Presentation and outcome of incarcerated external hernias in adults

Background: Incarcerated external hernias an the second most common cause o f small-intestinal obstructions. The purpose of this study was to examine t he presentation and management of incarcerated external hernia. Methods: The records of 385 consecutive patients undergoing emergency surgi cal operation for incarcerated external hernias in a large volume teaching hospital between August 1996 and October 1999 were analyzed. The patients' ages ranged from 15 to 100 years (mean 55.1). There were more men than wome n (250 and 135, respectively), and 165 (42.9%) patients were over 60 years of age. Inguinal and umbilical hernias were encountered most frequently, in 291 (75.5%) and 48 (12.5%) patients. respectively. The intestine was resec ted in 53 patients, 31 of whom were over 60 years of age (58.5%). Two hundr ed fifty-two (84.9%) patients presented 48 hours or more from the onset of symptoms. Significant concomitant diseases were noted in 52 men and 19 wome n. Results: The overall complication rate amounted to 19.5%, major complicatio ns 15.1%. The most serious postoperative complications were pulmonary and c ardiovascular. Adult respiratory distress syndrome developed in 10 patients , and congestive heart failure developed in 14 patients. Postoperative mort ality was 2.9%. Nine (81.8%) of the dead patients were older than 60. Nine (81.9%) of the dead patients were admitted to hospital more than 24 hours a fter incarceration. Mortality was high in patients with serious coexisting diseases whereas morbidity was linked with the duration of symptoms prior t o admission. Conclusions: Older age, severe coexisting diseases, and late hospitalizatio n were the main causes of unfavorable outcomes of the management of incarce rated hernias. (C) 2001 Excerpta Medica, Inc. All rights reserved.