A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. While many hernias are common and cause few symptoms, complications can lead to serious health issues. Medical attention is important in these situations, as untreated complications can become life-threatening.
Major Complications of Hernias
A hernia can become life-threatening through two complications: incarceration and strangulation. Incarceration occurs when the protruding tissue or organ becomes trapped and cannot be pushed back into its normal position. This trapped tissue can cause severe pain and, if it involves the intestine, can lead to a bowel obstruction, preventing food and gas from passing through.
Strangulation is a more severe complication that can arise from an incarcerated hernia. It occurs when the blood supply to the trapped tissue is cut off. Without oxygen-rich blood, the tissue begins to die (necrosis). This tissue death can result in gangrene and can also lead to perforation of the bowel, spilling contents into the abdomen. These events can cause a widespread infection called sepsis, which can be fatal if not immediately treated.
Types of Hernias and Their Risk
Different types of hernias carry varying risks of developing complications like incarceration and strangulation. Inguinal hernias, which occur in the groin, are the most common type and primarily affect men. While the risk of strangulation for inguinal hernias is low, around 2.8% at three months and 4.5% after two years, they can still become incarcerated. An incarcerated inguinal hernia can become an emergency if not addressed.
Femoral hernias, though less common than inguinal hernias and more frequent in women, have a higher risk of strangulation. This is due to the narrow opening through which they protrude, making it easier for the tissue to become constricted. The probability of strangulation for femoral hernias can be as high as 22% at three months and 45% after 21 months. Umbilical hernias, occurring near the belly button, are common in infants but can also affect adults, where they carry an intermediate risk of incarceration. Incisional hernias, which develop at sites of previous surgical incisions, have a lower risk of strangulation, especially if the underlying defect is large.
Recognizing Emergency Symptoms
Recognition of warning signs is important for a hernia that has become incarcerated or strangulated. One noticeable symptom is sudden, severe pain localized at the hernia site, which can rapidly worsen. The hernia lump may become firm, hard, or change color, appearing red, purple, or darker than the surrounding skin, and it typically cannot be pushed back into place.
Additional symptoms often indicate a more serious condition, particularly if the bowel is involved. These can include nausea and vomiting, signs of a bowel obstruction. A fever, rapid heart rate, or a general feeling of being unwell (malaise) can signal infection or inflammation from dying tissue. If any of these symptoms develop, immediate medical attention is necessary to prevent severe complications.
Emergency Medical Care for Hernias
When a life-threatening hernia complication is suspected, immediate medical evaluation is important. Healthcare providers typically diagnose incarcerated or strangulated hernias through a physical examination, sometimes supplemented with imaging tests like a CT scan. The primary goal is to determine if the hernia is trapped and if its blood supply has been compromised.
Urgent surgery is the standard and often only treatment for strangulated or severely incarcerated hernias. During the operation, the surgeon releases the trapped tissue and assesses it for damage. If any part of the intestine has died due to lack of blood flow, it must be removed to prevent further complications. Delaying treatment increases the risk of serious issues such as widespread infection (sepsis), organ damage, and can be fatal. Prompt surgical intervention is important for a positive outcome and recovery.