A hernia involves the protrusion of an organ or tissue through an abnormal opening in the body, often through a weak spot in muscle or connective tissue. While some hernias may not cause immediate concern, a severe and life-threatening complication known as hernia strangulation can develop. This condition occurs when the blood supply to the protruding tissue is cut off, requiring prompt medical attention.
The Mechanism of Strangulation
Strangulation begins when a portion of an organ, often a loop of the intestine, pushes through a weakened area in the abdominal wall. The protruding tissue then becomes tightly constricted by the narrow opening, cutting off its blood supply.
Without blood supply, the affected tissue begins to die, a process known as necrosis or gangrene. This tissue death can occur rapidly, sometimes within a few hours. Smaller hernia openings are more likely to tightly constrict the protruding tissue compared to larger defects.
Recognizing the Critical Signs
Recognizing the signs of a strangulated hernia is important for treatment outcomes. Sudden, severe pain at the hernia site, which often intensifies quickly and is accompanied by tenderness, is a primary indicator. The area around the hernia may also become firm, swollen, and warm.
A noticeable change in the hernia’s color, such as turning red, purple, or dark, is a warning sign. The inability to push the hernia back into the abdominal cavity, known as irreducibility, is also a symptom. As the condition progresses, individuals may experience nausea and vomiting, often from a bowel obstruction. Fever and a rapid heart rate may also be present, potentially signaling an infection. An inability to pass gas or have a bowel movement (constipation) can indicate an intestinal blockage.
Why Immediate Medical Attention Is Necessary
The consequences of an untreated strangulated hernia can escalate rapidly, leading to life-threatening conditions. As blood supply to the trapped tissue remains compromised, necrosis or gangrene sets in, leading to irreversible tissue death, often within hours. This dead tissue can then release harmful toxins into the bloodstream.
If the affected tissue, particularly a segment of the bowel, perforates or ruptures, its contents can leak into the abdominal cavity. This leakage can trigger peritonitis, a severe inflammation and infection of the abdominal lining. The infection can spread throughout the body, leading to sepsis, a systemic response that can result in multiple organ failure and death. A strangulated hernia will not resolve on its own and requires prompt medical intervention to prevent these complications.
Emergency Treatment Steps
Emergency surgery is necessary to treat a strangulated hernia. The goal is to release the trapped tissue and restore its blood supply. During surgery, the surgeon assesses the viability of the affected tissue to determine if it has suffered irreversible damage.
If tissue is necrotic, it must be removed, which may involve a bowel resection if a portion of the intestine is affected. After tissue assessment, the hernia defect is repaired, using stitches or a surgical mesh to reinforce the weakened abdominal wall. Recovery from emergency surgery for a strangulated hernia can be more extensive and prolonged compared to a planned repair.