Understanding Strangulated Hernias

A hernia may appear as a simple bulge or protrusion, but the potential consequences of this seemingly minor issue can be life-altering. One of the most severe hernia-related conditions, a strangulated hernia, can pose critical dangers to health if left untreated. With the renowned expertise and unparalleled compassion of the Iskandar Complex Hernia Center, you can navigate this medical situation with confidence. This article aims to educate you on the nature of strangulated hernias, their inherent risks, and the comprehensive treatment options that we provide.

What is a Strangulated Hernia?

A strangulated hernia is a serious medical condition that occurs when a part of an organ or tissue becomes trapped within a hernia, a noticeable bulge or protrusion through an opening or weak spot in the abdominal muscles or connective tissue. This entrapment can cut off the blood supply to the herniated tissue, causing it to become “strangulated.”

Typically, hernias occur in the abdominal region, and the protruding tissue often involves parts of the intestine or abdominal fat. In a strangulated hernia, the herniated tissue is tightly constricted by the surrounding muscles or tissues, which can lead to ischemia, or inadequate blood flow. This can cause the affected tissue to become deprived of necessary oxygen and nutrients, leading to cell death or necrosis.

Strangulated hernias are considered a medical emergency due to their potential to cause severe and life-threatening complications, such as infection, peritonitis (inflammation of the peritoneum or abdominal lining), bowel obstruction, or even gangrene. These complications can escalate rapidly, so immediate medical intervention is typically required to relieve the obstruction and restore normal blood flow.

The Unique Dangers of Strangulated Hernias

Strangulated hernias pose severe risks due to the interruption of blood flow, or ischemia, to the herniated tissue. When this happens, the tissue is starved of essential nutrients and oxygen, a state that can rapidly lead to cell death, or necrosis.

Necrosis is a condition where a portion of tissue dies off when the herniated tissue is deprived of oxygen for a prolonged period due to the cutoff of blood supply. Necrosis in itself is a severe condition, but it can also lead to more complications. For instance, the necrotic tissue can act as a breeding ground for bacteria, potentially leading to a widespread infection or septicemia.

Septicemia, also known as blood poisoning, is a serious, life-threatening infection that can quickly spread throughout the body. This can occur if bacteria from the necrotic, herniated tissue enter the bloodstream. Septicemia can lead to sepsis, a severe response to infection that can trigger a cascade of changes in the body, leading to multiple organ failure and, in severe cases, death.

If the strangulated hernia involves a portion of the bowel, the necrotic tissue and infection can spread to the peritoneum, the inner lining of the abdominal cavity. This condition, known as peritonitis, results in severe inflammation and infection that can be fatal if not treated promptly. Peritonitis can cause severe abdominal pain and other systemic symptoms like fever and rapid heartbeat.

Over time, a strangulated hernia can lead to a bowel perforation, or hole, in the wall of the bowel. This can cause the contents of the bowel to leak into the abdominal cavity, leading to severe infection and inflammation, another potential cause of peritonitis.

Due to the aforementioned complications, strangulated hernias significantly increase the risk of mortality. The longer the hernia remains strangulated, the greater the risk of these complications, which is why immediate medical intervention is critical.

The dangers of strangulated hernias underline the importance of swift intervention. The progression from hernia strangulation to complications such as necrosis and septicemia can happen rapidly, often within a few hours. Therefore, any suspected strangulated hernia should be considered a medical emergency, necessitating immediate evaluation and a physical examination by a physician and treatment.

If you or someone else exhibits symptoms of a strangulated hernia, such as sudden severe abdominal pain, nausea, vomiting, fever, or a rapid heartbeat, seek immediate medical attention at a hospital. Prompt intervention can restore blood flow, prevent tissue death, and avoid these potentially life-threatening complications. A strangulated hernia is not a condition to be managed at home or to be delayed; it is a surgical emergency requiring professional medical care without delay.

Identifying Strangulated Hernias

Symptoms and Signs of Strangulated Hernias

Strangulated hernias are severe medical conditions that display various symptoms, some of which can escalate quickly, alerting the individual to the critical nature of the situation. The following are key symptoms associated with strangulated hernias:

Severe Abdominal Pain: This is often the most apparent symptom of a strangulated hernia. The pain is usually sharp, sudden, and localizes around the site of the hernia. Unlike a typical hernia, which may be painless or cause only mild discomfort, a strangulated hernia leads to intense pain that generally worsens over time.

Nausea and Vomiting: As the strangulated hernia interrupts the normal flow of the gastrointestinal tract or digestive tract, it may lead to feelings of nausea or actual vomiting. This occurs because the entrapped segment of the bowel can cause a blockage or obstruction, disrupting normal digestion.

Fever: Inflammation and infection associated with a strangulated hernia can lead to a rise in body temperature, resulting in fever. Fever might be accompanied by other symptoms of infection such as chills, weakness, or fatigue.

Rapid Heart Rate: The body’s response to pain, stress, and potential infection from the strangulated hernia can trigger an increase in heart rate, a condition medically known as tachycardia.

It’s important to note that not all of these symptoms might be present in every case. Some individuals might experience additional symptoms such as a noticeable lump in the groin or abdominal area, a change in the color of the hernia (it might become dark or reddish), or constipation due to bowel obstruction.

Given the seriousness of a strangulated hernia, it’s critical to seek medical help immediately when these symptoms arise. In fact, any sudden, severe abdominal pain should warrant immediate medical attention. Quick action is crucial to prevent the escalation of a strangulated hernia and its potential life-threatening complications.

In conclusion, the timely identification of a strangulated hernia and quick medical intervention can make a significant difference in the outcome. Thus, understanding these signs and symptoms is crucial for prompt and effective treatment.

Treatment Options for Strangulated Hernias

Understanding the Need for Surgery

A strangulated hernia is a medical emergency that usually requires immediate surgical intervention. The reason for this urgency is that the strangulated part of the organ, often a section of the intestine, is cut off from its blood supply. As a result, the tissue begins to die due to lack of oxygen and nutrients, a process known as necrosis.

Surgery is necessary to restore blood flow to the strangulated tissue as quickly as possible, in an attempt to prevent or minimize tissue death. The operation also involves repairing the hernia – that is, moving the protruded tissue back into its proper location and strengthening the weakened area where the hernia occurred. This repair can prevent future hernias from developing in the same location.

Choosing not to undergo surgery for a strangulated hernia can lead to serious, life-threatening complications. One of the immediate risks of not treating a strangulated hernia is the development of a bowel obstruction. When fatty tissue or a part of the intestine protrudes and is trapped, the normal flow of contents through the digestive tract is blocked. This can lead to severe abdominal pain, constipation, nausea, and vomiting. If not promptly relieved, a complete bowel obstruction can cause the bowel to rupture, spilling its contents into the abdomen and leading to severe infection and inflammation.

If left untreated, a strangulated hernia can also lead to chronic issues with digestion. These can range from ongoing pain and discomfort to more severe issues like malnutrition due to impaired nutrient absorption, depending on the section of the bowel affected. In severe cases, the complications arising from a strangulated hernia, such as sepsis (a systemic response to infection), can lead to acute renal failure. This occurs when the kidneys are unable to filter waste products from the blood adequately. It’s a serious condition that requires intensive treatment and can be life-threatening.

While surgery always carries some level of risk, the dangers of not addressing a strangulated hernia through surgical intervention far outweigh those risks. The decision to undergo surgery is a crucial one that can prevent serious complications, long-term damage, and even save lives. As always, any concerns should be discussed thoroughly with a medical professional.

Surgical Procedures for Strangulated Hernias

Strangulated hernias, due to their severity and potential for life-threatening complications, typically require emergency surgery. Two primary procedures are used to address this condition – open hernia repair and laparoscopic hernia repair. The choice between these two techniques often depends on the specific circumstances of the patient, including the type of hernia, size and location of the hernia, the patient’s overall health status, and the surgeon’s expertise. The doctor starts by reducing the hernia by placing tender pressure to the hernia to release the stuck tissue to its original place in the abdomen.

Open Hernia Repair: Also known as a herniorrhaphy, open hernia repair is a traditional surgical method that involves making an incision near the hernia site. The surgeon pushes the protruding tissue back into place and sews the weakened muscle area closed. Sometimes a synthetic mesh is used to provide additional support to the area, reducing the risk of hernia recurrence. While this procedure may have a longer recovery period than laparoscopic repair, it can be the best choice in certain situations, particularly with large or complex hernias.

Minimally invasive (laparoscopic or robotic) Hernia Repair: Minimally invasive surgery (laparoscopic or robotic involves the use of a laparoscope, a thin tube equipped with a camera and light, to visualize the hernia from the inside. The surgeon makes several small incisions instead of a single large one and uses specialized instruments to repair the hernia internally. Like open repair, a mesh may be used to reinforce the weakened area. Laparoscopic repair often has the advantage of a shorter recovery time and less postoperative pain. However, it may not be suitable for all patients, particularly those with larger, complex, or recurrent hernias, or in cases where the hernia has resulted in significant complications.

The surgical approach to hernia repair has seen significant advancements in recent years, particularly with the incorporation of innovative techniques and materials. Synthetic or biological mesh is frequently used in both open and laparoscopic hernia repairs. The mesh, which is typically made of a durable, lightweight, and biocompatible material, is used to reinforce the weakened area where the hernia occurred, thereby reducing the risk of hernia recurrence. Some meshes are absorbable and designed to degrade over time, leaving behind a strengthened tissue structure.

Another exciting development in the field of hernia surgery is the use of robotic systems. This advanced technology provides surgeons with enhanced precision, flexibility, and control during the operation. Robotic surgery combines the benefits of minimally invasive laparoscopic techniques with the ability to visualize the surgical area in three dimensions and perform delicate maneuvers with enhanced steadiness. This can be especially beneficial in complex hernia cases, potentially leading to better outcomes and reduced recovery times.

While these techniques represent significant progress in hernia surgery, it’s essential to understand that every patient and hernia is unique. The choice of surgical technique should be individualized based on the patient’s specific situation and overall health status. Consulting with an experienced hernia surgeon like Dr. Iskandar is crucial to decide on the most appropriate and effective treatment strategy.

Why Choose The Iskandar Complex Hernia Center for Your Strangulated Hernia Treatment

Dr. Iskandar, is a board-certified general surgeon with fellowship training in minimally invasive complex hernia surgery as well as bariatric surgery. As one of the leading complex hernia experts in the United States, he brings to the table a wealth of knowledge and experience that enables him to handle even the most challenging hernia cases.

Dr. Iskandar’s philosophy of care emphasizes patient education and the use of innovative surgical techniques to achieve long-lasting and favorable outcomes. This patient-first approach is the cornerstone of our practice, ensuring that every individual is treated with respect, listened to with empathy, and given the best possible care at The Iskandar Complex Hernia Center.

Dr. Iskandar’s Credentials and Expertise

Dr. Iskandar, a board-certified general surgeon, boasts a distinguished career grounded in the pursuit of expertise in minimally invasive, bariatric, and complex hernia surgeries. A product of comprehensive training from esteemed institutions like the American University of Beirut and Mount Sinai Beth Israel, Dr. Iskandar went on to hone his skills in a fellowship at NYU-Langone and later served as an assistant professor of surgery at Mount Sinai School of Medicine. His notable tenure at Baylor Scott & White since 2019 has seen the establishment of the Center for Hernia Surgery, where he oversees the management of a range of hernia cases, from simple to intricate and recurrent.

Dr. Iskandar’s philosophy is underpinned by a commitment to achieving long-lasting, favorable outcomes thorough patient education, and the employment of innovative techniques and materials, including robotic surgery. This dedication has earned him affiliations with prestigious professional societies and numerous accolades, including three consecutive Offsite Attending of the Year awards for his work with surgical residents at Baylor University Medical Center. Notably, Dr. Iskandar’s contribution to hernia and bariatric surgery spans several peer-reviewed publications, book chapters, conference presentations, and lectures. Multilingual in English, French, and Arabic, Dr. Iskandar ensures clear and comprehensive communication with a diverse patient demographic.

The Iskandar Complex Hernia Center Experience

At The Iskandar Complex Hernia Center, we prioritize clear and compassionate communication. Our team, led by Dr. Iskandar, is both highly skilled and deeply caring. Dr. Iskandar’s exceptional bedside manner and attentiveness ensure a supportive environment for all patients, providing comfort and reassurance during a challenging time. We are committed to delivering the best patient experience, from hernia diagnosis through recovery.

Taking the Next Step Towards Improved Health and Quality of Life

Overcoming Strangulated Hernias

Every moment matters when dealing with a strangulated hernia. Delay in diagnosis and treatment can significantly increase the risk of complications and mortality. Timely intervention can dramatically improve a patient’s quality of life, alleviating chronic pain, lifting physical limitations, and resolving digestive issues.

Embracing a Hopeful and Healthier Future

Successful treatment of a strangulated hernia can be transformative. It brings relief from chronic pain, boosts physical activity, improves sleep patterns, and enhances self-confidence and body image. At The Iskandar Complex Hernia Center, we have numerous success stories of patients who are now leading healthier, hernia-free lives.

Why You Should Schedule a Consultation Today

An early consultation aids in early detection and comprehensive evaluation, enabling personalized treatment planning. If you suspect you may have a hernia, or if you are experiencing any discomfort or abnormalities in your abdominal area, reach out to us without delay. Call our office to schedule your consultation with Dr. Iskandar and begin your journey to a healthier you today.

Experience renowned expertise and unparalleled compassion from the leader in hernia repair.

Frequently Asked Questions About Strangulated Hernias

Which hernia has the highest risk of strangulation?

Femoral and inguinal hernias are considered to have the highest risk of strangulation due to the narrow inguinal and femoral canals through which they protrude, creating a tighter space that can more easily cut off blood supply. If an inguinal hernia doesn’t improve on its own, or if patients aren’t able to push the hernia in, the contents of the hernia can be trapped in the abdominal wall. As a result of cutting off the blood supply to the trapped tissue, a hernia that is incarcerated may become strangulated.

Can you live with a strangulated hernia?

A strangulated hernia is a medical emergency that requires immediate surgical intervention. If a patient decides not to have a strangulated hernia repaired, the condition can lead to serious complications such as tissue necrosis, sepsis, and even death.

How long is surgery for a strangulated hernia?

The length of surgery for a strangulated hernia can vary greatly, typically ranging from 1 to 3 hours. Factors influencing this include the complexity of the hernia, the patient’s overall health, and the chosen surgical approach.

How rare is a strangulated hernia?

Strangulated hernias are relatively rare but represent a serious complication of hernias. Approximately 1-3% of all abdominal hernias may become strangulated.

What is the difference between strangulated and incarcerated hernia?

An incarcerated hernia occurs when herniated tissue becomes trapped and cannot be pushed back into its proper place, while a strangulated hernia is an incarcerated hernia that has had its blood supply cut off, leading to tissue death if left untreated. Incarcerated hernias, like strangulated hernias require medical treatment.

How do you prevent hernia strangulation?

Hernia strangulation can often be prevented by seeking immediate medical attention when a hernia is first noticed. Regular medical check-ups, maintaining a healthy weight, avoiding heavy lifting, and promptly addressing persistent coughs or constipation can also help prevent hernias and their complications.

What to do while waiting for hernia surgery?

While waiting for hernia surgery, it’s crucial to monitor the hernia for changes or signs of complications, maintain a healthy lifestyle, and follow all pre-operative instructions given by the medical team. Avoid heavy lifting or straining and seek immediate medical attention if pain increases or other symptoms arise.

What is the survival rate of strangulated hernia?

The survival rate for strangulated hernia is high when immediate surgical intervention is administered. However, delayed treatment or presence of other serious medical conditions can significantly impact survival rates. Always seek prompt medical attention for suspected hernia strangulation.

When should you go to the ER for a hernia?

You should go to the ER for a hernia if you experience hernia symptoms suggestive of a strangulated or incarcerated hernia, such as sudden, severe pain, a hernia that turns red or purple, nausea, vomiting, fever, or if the hernia cannot be pushed back in.

What are risk factors for strangulated hernias?

Risk factors for a strangulated hernia include:

  • prior abdominal surgery such as C-section delivery that can debilitate the stomach wall
  • straining during bowel movements
  • pregnancy
  • chronic coughing
  • strenuous activity

Final Thoughts on Strangulated Hernia

From Dr. Iskandar

As a surgeon dedicated to complex hernia care, my promise to you is to provide top-quality, compassionate care with your well-being at the heart of everything we do. Our commitment is to your complete recovery and improved quality of life.

Your Health is Our Priority

At The Iskandar Complex Hernia Center, we place patients’ health above all. We invite you to join our community of healed patients and take the first step towards your recovery from a strangulated hernia. Don’t delay your health. Reach out to us today.

Posted on July 14, 2023

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Dr. Iskandar, MD, FACS is a board-certified general surgeon with fellowship training in minimally invasive surgery and bariatric surgery. He is an accredited Surgeons of Excellence in Hernia Surgery by the SRC. The Iskandar Complex Hernia Center is one of only two North Texas Hernia Centers deemed Centers of Excellence. As a globally respected complex hernia expert, he specializes in complex hernia repair and abdominal reconstruction. He is also an Associate Professor of Surgery at Texas A&M School of Medicine.