Afferent limb internal strangulation in obstructed inguinal hernia

Background: Intestinal obstruction is a major part of the emergency caseload in a general surgical department. It can pose diagnostic and treatment challenges with its varied presentation and multiple management options. The surgeon needs to use astute judgment to spot the diagnosis and plan the line of management. The aim of the study is to show the various etiologies most commonly presenting with intestinal obstruction in our institute in north Chennai. It also aims to evaluate markers of postoperative morbidity.Methods: This is a prospective study of about 50 patients with acute intestinal obstruction coming to the emergency department of the Government Stanley Medical College and Hospital from the time the patients were admitted they were followed up till their time of discharge/ death. X-ray abdomen erect and supine and CECT abdomen and pelvis were routinely taken for all the patients.Results: X-ray abdomen supine showed multiple air fluid levels as the commonest finding which was seen in 42 cases, 27 cases had dilated bowel loops and 2 cases showed coffee bean appearance. 6 cases had fluid levels less than 3 and were deemed in 49 cases and was inconclusive in 1 case to be inconclusive. CECT showed features of obstruction or pathological obstruction point.Conclusions: Corrections of dehydration and rapid resuscitation with correction of electrolyte disturbances would go a long way in reducing morbidity and mortality. Surgical intervention in a timely manner is the treatment of choice and prognosis is good when it is not delayed.

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“…Lower albumin was found to correlate with higher morbidity (65%) and mortality (29%) similar to our study. [13][14][15]…”

Section: Discussionmentioning

confidence: 99%

Etiology and outcome of intestinal obstruction: an institutional prospective study

Maniselvi

Gayathre

2018

Int Surg J

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The clinical and operative diagnosis of Maydl's hernia: A report of 5 cases

Bayley¹

1970

Journal of British Surgery

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Strangulated external hernia associated with generalized peritonitis

Ekwueme

1973

Journal of British Surgery

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SUMMARYThirteen patients are described in whom strangulated external hernia was associated with generalized peritonitis. T h e causes of this combination are discussed.Although the features of peritonitis are usually quite distinguishable from those of an uncomplicated strangulated hernia, in virtually all the cases previously reported in the literature the presence of peritonitis was not recognized until operation for the hernia was undertaken. Increased awareness of this complication and a conscious effort to exclude it resulted in the correct preoperative diagnosis i n 4 of our patients. When the peritonitis is recognized preoperatively it is suggested that a laparotomy should be performed to deal with the intraperitoneal lesion, and that the associated groin hernia should be repaired by a preperitoneal approach through the laparotomy incision. (1959) drew attention to the occasional occurrence of a collection of pus in a n empty hernial sac i n the course of a generalized peritonitis. T h e y reported 5 cases of their own and reviewed another 27 instances collected from the world literature, all of which were diagnosed preoperatively as strangulated hernia. Maurath and Frauke (1966), in their review, stated that failure to recognize the associated acute abdominal disease in such cases results in a mortality of 60-70 per cent. CRONIN and EllisAt Mulago Hospital, Kampala (the National Hospital of Uganda), strangulated external hernia is by far the commonest emergency surgical condition (McAdam, 1961), and in a review of the cases seen in the past 2 years three different causes of the combination of strangulated hernia and peritonitis were encountered in g patients. Recently a special effort has been made to recognize the presence of peritonitis in patients presenting with strangulated hernia, and this has resulted in a correct preoperative diagnosis being made in 4 patients. T h i s paper presents these two :groups of patients and discusses the problem of preoperative diagnosis and treatment. CASE REPORTSCase r.-N.A., a 40-year-old female, had had an umbilical swelling for 3 months. Four days before admission she developed severe colicky pain at the umbilicus which later became generalized and was associated with progressive abdominal distension. On examination. her temperature was 38.2" C., pulse-rate IOO per minute, and blood-pressure 100/70mm. Hg. There was generalized abdominal distension and tenderness, and a tender irreducible umbilical hernia, 5 cm. in diameter, was present.At operation the umbilical hernia contained strangulated omentum, but thin greenish pus poured out of the peritoneal cavity. The incision was then extended and exploration of the abdomen revealed a generalized peritonitis resulting from a ruptured right tubo-ovarian abscess. The pus was drained and the abdomen was closed with drainage to the pouch of Douglas. The patient made a steady recovery, although she developed severe wound infection. Secondary suture was performed on the twentyfirst postoperative day.Case 2.-G. M., a 48-year...

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Afferent limb internal strangulation in obstructed inguinal hernia

Cited by 11 publications

References 2 publications

Etiology and outcome of intestinal obstruction: an institutional prospective study

Etiology and outcome of intestinal obstruction: an institutional prospective study

The clinical and operative diagnosis of Maydl's hernia: A report of 5 cases

Strangulated external hernia associated with generalized peritonitis

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