Atypical Obstructions: What Do Emergency Providers Need to Know About Incarcerated and Strangulated Hernia, Closed Loop Obstruction, Volvulus, and Internal Hernia? What Is the Prognostic Value of a Lactate?

Abstract

Internal hernia, volvulus, and closed loop bowel obstruction have a particularly high morbidity and mortality. All can occur in patients without a surgical history and are important to include in the differential diagnosis of abdominal pain and vomiting. Closed loop bowel obstructions, which can be due to internal hernias, are more prone to bowel strangulation and are considered a surgical emergency. In incarcerated hernia, time from symptom onset to surgery is important in patient outcomes, particularly in patients with symptoms >8 h, comorbid conditions, high ASA scores, presence of strangulation, and advanced age. While lactic acid is routinely used as a marker for tissue ischemia, it has poor sensitivity and specificity for diagnosing acute bowel injury.