Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria

Abstract

Objective: To determine the incidence, pattern and outcome of obstructed abdominal wall hernia in a semi-urban and rural community. Design: A proforma was drafted to study all consecutive patients operated for obstructed anterior abdominal wall hernia over a period of five years. Clinical findings, preoperative treatment, operative findings and postoperative outcome were documented. Setting: Teaching hospital located in a semi-urban community comprising mostly agrarian population. Patients: A total 110 adult patients with obstructed anterior abdominal wall hernia who had operative intervention and other postoperative management. Results: There were 110 patients with 111 obstructed hernias, accounting for 26.4% of all abdominal wall hernias. The age ranged from 19-79 years with mean of 49.7 years. Males accounted for 81%. Inguinoscrotal hernia was the commonest occurring in 75.7%, 16.2% patients presented with inguinal hernia and five patients with femoral hernia. The greater proportion of inguinal hernia occurred in female. Eighty seven patients (79%) had emergency operations and elective in 23 patients (21%) who had spontaneous reduction while awaiting surgery. Ninety two percent of inguinoscrotal/ inguinal hernia were indirect. Omentum was trapped in 52 hernias (47.%), while in 15 patients (13.6%), gangrenous bowel segments were discovered. Scrotal oedema was the commonest complication accounting for 21%, while wound infection occurred in 20%. There were three deaths in elderly men with clinical symptoms and signs of acute intestinal obstruction and gangrenous bowel segments, accounting for 2.7% of the patients. Twenty eight per cent of patients were discharged within the first and second postoperative days. Two patients spent 36 and 56 days each in the hospital. Conclusion: This study showed that 26.4% of abdominal hernia presented with obstruction. With inguinoscrotal hernia predominating: male accounted for 81% and 13.6% of the obstructed hernia contained gangrenous bowel segments. Post-operative complications were common, mortality occurring mainly in elderly patients with late presentation.

A study on groin hernias presenting as acute surgical emergencies in adults

“…John T Jenkins et al reported that acute groin surgery had a 7% mortality rate. 28,29 Andrews 22 found a mortality of 37% for complicated groin hernias. McEntee 8 and colleagues recorded an overall mortality of 10.4%.…”

Hernia Surgery in Uganda An Experience of Doctors Worldwide / Uganda’da Fıtık Cerrahisi Yeryüzü Doktorları Deneyimi

“…This subject proves the severity of the inguinal hernia disease in Africa. In the long-term followup period, chronic groin pain and recurrence are the most important issues (32).…”

Hernia Surgery in Uganda An Experience of Doctors Worldwide / Uganda’da Fıtık Cerrahisi Yeryüzü Doktorları Deneyimi

“…Adesunkanmi et al reported the factors that affected the outcomes of inguinal hernia operations in Nigeria (32). A number of postoperative complications were documented including scrotal complications such as edema, hematoma, infection and necrosis.…”

“…A number of postoperative complications were documented including scrotal complications such as edema, hematoma, infection and necrosis. Wound infection and dehiscence were frequent complications as well (32). Postoperative outpatient attendance was poor as 298 patients were lost at the follow-ups in the postoperative sixth month, and only 17 patients attended the outpatient follow-ups for more than 2-5 years.…”