Strangulated Hernia

What is a strangulated hernia?

A strangulated hernia is a life-threatening condition that happens when blood supply is cut off to the pieces of tissue or intestine inside the hernia. Blood carries oxygen. Without oxygen, the intestine or tissue in the hernia starts to die (necrosis). Necrosis may lead to potentially fatal conditions like gangrene and sepsis. Strangulated hernias don’t happen very often. It takes time for them to develop. Understanding how that happens may reduce your risk.

How do you know a hernia is strangulated?

You may have a strangulated hernia if you have symptoms like a painful bulge or lump in your abdomen along with:

• Nausea and vomiting
• Severe pain in your abdomen or groin that doesn’t go away and gets worse
• Skin color changes (the skin around the bulge or lump may be reddish or darker than usual)

How long does it take for a hernia to become strangulated?

The intestine trapped in the hernia could begin to die in as little as four hours after blood supply is reduced.

What causes a strangulated hernia?

Hernias develop when pieces of tissue, organs or your intestine in your abdomen push through a weak spot in the muscles that make up your abdominal wall. The hernia makes a bump or lump that you can see and feel. Often the bump or lump will come and go as the hernia goes back through the weak spot.

But hernias can get stuck in your abdominal wall (incarcerated hernia). Blood still flows to the hernia’s contents. Over time, an incarcerated hernia may get large enough that pressure from your abdominal muscles cuts off blood flow to the hernia’s contents.

How is a strangulated hernia diagnosed?

A healthcare provider will do a physical examination. They’ll ask about your symptoms and your medical history. They may do tests like:

• Complete blood count (CBC) and basic metabolic (BMP) panel to check your white blood cell count and other issues with your blood cells
• Computed tomography (CT) scan
• Abdominal ultrasound

How do you treat a strangulated hernia?

Open hernia repair surgery is the most common treatment. In open hernia surgery, your surgeon makes a single incision (cut) to move the hernia and its contents back in place. They’ll use stitches to close the gap in your abdominal muscles. They may sew a piece of mesh material to your muscles to support them.

Your surgeon may do a small bowel resection or colon resection surgery to treat a strangulated hernia. That may be the case if blood loss damages a piece of intestine in the hernia.

Complications of hernia surgery

Open surgery to fix a strangulated surgery does come with some risks. Complications may include:

• Damage to nearby blood vessels, organs or tissues
• Hematoma (blood collecting under your skin at the surgery site)
• Seroma (fluid collecting under your skin)
• Surgical site infection

How long does it take to recover from this surgery?

You may need to stay in the hospital for several nights after your surgery. It takes time to recover from surgery to repair a strangulated hernia. How much time depends on your situation.

For example, most people who have hernia surgery can return to their daily routines within a few days but with lifting restrictions. But talk to your surgeon if your daily routine involves lifting heavy objects. They’ll explain how long you should wait to start that kind of activity.

Your recovery time will be longer if you had surgery to remove a damaged intestine. It can take six weeks to recover from surgery to remove a part of your intestine. Your surgeon will explain what you can expect during your recovery.

Can a strangulated hernia be prevented?

Yes, it can. Talk to a healthcare provider if you think you have a hernia. They’ll let you know if you need surgery to repair the hernia and keep it from becoming incarcerated or strangulated.

What can I expect if I have a strangulated hernia?

Surgery to repair the hernia typically solves the issue. But hernias can happen again. If you’ve had hernia surgery, talk to your healthcare provider if you think you might have a new hernia. You may need surgery to repair the new hernia. Repairing the new hernia reduces the risk that it’ll become strangulated.

What’s the survival rate for someone with a strangulated hernia?

The overall survival rate is good. But survival rate depends on factors like your health, age and whether you have surgery to remove part of your intestine.

Strangulated hernias can lead to life-threatening sepsis or gangrene. Without treatment, gangrene and sepsis can be fatal:

• Gangrene that causes a bacterial infection can lead to death within 48 hours.
• Sepsis is your body’s overwhelming response to an infection. Without treatment, severe sepsis (septic shock) can lead to death within 12 hours.

When should I see my healthcare provider?

If you have a hernia, talk to your provider about treatment. If you think you may have a strangulated hernia, go the emergency room right away. Call 911 or your local emergency number if you have symptoms like:

• Sudden, severe pain
• The skin around the bulge or lump in your abdomen or groin becomes paler than usual, then turns darker than usual