Whilst strangulation is a relatively rare complication of hernias it can occur with any type of hernia. Strangulation risk is probably greatest with femoral hernias.
Strangulated hernia
The femoral hernia is the most susceptible to this complication. Symptoms of a strangulated hernia include nausea, vomiting and severe pain. Prompt medical attention and surgery is vital. Untreated, a strangulated hernia can lead to gangrene of the trapped bowel.
Risks of strangulation
The risk of strangulation and obstruction is lowest for direct inguinal hernias as they have a wide neck, which can often be monitored and managed conservatively.
Incarceration occurs when this organ cannot be pushed back into its original cavity. Incarcerated hernias are often surgical emergencies, and a clinician should be consulted early. Inguinal hernias are more common among men, and of those, incarceration is more common in hernias of the right side.
The risk of strangulation is no more than about 2% per year with an inguinal hernia.
Warning Signs. Indirect inguinal hernias are more likely to cause bowel obstruction than direct inguinal hernias. This is because that tunnel described above, the inguinal canal, can be narrow. The narrow area enlarges as the canal travels downward.
Incarceration or strangulation is common with a femoral hernia due to the small size of the hernia neck or orifice. All patients with a femoral hernia should be considered for repair due to the high risk of complications associated with femoral hernias.
Due to the rigid borders that encase a Spigelian hernia, incarceration rates are significantly higher than other abdominal wall hernias. Several studies have shown that roughly 27% of diagnosed Spigelian hernias will incarcerate.
The difference between indirect and direct inguinal hernias is in the anatomical location. Direct hernias protrude through the posterior (back) wall of the inguinal canal (passages that run down the lower abdomen on either side of the groin). Indirect hernias protrude through the inguinal ring.
Richter's hernia, where only a part of the intestinal wall is strangulated, De Garengeot hernia, where the appendix is incarcerated in the femoral canal and Littre's hernia belong to this category of strangulated femoral hernias without intestinal obstruction.
In general, organs that herniate through your diaphragm aren't likely to get stuck. A hiatal hernia rarely causes complications, except for chronic acid reflux. On the other hand, a congenital diaphragmatic hernia (CDH) is always complicated, because it affects the way fetal organs develop.
Incarcerated hernia is a common emergency, with a risk of increasing bowel necrosis (BN) and necessitating emergency interventions.
Inguinal hernia is the commonest hernia type in females followed by incisional hernias which also accounteds for most recurrent cases. Age appears to be a risk factor for developing complications.
Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. It is also called “spontaneous lateral ventral hernia” or “hernia of semilunar line”. The hernia ring is a well-defined defect in the transversus aponeurosis. The diagnosis of spigelian hernia is difficult.
Inguinal hernias account for 75% of all abdominal wall hernias. The incidence of inguinal hernias has a bimodal distribution, with peaks around age 5 and after age 70. Two-thirds of these hernias are indirect, making an indirect hernia the most common groin hernia in both males and females.
Indirect inguinal hernia: An indirect inguinal hernia enters your inguinal canal through the top. This usually occurs because of a birth defect. In some fetuses, the opening to their canal doesn't close all the way during development in the uterus.
Indirect hernias are the most common type of inguinal hernia. Although they occur in both sexes, they are more more common in males than females .
Spigelian Hernias
This hernia is the result of a weakness of the linea semilunaris, which is the fibrous sheath of tissue between the rectus abdominis muscles and the transverse and oblique abdominal muscles of the lateral abdominal wall.
Like other hernias, the spigelian type is mainly caused by an opening or a weakness in the abdominal wall. Other common causes include: Long-standing medical conditions that increase abdominal pressure, like chronic coughing, liver cirrhosis with fluid collection (ascites), pregnancy, and obesity.
The incidence of metachronous contralateral inguinal hernia (MCIH) is high in infants with an inguinal hernia (5–30%), with the highest risk in infants aged 6 months or younger. MCIH is associated with the risk of incarceration and necessitates a second operation.
During a laparoscopic inguinal hernia repair, the dangerous triangle (the triangle of doom) refers to a triangular area bound by the vas deferens, the testicular vessels and the peritoneal fold. Within the boundaries of this area, you can find the external iliac artery and vein.
Inguinal hernia is probably one of the most common surgical conditions, with strangulation accounting for a good number of acute surgical admissions. It has always been known that direct hernias are less likely to strangulate due to wide hernial defects in comparison to indirect hernia.
The risk of strangulation of femoral hernias increases with time following initial diagnosis; after 3 months the risk of strangulation is 22% and reaches 45% after 21 months. As with any hernia, there is also a risk of becoming obstructed.
The risk of complications is greater with femoral hernias. Inguinal hernias often don't cause any severe symptoms, and can be treated quite effectively with surgery. Femoral hernias, on the other hand, can cause more problems because they are more likely to "pinch" a part of the bowel.
All inguinal hernias in females occur as indirect protrusions.