Hernia incarcerated

Besides perforated appendicitis and intussusception, the most common causes of small howel obstruction are incarcerated hernias and adhesions. Other causes of small bowel obstruction comprise a miscellaneous group of rare conditions, such as midgut volvulus, Meckel s diverticulum, advanced stages of Crohn s disease, and bezoars. Adhesions usually result from prior surgery and are often multiple. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. 

The diagnosis of bowel obstruction is established on clinical grounds and usually confirmed with plain abdominal radiographs. Plain radiographs usually show distended bowel loops with air-fluid levels (Fig. 1.66). In inguinal incarcerated hernia, plain film will also show thickening of the... 

Paralytic ileus, due to intrinsic abnormalities of the bowel wall, can be caused for example by drugs, after laparotomy, sepsis or peritonitis. Obstructive ileus is most often due to extrinsic causes, for example adhesions (in 70% of cases), incarcerated hernia, small bowel wall hematoma posttraumatic, neoplasms, Crohn disease and intussusception (Parker 2003 Devos and Meradji 2003). Clinically the child has a distended and tender abdomen with failure to pass stools or no defecation and possibly (bilious) vomiting. 

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... 

Lemmer, J.H., Strodel, W.E., Eckhauser, F.E. Umbilical hernia incarceration a complication of medical therapy of ascites. Amer. X Gastroenterol. 1983 78 295 - 296... 

Fig. 5.2a,b. Incarcerated femoral hernia, a Transverse scan at the level of the femoral vessels of right side shows the neck of the sac containing omentum (arrows) medial to the femoral artery (FA). The femoral vein is not visualized, as it is compressed. b Longitudinal scan shows the echogenic omentum (OM) in the sac with fluid (FL) due to incarceration... 

Bozdogan N, Sener M, Caliskan E, Kocum A, Aribogan A. A combination of ketamine and dexmedetomidine sedation with caudal anesthesia during incarcerated inguinal hernia repair in three high-risk infants. Paediatr Anaesth 2008 18(10) 1009-11. 

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