From the Guidelines
Hernia strangulation symptoms include severe, sudden pain at the hernia site that worsens over time, tenderness and redness around the bulge, nausea, vomiting, fever, rapid heart rate, and inability to push the hernia back in, and immediate medical attention is required to prevent tissue death and life-threatening infections. The symptoms of hernia strangulation can be identified by a combination of clinical and laboratory findings, including systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, serum creatinine phosphokinase (CPK), and D-dimer levels 1. Some key symptoms and signs include:
- Severe, sudden pain at the hernia site that worsens over time
- Tenderness and redness around the bulge
- Nausea, vomiting, fever, rapid heart rate
- Inability to push the hernia back in
- The hernia bulge may become firm, swollen, and discolored (red, purple, or dark)
- Abdominal bloating, constipation, and inability to pass gas if intestinal obstruction occurs It is essential to seek immediate medical attention if any of these symptoms occur, as hernia strangulation is a medical emergency that requires prompt surgical intervention to prevent tissue death and life-threatening infections like peritonitis or sepsis 1. The use of diagnostic tests such as CPK, D-dimer, and lactate levels, as well as CT findings, can help predict bowel strangulation and guide treatment decisions [1, @24@, @25@]. In particular, a study published in 2012 found that an arterial blood lactate level of 2.0 mmol/L or greater was a useful predictor of non-viable bowel strangulation [@25@]. Another study published in 2014 found that CT findings of reduced wall enhancement were the most significant independent predictor of bowel strangulation, with 56% sensitivity and 94% specificity [@27@]. Overall, prompt recognition and treatment of hernia strangulation symptoms are critical to preventing morbidity and mortality, and immediate surgical intervention is recommended when intestinal strangulation is suspected 1.
From the Research
Symptoms of Hernia Strangulation
The symptoms of hernia strangulation can be severe and require immediate medical attention. According to the studies, the following are some of the key points to consider:
- Hernia strangulation can occur in patients with a history of hernia, with 58% of patients having noted a hernia present for at least 1 month before strangulation 2
- The duration of hernia before strangulation can vary, with 40% of patients presenting primarily with strangulation within days of developing a hernia 2
- The risk of strangulation is higher in femoral hernias, with a cumulative probability of strangulation of 22% at 3 months and 45% at 21 months 3
- The elapsed time from onset to surgery is a critical factor in determining outcomes, with longer times associated with a higher risk of bowel resection 4
- Early diagnosis and transportation to a tertiary center are essential for good outcomes, with patients who present initially to the tertiary center having a significantly lower resection rate than those transported from other hospitals 4
Clinical Presentation
The clinical presentation of hernia strangulation can include:
- Severe abdominal pain
- Nausea and vomiting
- Fever
- Tenderness and guarding in the affected area
- A palpable mass in the groin or femoral area
- Signs of bowel obstruction or ischemia, such as abdominal distension, constipation, or bloody stools
Management
The management of hernia strangulation typically involves emergency surgery, with the goal of relieving the strangulation and restoring blood flow to the affected area. The use of monofilament polypropylene mesh for strangulated inguinal hernia repair is safe, and the risk of local infectious complications is low 5. The optimal timeline for emergency surgery is critical, with delays in surgery associated with a higher risk of complications and poor outcomes 4.