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Strangulated Hernia

  • What is a strangulated hernia?

    A strangulated hernia is a complication that occurs when a hernia is cutting off the blood supply to the intestinal tissues. It is a medical emergency as the strangulated tissue can release toxins in the bloodstream, causing infection that can lead to sepsis or death.

    While there are many types of hernias, strangulated hernia is more common in:

    • Epigastric – when fat pushes through a weakened part of the abdominal wall
    • Umbilical – when intestines or fluid pushes through near the umbilicus, more commonly seen in infants
    • Femoral – bulges into the upper thigh, mainly seen in older women
    • Incisional – post surgery hernia due to poor wound healing
    • Inguinal – the protrusions of intestines through weakened abdominal walls in the groin area, a condition especially common especially in men
    • Spigelian hernia – also known as a lateral ventral hernia, is the protrusion of peritoneal fat, peritoneal sac, or organs through a defect in the abdominal wall and fascia

    Strangulated hernia

  • Patients presenting with strangulated hernia usually have a history of a pre-existing hernia. The narrower the neck of the protrusion, the higher are the chances of strangulation occurring. Therefore, certain types of hernia such as the femoral hernia, are more likely to become strangulated.

    While some hernias are congenital, the majority of hernias are caused by:

    • Abdominal surgery
    • Chronic cough or sneezing
    • Injury to the abdominal wall
    • Obesity and high visceral fat
    • Other causes of increased intra-abdominal pressure
    • Strenuous activities
    • Straining during bowel movement or micturation (urinating)
    • Weakened muscles due to ageing
  • The hallmark of a strangulated hernia is acute, constant and severe pain over the hernia swelling. Other symptoms include vomiting and constipation due to bowel obstruction. Prolonged strangulation can be dangerous and could result in a patient having fever and feeling very ill.

  • A strangulated hernia is a medical emergency. An experienced doctor will be able to clinically diagnose a strangulated hernia based on your signs and symptoms. Occasionally, CT scans and X-rays may be ordered for further assessment.

  • Immediate surgery is required to reduce and repair the hernia. Surgery is usually done by conventional open surgery, but laparoscopic surgery can be considered in selected patients. Besides hernia repair, bowel resection is sometimes required if the strangulation has resulted in unhealthy and non-viable bowel.

    Recovery is fairly quick if the bowel is viable and no resection is done. Bowel movement should return to normal within 1 – 3 days. The patient can resume normal activities within a week with strenuous activity and heavy lifting avoided for up to 6 weeks.

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  • While elective hernia surgery has a relatively low risk, strangulated hernia can present with more complications.

    Sometimes, wound infection from bacteria in the bowel can happen especially when there is a need for bowel resection. To prevent infection, the patient is given prophylactic antibiotics prior to the surgery for strangulated hernia.

    Other possible complications are:

    • Anaesthetic complications
    • Leakage from the bowel anastomosis if bowel resection was performed
    • Recurrence of the hernia
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    • Alan Cheung

      Specialty:
      Orthopaedic Surgery

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      Clinic:
      International Orthopaedic Clinic
      Location:
      38 Irrawaddy Road #05-24
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6253 7111
    • Anandakumar S/O Vellasamy

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      Centre For Foot And Ankle Surgery
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      38 Irrawaddy Road #10-34/35
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
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      6684 5828
    • Andrew Quoc Dutton

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      Clinic:
      Elite Orthopaedics Pte Ltd
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      3 Mount Elizabeth #12-10
      Mount Elizabeth Medical Centre
      Singapore 228510
      Contact No:
      6836 8000
    • Ang Chia Liang

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      Sub-specialty:
      Orthopaedic Surgery - Sports Medicine

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      Clinic:
      Centurion Orthopaedic Centre
      Location:
      38 Irrawaddy Road #08-35
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6970 5835
    • Ang Kian Chuan

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      Clinic:
      Orthosports Orthopaedic Surgery & Sports Medicine
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      38 Irrawaddy Road #10-41
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
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      6734 8168
    • Antony Gardner

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      Clinic:
      Orthopaedic Associates
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      38 Irrawaddy Road #11-49/50/51
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
      Contact No:
      6334 0622
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      Orthopaedic Associates
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      3 Mount Elizabeth #16-03
      Mount Elizabeth Medical Centre
      Singapore 228510
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      62358755
    • Bell David Paul

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      Clinic:
      Orthosports Orthopaedic Surgery & Sports Medicine
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      38 Irrawaddy Road #10-41
      Mount Elizabeth Novena Specialist Centre
      Singapore 329563
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      6734 8168
    • Bose Kamal

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      Clinic:
      Bose Bone, Joint & Spine Clinic
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      3 Mount Elizabeth #14-12
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      67387155
    • Chan Beng Kuen

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      Orthopaedics International
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      3 Mount Elizabeth #06-03
      Mount Elizabeth Medical Centre
      Singapore 228510
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      67376386
    • Chan Ying Ho Henry

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      Clinic:
      Hc Orthopaedic Surgery
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      3 Mount Elizabeth #15-14
      Mount Elizabeth Medical Centre
      Singapore 228510
      Contact No:
      6732 8848

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