Strangulated hernia

Rutherford died of a strangulated hernia on October 19,1937, at the age of 66. On October 21 his remains were cremated. His ashes were interred in Westminster Abbey among the remains of England s other great scientists, including Newton. When J. J. Thomson died in 1940, his remains were placed next to those of Rutherford, the man who had disproved his theory of the atom. 

The pattern of complications is common for all types of hernia. The complications are irreducibility, obstruction and strangulation. Irreducible (incarcerated) hernia may be due to a narrow neck or adhesion of contents to the sac wall. In obstruction, the intestine in the hernia gets obstructed due to a narrow neck, adhesion or volvulus, but it is viable. Strangulation results when there is compromise to venous drainage and later arterial supply of the contents. In obstructed hernia there is colicky pain, abdominal distension and vomiting. Incarcerated hernia is present at rest it is irreducible and usually contains some fluid in the sac that can be seen on sonography (Fig. 5.2b Rettenbacher et al. 2001). In obstructed hernia the patient has symptoms of intestinal obstruction. There are dilated bowel loops... 

Fig.5.4a-d. Complicatedhernia.aAfferentloop obstruction shows the transition between the dilated intraabdominal loop (BO) and collapsed loop in inguinal hernia (arrow), b Efferent loop obstruction shows dilated bowels in ventral hernia (BO) with transition between the dilated loop in hernia and collapsed intraabdominal loop at the neck of the sac (arrow), c Tensely distended loop is devoid of air in a ventral hernia due to closed loop obstruction, d Strangulated loop of bowel (BO) in a ventral hernia shows thick walls... 

A 65-year-old lady was admitted to hospital for repair of a strangulated incisional hernia. Post-operatively the wound site failed to heal. The patient was sent home with a discharging and offensive wound. She returned three days later with a gaping and infected wound, which required cleansing and re-suturingimder a general anaesthetic, antibiotics and an extended hospital stay of 15 days. 

Figure 4-7. Drawing made of the Pavlov pouch of josefine F. resulting from strangulation of a gastric hernia in the first year of her life. (From Cade A, Laterjet A. Realisation pathologique du petit estomac de Pavlov. I Physiol Paris 7 221-233, 1905.)...

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