Nazir Ahmad, Sadaqat Ali Khan, Khalid Javed Abid.
Management of Strangulated Inguinal Hernia in Adults.
Pak J Med Health Sci Jan ;8(1):34-6.

Aim: To analyze the clinical presentation and factors affecting the outcome in the management of strangulated inguinal hernia in adults. Study Design: The prospective study included 50 consecutive patients of strangulated inguinal hernia. Settings: West Surgical Ward, Mayo Hospital, Lahore. Duration: October 2011 to December 2013. Methods: All the patients above 12 years of age either referred from the periphery or directly admitted in the Accident and Emergency Department, Mayo Hospital, Lahore with the diagnosis of strangulated inguinal hernia were included in the study. The symptoms and signs, factors for delayed presentation, peroperative findings and postoperative complications were recorded on the prescribed proforma. Results: The mean age of the patients was 50 + 21.3 years, 49(98%) patients were men and only 1(2%) woman in the series. Right inguinal hernia was strangulated in 36(72%) patients and left in 14(28%). Irreducible inguinal swelling, absent cough impulse and localized tenderness were observed in 50(100%) and signs of intestinal obstruction in 33(66%) patients. The small gut alone or with omentum was the most frequent content of the hernial sac, found in 31(62%) patients. Resection and end-to-end anastomosis of ileum was performed in 16(32%) and partial omentectomy in 13(26%) patients. Open method herniorraphy was adopted in 44(88%) patients. No mesh was used in the series. The overall morbidity was 30% with no mortality in the study. Conclusion: Elderly age, poverty, longer duration of symptoms, late hospitalization, gangrenous sac contents and significant concomitant medical illnesses are the major factors directly linked with unfavorable outcome of strangulated inguinal hernia in developing countries like Pakistan. Because of complications associated with emergency surgery in strangulation, the inguinal hernia should be repaired electively whenever possible.

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