Blood supply to the herniated tissue is compromised in a strangulated hernia and hence a medical emergency. The herniated bowel contents pass through an opening the subsequently reduces venous return. This leads to an edematous tissue, compromised circulation and arrest of arterial supply. Strangulated hernias can prove fatal if left untreated. When blood supply stops, it results in a dead intestine and bowel that releases toxins into the blood stream causing septicemia which can even lead to death. Small hernias tend to be strangulated rather than large ones.
Signs and symptoms
- Blood in excreta
- Painful bulge appearing red and irritated
- Patient experiences sudden and severe pain which gradually becomes worse
- Gastrointestinal symptoms such as nausea and vomiting or constipation
- Malaise may or may not be accompanied by fever
- Burning sensation around the hernia
Strangulated hernias appear suddenly and surgeries for these have to be performed under an emergency. The patient has to be staying in the hospital for at least 3 to 4 days. It is not a pre-determined surgery and repair with mesh therapy is usually risky. In some cases, the intestine may have to be ablated.
In a strangulated hernia Stage II, the knob does not disappear. If ignored, intestine passage stops, patient cannot de-gase and fecal incontinence occurs. There is spasmodic spread of pain to the abdominal area.
At Stage III, the intestinal blood circulation will be disturbed. If a leukocyte count is taken at this time, it will be elevated. There will be intense pain.
Finally in Stage IV, when the patient is still left untreated, wide peritonitis is observed in the abdomen and the intestine turns gangrenous. Patient will show signs of fever with rise in body temperature. Sepsis develops leading to death.
Surgery is aimed at reducing the contents of the sac. A herniotomy or excision of the sac is performed in most cases. A herniorrpahy is done by approximating adjacent tissues to achieve near to normal anatomy. A hernioplasty is conducted by inserting additional material is added.
Laparoscopic repair of hernia
General anaesthesia is induced to the patient undergoing laparoscopic repair of a strangulated hernia. The operation is performed under an extraperitoneal or a transperitoneal approach. The sac is excised after separating it from the spermatic cord. A mesh is then inserted to strengthen the posterior wall. A small plug made of synthetic material may be inserted into the deep ring.