Symptomatic hernia: Strangulated hernia combined with acute abdominal disease

Abstract

Strangulation of a previously unknown or asymptomatic hernia may be caused by acute abdominal disease. If the presence of such a disease is not recognized, it will result in high morbidity and mortality. Five cases are presented. In only one was the correct diagnosis of acute abdominal disease made preoperatively. In three cases, the correct diagnosis was made only during hernial repair. In one case, an umbilical hernia became strangulated soon after laparotomy for a periappendiceal abscess. Three of the five cases were complicated by severe wound infection. Preoperative diagnosis is difficult because clinical and laboratory findings are frequently similar in both conditions. A strangulated hernia, especially one which was previously unrecognized and asymptomatic, should raise the suspicion of an underlying acute abdominal disease. Careful evaluation of the patient's history, physical and laboratory findings as well as of the situation during surgery will enhance the possibility of correctly diagnosing this condition, thus reducing both morbidity and mortality.