A hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. An “incarcerated hernia” is a more serious condition where the trapped tissue cannot be manually returned to its normal position. This condition requires immediate medical attention due to the risk of serious complications.
What is an Incarcerated Hernia?
An incarcerated hernia develops when a section of the intestine or other abdominal tissue becomes trapped within the hernia sac, preventing it from receding. Patients often experience severe pain, tenderness, and swelling at the hernia site, along with a noticeable bulge in the groin or abdomen that does not disappear. Gastrointestinal symptoms like nausea, vomiting, constipation, or an inability to pass gas or have a bowel movement can also occur if the trapped tissue affects the digestive tract.
It is important to understand the difference between an incarcerated hernia and a strangulated hernia. In an incarcerated hernia, the blood supply to the trapped tissue is still intact, though it may be compromised. If the blood supply is completely cut off, the condition progresses to a strangulated hernia, a medical emergency that can lead to tissue death. Incarceration increases the risk of strangulation, requiring prompt medical evaluation and treatment.
Immediate Steps for Treatment
Healthcare professionals will assess the situation and manage pain. If there are no signs of strangulation, a manual reduction, also known as taxis, may be attempted. This procedure involves a healthcare professional gently trying to push the trapped tissue back into the abdominal cavity.
Manual reduction is performed in an emergency room setting, sometimes with conscious sedation, using medications like intravenous morphine and short-acting benzodiazepines. Following a successful manual reduction, patients are observed for about 24 hours to monitor for any complications. If manual reduction is unsuccessful, or if there are any indications of strangulation, immediate surgical intervention becomes necessary to prevent further harm.
Surgical Repair of Incarcerated Hernias
Surgery is the definitive treatment for incarcerated hernias, particularly if manual reduction fails or if there is suspicion of strangulation. Two common surgical approaches are open repair (herniorrhaphy/hernioplasty) and laparoscopic repair. Open repair involves making a single, longer incision directly over the hernia site to access the trapped tissue.
During an open procedure, the surgeon gently returns the incarcerated tissue to its proper location within the abdominal cavity, assessing its viability. The weakened abdominal wall is then reinforced, often with a synthetic mesh, to provide additional support and reduce the chance of recurrence. If the tissue is found to be strangulated and non-viable, a section of the affected bowel may need to be removed in a procedure called bowel resection.
Laparoscopic repair, a minimally invasive alternative, involves several small incisions through which a camera and specialized instruments are inserted. This technique allows the surgeon to view the hernia internally and perform the repair. While laparoscopic repair offers benefits like smaller incisions and potentially faster recovery, the choice of surgical method depends on factors like the hernia’s complexity, the patient’s overall health, and the presence of strangulation.
Recovery After Treatment
Following incarcerated hernia treatment, patients can expect a recovery period that varies based on the surgical approach and individual health. Immediately after surgery, pain and discomfort at the surgical site are common and managed with prescribed pain medications. Swelling and bruising around the incision are also common as the body begins to heal.
Patients are advised to follow specific post-operative instructions, including proper wound care to prevent infection and avoiding heavy lifting or strenuous activities for several weeks, four to six weeks. Light activities, such as walking, are encouraged to promote circulation and aid in healing. The hospital stay for hernia repair can range from same-day discharge for less complex cases to a few days for more involved procedures, especially if bowel resection was required. Patients should monitor for signs of complications like fever, excessive bleeding, or worsening pain and attend all follow-up appointments to ensure optimal healing.