Sudden pain at the site of a Hernia followed by Vomiting and inability to put the Hernia inside the Abdomen, is a sign of emergency: this may mean that the Hernia has become obstructed and may need emergency surgery. At this point, the patient needs to go to a hospital and consult a Surgeon. The surgeon will then examine the patient and determine whether there is true emergency needing urgent surgery, or the pain can be managed conservatively. This condition is known as Obstructed or Strangulated Hernia.
What is the mechanism of Obstruction/Strangulation?
A hernia is basically a small Hole with a ring through which the Intestines come out: most of the times, the hole is smaller than the amount/length of Intestinal loop which comes out. This loop comes out on standing, coughing or straining. But it also goes inside on lying down in sleeping position. But sometimes the amount / length of loop coming out is much larger than the ring, and it cannot go back inside the Abdomen: when this happens gradually over a period of days or months and there is no pain, then it is called irreducibility. However, when this loop gets stuck outside suddenly and gets pinched by the narrow ring, the Air, fluid and blood supply inside the loop gets trapped and causes pain and swelling. This further increases the size of the loop in the limited space causing severe pain: this now is called as an Obstructed Hernia.
now becomes an emergency and needs emergency surgery to open the Hernial sac, open the constricting ring and put the loopback.
The further situation of an Obstructed Hernia is even more Life-threatening: The constricting ring of hernia defect also blocks the blood supply to the Loop of Intestines, putting the life of that loop at stake, and if the loop is not released urgently, it will lose its blood supply totally and become dead: called as Gangrene of Intestine. This is a life-threatening condition. In this situation, urgent surgery is required.
what surgery is done in this situation?
Under Anaesthesia, an incision is taken on the Hernia site, the sac is opened. The loop of stuck intestine is separated. The constricting ring of a hernia is cut open at a safe site, and then the loop of Intestine is observed for some time. The swelling will reduce and it is then put back inside the Abdomen.
If the Intestinal loop has already become dark, blue or black, this means that the blood supply to the loop is obstructed or cut off. This is called Strangulation or Strangulated Hernia. If the Intestines are still living, then as soon as the constricting ring is cut, the blood supply is restored and the Intestinal loop rapidly regains its normal color showing that it is not yet dead. However, the color may not become normal and remain blue or totally dark or blackish: this means that there is Gangrene of the Intestine, and that part of Intestine has to be removed. The remaining two ends of normal looking Intestines are joined back together and returned to the Abdomen.
What happens to the Hernia/ Is it repaired?
If the Intestine is only stuck, Obstructed without losing its blood supply, then a complete repair of a hernia is done by closing the Defect and putting a Mesh.
If the Intestines have lost their blood supply temporarily (Strangulation) or permanently, (gangrene), then only the defect is closed, but no Mesh is put: this is because the intestines are full of Bacteria which get releases due to lack of blood supply into the area: this bacteria can then cause infection of the Mesh. So Mesh repair is not done in a Strangulated Hernia: it is done a few days or weeks later.