A hernia occurs when an internal organ or tissue pushes through a weakened area in the muscle or connective tissue that normally holds it in place. This often results in a visible bulge, commonly in the abdomen or groin area. While many hernias can be uncomfortable, a strangulated hernia is a severe type where the protruding tissue has a compromised blood supply.
What a Strangulated Hernia Is
A strangulated hernia develops when a loop of intestine or other tissue, which has pushed through a weak spot in the abdominal wall, becomes tightly constricted. This constriction cuts off the blood flow to the trapped tissue, a process known as ischemia. Without blood supply, the affected tissue is deprived of oxygen and nutrients. This lack of blood flow differentiates a strangulated hernia from other types, such as an incarcerated hernia, where the tissue is trapped but still receives blood flow.
The Rapid Progression of Complications
If left untreated, a strangulated hernia can lead to severe complications. The lack of blood supply causes the affected tissue to die, a process called necrosis. This dead tissue can then develop into gangrene, a condition where the tissue decays due to bacterial infection. Gangrenous tissue can release toxins and bacteria into the bloodstream, potentially leading to a widespread infection known as sepsis.
Sepsis is the body’s life-threatening response to an infection, which can cause organ damage and failure. The dead or dying tissue can perforate or rupture, allowing its contents to leak into the abdominal cavity. This leakage can cause peritonitis, a severe inflammation and infection of the abdominal lining, which can be fatal. Without intervention, these complications can develop within hours to a few days.
Recognizing the Warning Signs
Recognizing the symptoms of a strangulated hernia is important for prompt medical attention. A person may experience sudden, severe pain at the hernia site that intensifies quickly and does not subside. The area around the bulge may become tender to the touch, and the skin might appear red or discolored, indicating compromised blood flow.
Other symptoms can include nausea and vomiting, which often signal a bowel obstruction caused by the trapped tissue. A fever may also develop, along with general malaise and a rapid heart rate. The inability to pass gas or have a bowel movement, or the presence of bloody stools, can also indicate that the intestine is affected.
Emergency Treatment and Outlook
Emergency surgical intervention is the only treatment for a strangulated hernia. The goal of surgery is to release the entrapped tissue and restore blood flow as quickly as possible. During the procedure, the surgeon will reduce the hernia, guiding the trapped tissue back into the abdominal cavity.
If any tissue has been damaged due to lack of blood supply, it will be removed. This may involve removing a section of the intestine if it has become necrotic. After addressing the strangulation and any tissue damage, the weak area in the abdominal wall is repaired, often using stitches or a synthetic mesh to strengthen the site and prevent future occurrences. Without immediate surgery, a strangulated hernia is almost always fatal within hours to a few days due to complications like gangrene and sepsis. With prompt and successful surgical treatment, the outlook is generally good, though recovery time varies based on the extent of tissue damage and whether a portion of the intestine needed to be removed.