A strangulated hernia is a serious medical emergency. It occurs when blood supply to tissue, often part of the intestine, is cut off after it protrudes through a weak spot in the abdominal wall. Without immediate treatment, the affected tissue can die, leading to severe complications. Recognizing its signs is critical for prompt medical attention.
What is a Hernia?
A hernia occurs when an internal organ or fatty tissue pushes through a weak point in surrounding muscle or tissue. This often creates a visible bulge, most commonly in the abdomen or groin. While some hernias cause no significant symptoms, others lead to discomfort, especially during activities like coughing or lifting.
Common types of hernias include:
Inguinal hernias, the most frequent, occurring in the groin.
Femoral hernias, found in the upper thigh, more common in women.
Umbilical hernias, appearing near the belly button.
Incisional hernias, developing at the site of a previous surgical incision.
Hiatal hernias, involving part of the stomach pushing into the chest cavity through the diaphragm.
What Makes a Hernia “Strangulated”?
A hernia becomes “strangulated” when the blood supply to the herniated tissue is completely cut off. This happens when the opening clamps down tightly, constricting blood vessels. The lack of blood flow deprives the tissue of oxygen and nutrients, initiating ischemia.
If ischemia persists, cells within the trapped tissue begin to die (necrosis). This tissue death can occur rapidly, sometimes within hours. It differentiates a strangulated hernia from an incarcerated hernia, where tissue is trapped but has an intact blood supply. Tissue death can release toxins, leading to widespread infection and organ failure.
Recognizing the Warning Signs
Identifying strangulated hernia warning signs is crucial for timely medical help. A primary indicator is sudden, severe, and worsening pain at the hernia site. This pain often does not subside and can become excruciating.
Other symptoms include tenderness to the touch and changes in skin color over the bulge, which may appear reddish, purple, or darker. The hernia bulge might feel firm or hard and cannot be pushed back. Patients may also experience nausea, vomiting, fever, an increased heart rate, and a general feeling of being unwell. Inability to pass gas or have a bowel movement, along with severe constipation, can also signal this serious complication.
Immediate Medical Attention and Treatment
When a strangulated hernia is suspected, immediate medical attention is necessary. Diagnosis begins with a physical examination by a healthcare provider, who inquires about symptoms and medical history. Imaging tests, such as a contrast-enhanced CT scan of the abdomen and pelvis, confirm the diagnosis and assess for complications like bowel ischemia. While not always reliable for excluding strangulation, CT scans offer high diagnostic accuracy for bowel obstruction and can detect signs of tissue damage.
Prompt intervention prevents severe complications like bowel perforation (a hole in the intestine) and peritonitis (an infection of the abdominal lining). Untreated strangulation can also lead to sepsis, a life-threatening systemic response to infection, and death. The primary treatment is emergency surgery, often an open hernia repair. During this procedure, the surgeon relieves the strangulation, assesses tissue viability, and removes any damaged sections of the intestine before repairing the hernia defect, sometimes using a mesh.
Recovery and Outlook
Recovery after emergency surgery for a strangulated hernia varies depending on individual health, hernia type, and procedure complexity, especially if bowel resection was necessary. Patients often experience pain for several days post-surgery, managed with prescribed pain relievers. Most individuals return to light daily routines within a few days, but activities involving heavy lifting or strenuous exercise are restricted for several weeks (often 4 to 6 weeks) to allow for proper healing and prevent recurrence.
While the outlook is generally good with prompt diagnosis and surgical intervention, potential complications can include wound infection, fluid collection (seroma), blood collection (hematoma), or hernia recurrence. Some patients may experience chronic pain after surgery. Adhering to post-operative instructions and attending follow-up appointments are important for a successful recovery and minimizing risks.