduction and the fact of its independent reduction. A reduced strangulated hernia should also be considered a hernia, the fact of self-reduction of which occurred (and is recorded in medical documents) in the presence of medical personnel (at the pre-hospital stage - in the presence of an ambulance medical staff, after hospitalization - in the presence of an OEMP surgeon on duty).

Group 4 - strangulated postoperative ventral hernia

Infringement of postoperative ventral hernias is observed in 6 - 13% of cases. Clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are fecal and elastic infringement.
With fecal infringement, a gradual onset of the disease is observed. Constantly existing pains in the area of ​​the hernial protrusion increase, become cramping in nature, and subsequently the symptoms of acute intestinal obstruction join - vomiting, gas retention, lack of stool, bloating. Hernial protrusion in the supine position does not decrease, acquires clear contours.
Elastic incarceration is typical for hernias with small hernial orifices. There is a sudden onset of pain due to the introduction of a large segment of the intestine into the hernial sac through a small defect in the anterior abdominal wall. Subsequently, the pain syndrome intensifies and symptoms of intestinal obstruction join.

Examination protocols in OEMP

Laboratory research:
- clinical blood test,
- blood group and Rh factor,
- blood sugar
- bilirubin,
- coagulogram,
- creatinine,
- urea,
- blood on RW,
- clinical analysis of urine.

Instrumental research:
- ECG
- Plain chest x-ray
- Survey radiography of the abdominal cavity.
- Ultrasound of the abdominal cavity and hernial protrusion - according to indications

Therapist's consultations
Anesthesiologist consultation (if indicated)

With the diagnosis established, the patient's strangulated hernia is immediately sent to the operating room.

Protocols of preoperative preparation in OEMP

1. Before the operation, a gastric tube is necessarily placed and the gastric contents are evacuated.
2. The bladder is emptied and the operative area and the entire anterior abdominal wall are hygienically prepared.
3. If there is a complicated strangulated hernia and a serious condition, the patient is sent to the surgical intensive care unit, where intensive therapy is carried out for 1-2 hours, including active aspiration of gastric contents, infusion therapy aimed at stabilizing hemodynamics and restoring water and electrolyte balance, as well as or antibiotic therapy. After preoperative preparation, the patient is sent to the operating room.

II. Protocols for anesthetic performance of the operation

1. In case of incarceration of inguinal and femoral hernias with short periods of incarceration, general satisfactory condition, absence of symptoms of acute intestinal obstruction, surgery can be started under local infiltration anesthesia to visually assess the viability of the organ strangulated in the hernia.
2. The method of choice is endotracheal anesthesia.

III. Protocols for differentiated surgical tactics

13. In case of strangulated hernias complicated by small bowel obstruction, the small intestine is drained using a nasogastrointestinal tube.
14. With phlegmon of the hernial sac, the operation is performed in 2 stages. The first stage is a laparotomy. In the abdominal cavity, a resection of the strangulated organ is performed with the delimitation of the hernial sac and its contents from the abdominal cavity with a purse-string suture. The second stage is herniotomy with the removal of the strangulated organ outside the abdominal cavity. Plastic hernial orifice with phlegmon of the hernial sac is not performed.
15. Surgical intervention ends with plastic closure of the hernial orifice. The nature of the plasty is determined by the location and type of hernia. Hernioplasty is not performed for giant multi-chamber postoperative ventral hernias.

VI. Protocols for postoperative management of patients with uncomplicated course

1. General analysis blood is prescribed a day after the operation and before discharge from the hospital.
2. All patients are prescribed intramuscular injection of painkillers (analgin, ketarol) on the 1st - 3rd day after the operation; broad-spectrum antibiotics (cefazolin 1 g x 2 r / day) for 5 days after surgery.
3. The sutures are removed on the 8th - 10th day, the day before the patients are discharged for treatment in the clinic.
4. Treatment of developing complications is carried out in accordance with their nature