Strangulated Hernia

Is a strangulated hernia dangerous?

YES – EXTREMELY! Strangulated hernias can prove fatal.

At best they can be extremely painful and are surgical emergencies. That means they require urgent professional attention.

Also, patients tend to do less well after emergency surgery than they do following planned procedures. A large study in Sweden concluded:

“Mortality risk following elective hernia repair is low, even at high age.
An emergency operation for groin hernia carries a substantial mortality risk.*”

The risk of mortality is 7 times higher when a hernia operation is carried out as an emergency and 20 times higher if a bowel resection was involved!

Clearly, the evidence shows it is vastly preferable to prevent strangulation and avoid emergency surgery in the first place. In other words never let it get that bad.

What is a strangulated hernia?

Abdominal wall hernias occur by a window of weakness opening in the abdominal wall, allowing intestine (commonly bowel) to poke through the window **.

Picture then, that window clamping shut whilst a fold of bowel is poking through it. It is, after all a wall of tough muscle and that clamping action would be enough to squeeze and shut off the blood vessels inside the intestine which would result in tissue death quite rapidly.

Dead intestine, including the bowel, tends to turn extremely nasty very quickly and that process releases all kinds of toxins (poisons) into the blood stream which in turn causes septicaemia (blood poisoning) and ultimately death.

** For a better understanding of the anatomy of hernia, see the Hernia Overview section and come back to this page.

What warning do I get?

Unfortunately, the warning might come on very suddenly indeed, from nothing at all. The first thing to happen is usually acute pain
(click hereHernia Pain to open in a separate window for a better understanding of what is causing the pain)

That pain can rapidly become severe and nothing relieves it other than attention by a suitable surgeon or physician. It is common for this onset to be measured in minutes.

The most common cases of strangulation are the smaller hernias as the larger ones tend to slide in and out easily, and so are less at risk of being clamped shut by the muscle ‘opening’.

Be especially alert for a hernia when associated with:

  • Sharp or Severe pain
  • Vomiting
  • Blood in Excrement
  • Constipation
  • Malaise with or without a fever
  • A burning or hot sensation around the hernia

What is done to treat a Strangulated Hernia?

A strangulated hernia repair is an emergency.  The surgeon’s priority is to ‘reduce’ the hernia, which means to release the entrapped bowel and return it where it belongs, inside the abdominal cavity. That must be done before the tissue is permanently damaged, which would be an extremely unpleasant complication. Once that is done, the proper approach would be to repair the hernia immediately so as to prevent it happening again. Sadly, being an emergency, it is commonly the case that the Emergency Room surgeon stops there, having ‘reduced’ the hernia as described and the patient is released in the hope that it is repaired in due course before it strangulates again. This is as bad a situation as it sounds.

How do I avoid a strangulated hernia?

Only by attending to the hernia before it gets that bad. Also, Strangulation can happen at any time. You do NOT want that to be when away on holiday somewhere or at any time away from rapid, high-quality surgical help.

What should I do if I suspect my hernia might strangulate?

If you start experiencing sharp pain and it is not yet severe, you need to see an expert, preferably a specialist in hernia as soon as possible, ideally within a day or two. You need to avoid it actually strangulating at all costs and pain is your best warning of that risk.

Should you wish the British Hernia Centre to see you, we will always endeavour to see a case like this without delay. Call the number given in Contact Us and mention the nature of the pain. If it is really unbearable, or you are vomiting, it might already be an emergency, call an ambulance.

Next: Hernias in Pregnancy

* Ann Surg. 2007 April; 245(4): 656–660.

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