Predictors of ischemic bowel in patients with incarcerated hernias

Hernia. 2019 Apr;23(2):277-280. doi: 10.1007/s10029-019-01884-1. Epub 2019 Jan 28.

Abstract

Purpose: Diagnosing intestinal strangulation in the setting of incarcerated hernias remains challenging. Hyponatremia has been identified as a predictor of necrotizing soft tissue infections and gangrenous cholecystitis. We hypothesized that hyponatremia could predict bowel ischemia in patients with incarcerated hernias.

Methods: Medical records for 163 patients with incarcerated hernias over a 5-year period were reviewed. Preoperative clinical, laboratory, and radiologic findings and final intraoperative diagnosis were collected.

Results: Thirty-six patients (22.1%) had ischemic bowel requiring resection. Univariate analysis identified multiple significant variables including lower serum sodium (p = 0.002), lower bicarbonate (p = 0.04), elevated glucose (p = 0.0002), elevated white blood cell count (p = 0.001), and skin changes (p = 0.001). In a multivariable model, skin changes were associated with an odds ratio for ischemia of 3.3 (1.3-8.6 p = 0.02). Sodium of less than 135 had an odds ratio for ischemia of 3.9 (1.7-9.1, p = 0.004).

Conclusion: Hyponatremia should raise suspicion for underlying strangulated bowel and prompt urgent exploration in patients with incarcerated hernias.

Keywords: Hyponatremia; Incarcerated hernia; Ischemic bowel.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Female
  • Hernia, Abdominal / blood*
  • Hernia, Abdominal / complications
  • Hernia, Abdominal / surgery*
  • Humans
  • Hyponatremia / blood*
  • Hyponatremia / diagnosis
  • Hyponatremia / etiology
  • Intestinal Obstruction / blood
  • Intestinal Obstruction / etiology
  • Intestinal Obstruction / surgery
  • Intestines / blood supply*
  • Intestines / surgery
  • Ischemia / blood*
  • Ischemia / etiology
  • Ischemia / surgery
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Sodium / blood*

Substances

  • Biomarkers
  • Sodium