Pelvic and lateral abdominal wall hernia after iliac bone removal

　　Etiology

　　Firstly, bone removal leads to local defects and weakness:The occurrence of pelvic and lateral abdominal wall hernia after iliac bone removal is unrelated to incisions or peritoneal rupture. Improper iliac bone removal is the main factor leading to pelvic and abdominal wall defects and weakness.

　　1. Improper and excessive bone removal leads to local defects in the pelvic wall.

　　2. The lateral abdominal wall of the lower abdomen is composed of the external oblique muscle, internal oblique muscle, transverse muscle, transversalis fascia, peritoneum, etc. Among them: the external oblique muscle originates from the outer surface of the lower 7 pairs of ribs, lumbar fascia, the outer edge of the iliac crest, and the inguinal ligament; the internal oblique muscle originates from the lower 5 pairs of ribs, lumbar fascia, the central part of the iliac crest, and the outer 1/2 of the inguinal ligament; the transverse muscle starts from the lower 5 pairs of ribs, lumbar fascia, the inner edge of the iliac crest, and terminates at the outer 1/3 of the inguinal ligament. The iliac crest, part of the inner and outer plates of the iliac wing, and the anterior superior iliac spine were resected, causing local bone defects in the pelvic wall and making the insertion points of the external oblique muscle, internal oblique muscle, transverse muscle, and inguinal ligament lose their attachment sites. Moreover, the starting points of the damaged abdominal wall muscles and the insertion points of the inguinal ligament were not repaired and fixed during the bone removal, resulting in, in addition to the local bone defects in the pelvic wall, a large-scale relaxation and bulging of the lower abdominal wall, providing an anatomical basis for the occurrence of postoperative hernia.

　　In addition, as the course of the disease progresses and the hernia mass increases, the local muscles, aponeuroses are compressed, atrophied, and degenerated more seriously, which can make the local anatomical structure increasingly weak and the defect larger.

　　Second, the tendinous fascia connective tissue of the abdominal wall is weak and cannot resist the intra-abdominal pressure:Due to the increase of adipose tissue and the infiltration of fat, the degeneration of ligaments and tendons and other tissues, especially in elderly multiparous women, during the process of repeated pregnancy, the abdominal wall muscles are stretched and damaged, leading to weakened abdominal wall tissue. In addition, most patients with this disease undergo bone grafting surgery due to non-union of fractures. After surgery, the long period of bed rest leads to varying degrees of atrophy of the whole body muscle tissue, accelerating the degeneration of muscle tissue.

　　Third, increased abdominal pressure:Elderly patients are often accompanied by chronic tracheitis, emphysema, or long-term cough, as well as a history of long-term habitual constipation, or due to the need for a longer period of bed rest after surgery, during the period of bed rest, there may be varying degrees of difficulty in defecation and other factors, which can increase the intra-abdominal pressure of the patients, promoting the occurrence of hernia.

　　1. In some cases, the abdominal wall defect is small, but the abdominal cavity organs that are squeezed out cannot return, which is called incarcerated hernia; in some cases, the vessels are compressed, only the protruding organs are ischemic, which is called strangulated hernia. Strangulated hernia can cause necrosis of the protruding organs.

　　2. If the protruding object is the intestine, it can cause intestinal obstruction, intestinal necrosis, perforation, peritonitis, and so on. It can also break through the abdominal wall to form a fecal fistula. After the hernia is formed, as the organs repeatedly protrude, the hernia sac gradually expands.

　　3. It may also lead to the possibility of infection.

　　Commonly seen in elderly and multiparous women, early symptoms are not obvious due to postoperative bed rest, and symptoms are found when getting out of bed after bone healing, such as hidden pain and discomfort at the bone extraction incision and lower abdominal lateral abdominal wall, gradually herniating, more obvious when standing, disappearing when lying down, due to the large hernia ring, rarely incarcerated, physical examination can see scars of bone extraction surgery, convex lower abdominal wall, and can be touched bone defect and hernia ring edge, and the hernia contents can all be reduced.

　　1. Correct bone extraction:Including: Avoiding the complete resection of the iliac crest and iliac wing, it is sufficient to only remove the outer plate to prevent injury to the attachments of the external oblique, internal oblique, and transverse abdominal muscles; do not remove the anterior superior iliac spine to prevent injury to the insertion of the inguinal ligament and lead to relaxation of the lower abdominal wall.

　　2. Once the origin of the muscle and the insertion of the inguinal ligament are damaged, they should be sutured to repair them, and if necessary, artificial patches (Gore-Tex) can be directly applied to repair and strengthen the pelvic and abdominal wall at the bone grafting site.

　　3. Active treatment:Comorbidities that can easily cause increased abdominal pressure, such as cough and constipation.

　　Early symptoms are not obvious due to postoperative bed rest. When getting out of bed to move after the fracture healing, the incision at the bone grafting site and the hidden pain and discomfort of the lower abdominal lateral abdominal wall gradually herniate, which is more obvious when standing and disappears when lying down. Due to the large hernia ring, it is rarely incarcerated.

　　Physical examination can see scars from the bone grafting surgery incision, convexity of the lower abdominal wall, and can touch the bone defect and hernia ring edge hernia contents can all be returned.

　　1. What foods are good for the body after iliac bone grafting and pelvic lateral abdominal wall hernia

　　Pay attention to a light diet. In the first few days after surgery, adjust the diet according to personal condition, mainly consume liquid and semi-liquid foods, and eat more high-protein foods to promote wound healing. Supplement a variety of vitamins, eat more fresh vegetables and fruits. You can eat various lean meats, milk, eggs, and other foods rich in protein.

　　2. What foods should be avoided after iliac bone grafting and pelvic lateral abdominal wall hernia

　　Avoid too greasy foods, do not choose foods such as preserved bean curd, scallion, chili, chive, etc., as they are not conducive to wound healing because they are prone to cause infection.

　　(The above information is for reference only, please consult a doctor for details)

　　1. Non-surgical Treatment

　　Indicated for those who cannot undergo surgery temporarily or have surgical contraindications. Method: Place a thick soft pad at the weak and defective area of the pelvic abdominal wall (hernia ring) and then apply pressure to fix it. The purpose is: to prevent the hernia mass from gradually increasing and causing the hernia ring to further expand, leading to increased pressure and atrophy of the abdominal wall, and to increase the difficulty of surgery and the possibility of postoperative recurrence.

　　2. Surgical Treatment

　　The operation is easy to succeed if the time of onset is short, the hernia mass is small, and the local defect is not large. Patients with a longer history of illness due to the long-term existence and continuous growth of the hernia mass, the abdominal wall muscles and aponeurosis around the hernia ring are further atrophied and degenerated, making the local anatomical structure increasingly weak, the defect larger, and prone to surgical difficulties and recurrence.