Strangulated Abdominal Hernia
What is a Strangulated Abdominal Hernia?
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Strangulated abdominal hernia is that hernia of the abdomen in which some intra-abdominal structure protrudes or "comes out" through the hernial orifice being, in such a way trapped, that it is practically "hanged" causing lack of blood circulation and vitality.
Strangulated abdominal hernias are always surgical emergencies that must be treated by a hernia surgeon immediately, as the consequences of not doing so can be dramatic, costly and even fatal.
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Any of the abdominal hernias can be strangled and, unfortunately, it is impossible to predict when this could occur.
The causes of strangulated abdominal hernia are diverse: a sudden and intense effort, the use of very tight girdles or belts or any other situation that causes increased intra-abdominal pressure. Strangulation can occur at the site of a previously known abdominal hernia or, at sites where no hernia was known to exist in the abdominal wall or also inside the abdomen in so-called internal hernias.
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Symptoms of Strangulated Abdominal Hernia
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Symptoms of a strangulated abdominal hernia appear depending on the organ trapped in the strangulation and the time that has elapsed since it began; these symptoms are:
Progressive pain at the hernia site; it is mild in the early stages and becomes intense as time goes on.
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Increase in volume of a previously known hernia that is perceived as a tense and painful mass that cannot be reduced with external maneuvers. This type of mass can appear suddenly in any part of the abdomen, even without having prior knowledge of an abdominal hernia.
Vomiting, abdominal distention, absence of evacuations and inability to channel gas through the rectum. These symptoms appear when the intestine is the organ trapped in the hernia. The vomiting becomes very numerous and the distention becomes large when more than four hours have passed after the start of strangulation. The evacuation stops and gases are not eliminated through the rectum as a consequence of the obstruction of the intestine at the level of the strangulation.
Dehydration as a result of so many vomiting and other phenomena that occur at the micro-circulatory level.
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Diagnosis of Strangulated Abdominal Hernia
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The diagnosis of a strangulated abdominal hernia is confirmed by identifying these symptoms. If so, it is important to ask the opinion of a hernia specialist surgeon since these cases require immediate hospitalization to fully evaluate the case and be able to perform some auxiliary diagnostic studies such as:
Basic studies of blood in the laboratory, X-rays or, tomography if required, rehydrate the patient with intravenous solutions and prepare him for his definitive treatment.
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Treatment of Strangulated Abdominal Hernia
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Treatment. All cases of strangulated abdominal hernia should undergo surgery in the shortest possible time using the most appropriate operative technique selected by the hernia surgeon. The less time it takes to perform the surgery, the less damage will be found and the less likely it is that the strangulated intra-abdominal organ will have to be removed.
There are surgical techniques with open or traditional procedures and laparoscopic techniques. Both techniques can be performed on a case-by-case basis and according to the experience of the hernia surgeon.
The risk of these operations is high and increases when there are associated chronic diseases such as diabetes, lung diseases, heart disease or in elderly patients. The risks are multiplied when it is necessary to remove the strangulated organ and, mainly, if it is the intestine.
The recovery of these operations is unpredictable since it will depend on the factors mentioned. Hospital stay after surgery is generally 3 to 8 days, although some cases warrant management in intensive care, which increases the number of days and also the economic cost. It is important to know that mortality in cases of strangulated abdominal hernia continues to be high. Until the year 2000, mortality reached 25% in the adult population; however, due to new operative techniques and the great advantages of technology and the progress of new antibiotics, this mortality has decreased to 3% in the year 2015.
