TRYOYTTSA HERNIA (W. Treitz, Austrian doctor, 1819 — 1872; synonym:
Fig. Diagrammatic representation of a back wall of an abdominal cavity (anterior aspect):
the mesenteric department of a small bowel is delayed to the right, the cross colon and a big epiploon are delayed up; 1 — a cross colon; 2 — a mesentery of a cross colon; 3 — a duodenal and lean bend; 4 — an upper duodenal fold; 5 — upper duodenal deepening (Treyt-ts's pocket); 6 — the lower duodenal fold; 7 — the descending colonic cat; 8 — an ileal gut; 9 — a mesentery of a small bowel; 10 — a jejunum; 11 — a big epiploon; the dotted line designated a projection of a hernial bag at left-side hernia of Treytts.
paraduodenal hernia) — the internal hernia of a stomach which is formed owing to gradual implementation of any abdominal organ (loops of intestines are more often) in Treytts's pocket (upper duodenal deepening).
It is for the first time described by Treytts in 1857. According to Yu. Yu. Kramarenko (1956), patients with Of this year make apprx. 30% of all patients with internal hernias of a stomach. Among the reasons promoting emergence Of this year features of turn of intestines (see) in the pre-natal period and the related deviations have essential value during the formation of a pocket of Treytts. As well as other types of hernias, Of this year has hernial gate, a hernial bag and hernial contents (see Hernias). Treytts's pocket (upper duodenal deepening) is formed on a front surface of a back abdominal wall at the level of II of a lumbar vertebra to the left of it at the place of transition of a duodenum in lean (fig.). This deepening is limited to a duodenal and lean bend of a small bowel, on the right at the left and from above — an upper duodenal fold of a peritoneum, edges goes from a top of a bend to a back abdominal wall below a body of a pancreas and comprises the lower mesenteric vein.
The lower bound of a pocket of Treytts is the lower duodenal fold of a peritoneum, edges passes on a back wall of an abdominal cavity between bottom edge of a bend of a small bowel and edge of an upper duodenal fold of a peritoneum. The called borders of deepening also are in case of development Of this year borders of hernial gate, to-rye usually have an appearance of a semi-oval or narrow crack. The bottom of deepening is covered by the pristenochny peritoneum (see) covering a pancreas; at education Of this year this site of a peritoneum is invaginated in retroperitoneal cellulose of a kzada from a pancreas and forms the hernial bag extending sometimes to a spleen. Hernial contents usually are loops of a thin GUT -
Distinguish left-side and right-hand Of this year. At left-side hernia, edges meets by 3 — 4 times more often right-hand, hernial gate and a hernial bag are located to the left of a backbone; at right-hand hernia hernial gate and the hernial bag extending to a liver are located to the right of a backbone.
Wedge, a picture at neushchemlenno is characterized Of this year by the colicy pains in a stomach with irradiation in an anticardium arising in 1 — 3 hour after meal and also at an exercise stress. Pains amplify in vertical position of the patient and abate at left-side hernia in situation on the right side, and at right-hand — in situation on the left side. At a palpation of a stomach the greatest morbidity is defined above and, depending on its localization, more to the left of or more to the right of a navel. The eructation, sometimes vomiting, a meteorism are noted. In the anamnesis there are instructions on persistent locks. At a strangulation of a hernia there is a symptomatology of high enteric impassability (see Impassability of intestines). In this case at a palpation of a stomach slightly above a navel the tumorous education with smooth contours of a myagkoelastichesky consistence which is displaced at breath is found.
The diagnosis is made Of this year on the basis by a wedge, pictures and data rentgenol. researches. The last is carried out in vertical and side provisions of the patient. For high cross position of a stomach and expansion of the first loop of a lean kpshka, shift of the expanded segments of a small bowel which are in Treytts's pocket to a back wall of a stomach is characteristic Of this year. For right-hand the shift of a duodenum to the right, and a jejunum to the right and kzad is characteristic Of this year. Differential diagnosis is carried out with acute pancreatitis and a tumor or a cyst of an abdominal cavity (see. Acute abdomen). Because of difficulty of diagnosis Of this year quite often distinguish only during operation.
Treatment Of this year only operational. The preparation for surgery concerning not restrained hernia is carried out by the general rules (see. Preoperative period), concerning restrained — as at impassability of intestines (see). Anesthesia — the general endotracheal (see. Inhalation anesthesia). At operation use an upper median laparotomy (see). Operation consists in a section of hernial gate, release, audit, and in the presence of indications — resections of the restrained loops of guts and excision of a hernial bag. Hernial gate take in silk.
The forecast at the diagnosis restrained Of this year in connection with difficulties and complexity of operation sometimes happens adverse.
See also Hernias.
Bibliography: Kramarenko Yu. Yu.
Internal belly hernias and intestinal impassability, M., 1956; H at x r and e D. P's N'ko. Infringement of guts in openings of a mesentery, an epiploon and a wide ligament of a uterus (according to medical institutions of Ukraine), Surgery, No. 7, page 47, 1953; T r e i t z W. Hernia retroperitonealis, ein Beitrag zur Geschichte innerer Hernien, Prag, 1857. Yu. A. Nesterenko.