Muhammad Hasan Abbas.
Outcome of strangulated inguinal hernia.
Pak J Med Sci Jan ;21(4):445-50.

Objective: To find out the presentation of strangulated inguinal hernia and look for features associated with morbidity and mortality. Methods: Fifty consecutive patients presenting over one year period to emergency department with non-reducibility and pain in inguinal hernia were included in study. Detailed symptomatology and clinical findings at presentation were noted and patients were followed through their operative and postoperative period. Results: Most of the patients (56%) were above fifty years of age. Ileum (74%), Omentum (36%) and large gut (14%) were encountered in strangulation in descending order of frequency. Fifty four percent of contents were non-viable. Duration of symptoms at presentation was the most important determinant factor regarding gut viability (14.48 hours [viable] vs. 59.04 [non-viable], p= 0.004) and mortality (26.26 hours [alive] vs. 101.29 [dead], p= 0.0001). Mortality was also noted to be higher in old age. Pre operative findings of absent bowel sounds, abdominal distension and redness of swelling were associated with non-viable contents (p<0.05) and along with peritonitis, when present were associated with high mortality (p<0.05). Overall mortality was 14%. Conclusion: Operative mortality of strangulated inguinal hernia remains high. Late presentation is the most important determinant of this outcome. Constipation, abdominal distention, absent bowel sounds and redness of swelling are important pre-operative findings associated with higher morbidity and mortality.

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