Symptoms of Hernia Strangulation
The key symptoms of hernia strangulation include severe pain, signs of systemic inflammatory response syndrome (SIRS) such as fever and tachycardia, and laboratory findings including elevated lactate, serum creatinine phosphokinase (CPK), and D-dimer levels. 1
Primary Symptoms
- Severe, continuous pain at the hernia site that may worsen over time
- Irreducibility of the hernia (cannot be pushed back in)
- Tenderness and firmness of the hernia on examination
- Redness or discoloration of the skin overlying the hernia
- Nausea and vomiting, particularly with bowel obstruction
Systemic Signs
- Fever
- Tachycardia (rapid heart rate)
- Leukocytosis (elevated white blood cell count)
- Abdominal wall rigidity
- Peritonitis (in advanced cases)
Laboratory Findings
- Elevated lactate levels - indicator of tissue ischemia
- Increased serum creatinine phosphokinase (CPK) - marker of muscle damage
- Elevated D-dimer levels - suggests thrombosis
Progression of Symptoms
Many patients report pre-strangulation symptoms days to weeks before actual strangulation occurs:
- Change in hernia size
- Intermittent irreducibility
- Increasing pain
- Discomfort with physical activity 2
Warning Signs by Hernia Type
Different hernia types may present with specific symptoms:
Diaphragmatic Hernia
- Respiratory symptoms (dyspnea)
- Gastrointestinal symptoms (obstruction)
- May progress from asymptomatic to obstructive phase with ischemia 1
Umbilical Hernia
- Particularly high risk in patients with ascites
- May present with skin ulceration over the hernia
- Risk of rupture in addition to strangulation 3
Time-Sensitive Nature
The elapsed time from symptom onset to surgery is the most important prognostic factor. Symptomatic periods lasting longer than 8 hours significantly affect morbidity rates, and treatment delayed for more than 24 hours is associated with higher mortality rates 1.
Important Clinical Pitfall
It's crucial to note that the classic combination of continuous abdominal pain, fever, tachycardia, and leukocytosis may not reliably distinguish strangulated from simple obstructions. Therefore, a high index of suspicion must be maintained even when not all symptoms are present 1.
High-Risk Factors for Strangulation
- Femoral hernias (highest risk)
- Short history of hernia (<1 year)
- Advanced age
- Presence of comorbid diseases
- High ASA scores
Early detection of progression from incarceration to strangulation is challenging but critical for reducing mortality. When strangulation is suspected, immediate surgical intervention is necessary as the benefits outweigh the risks of surgery 1.