Crescent line hernia

　　Crescent line hernia is an interabdominal hernia that is relatively rare, with the onset age usually around 50 years old, with a male-to-female ratio of about 1:1.6. The incidence of incarceration and strangulation can reach 21%, so early surgical treatment should be considered. The causes of the disease are often the following points:

　　1. Abdominal wall tissue inflammation, abscess, or postoperative changes, causing local tissue to become degenerative and form a weak area.

　　2. Direct trauma.

　　3. Nerve injury causes local tissue to lose nerve support, reducing the ability to resist abdominal pressure. The anatomical structure of the abdominal muscles can be divided into three layers: the first layer is the inward extension of the external oblique muscle, which merges with the middle and anterior sheath of the rectus abdominis muscle; the second layer is the thickest aponeurosis of the internal oblique muscle, forming the main body of the crescent line, participating in the formation of the anterior and posterior sheaths of the rectus abdominis muscle above the semicircular line; the third layer is the aponeurosis of the transversus abdominis muscle, which inwardly moves to form the posterior sheath of the rectus abdominis muscle. In the transition area from this aponeurosis to the anterior and posterior sheaths of the rectus abdominis muscle, hernias can form when there are defects or gaps due to certain reasons, with the peritoneum and visceral organs herniating out.

　　Crescent line hernia often occurs above the inferior epigastric vessels, at the level of the umbilicus, and especially at the intersection of the crescent line and the semicircular line (the level of the midpoint between the umbilicus and the symphysis pubis). This disease is prone to incarceration or strangulation, forming an incarcerated hernia. At this time, there may be severe abdominal pain, accompanied by nausea and vomiting, local mass tenderness, and sometimes symptoms such as pain in the upper abdominal area..

　　The symptoms of this disease are usually mild, only pain or坠胀感 in the hernia area, and often exacerbated by increased intra-abdominal pressure. As the course of the disease progresses, the pain gradually becomes dull and diffused, making diagnosis more difficult. If the hernia contents are greater omentum and intestinal loops, there may be deep pain. Once incarcerated or strangulated, the pain becomes severe, accompanied by symptoms such as nausea and vomiting.

　　Common signs

　　The external abdominal wall mass is the main sign. Because the crescent line hernia is an interabdominal hernia, the sac is often below the aponeurosis of the external oblique muscle. The shape of the hernia mass is mostly flat, and the diameter rarely exceeds 2cm. It is not easy to find during physical examination, but there is often fixed tenderness at the hernia orifice, and sometimes accompanied by upper abdominal pain. For those with small hernia masses or those that are difficult to palpate after retraction, they can be asked to stand up, exert force, and then press on the bulging and protruding area. The hernia mass can disappear with a gurgling sound, and the margin of the hernia ring can be felt.

　　The probability of incarceration and strangulation of inguinal hernia is relatively high, so once the disease is diagnosed, timely surgical treatment should be given. To prevent the occurrence of the disease, it is mainly to reduce or avoid factors that increase abdominal pressure and actively treat the primary disease.

　　The probability of incarceration and strangulation of inguinal hernia is relatively high, so once the disease is diagnosed, surgical treatment should be given as soon as possible. After surgery, inguinal hernia patients should pay attention to diet, prefer to adjust, high-protein, high-vitamin, low-fat foods, and eat more vegetables and fruits, which is conducive to early recovery.

　　The probability of incarceration and strangulation of inguinal hernia is relatively high, so once the disease is diagnosed, if the patient has no surgical contraindications, surgical treatment should be given. Generally, a transverse incision is made, separated according to the direction of the aponeurosis of the external oblique muscle, the hernial sac is identified and separated, incised, and ligated. The defect in the transversalis fascia is usually sutured with silk thread in a horizontal overlap mattress suture.