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Hernia

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Predictors of ischemic bowel in patients with incarcerated hernias

  • J. A. KeeleyEmail author
  • A. Kaji
  • D. Y. Kim
  • B. Putnam
  • A. Neville
Original Article
  • 37 Downloads

Abstract

Purpose

Diagnosing intestinal strangulation in the setting of incarcerated hernias remains challenging. Hyponatremia has been identified as a predictor of necrotizing soft tissue infections and gangrenous cholecystitis. We hypothesized that hyponatremia could predict bowel ischemia in patients with incarcerated hernias.

Methods

Medical records for 163 patients with incarcerated hernias over a 5-year period were reviewed. Preoperative clinical, laboratory, and radiologic findings and final intraoperative diagnosis were collected.

Results

Thirty-six patients (22.1%) had ischemic bowel requiring resection. Univariate analysis identified multiple significant variables including lower serum sodium (p = 0.002), lower bicarbonate (p = 0.04), elevated glucose (p = 0.0002), elevated white blood cell count (p = 0.001), and skin changes (p = 0.001). In a multivariable model, skin changes were associated with an odds ratio for ischemia of 3.3 (1.3–8.6 p = 0.02). Sodium of less than 135 had an odds ratio for ischemia of 3.9 (1.7–9.1, p = 0.004).

Conclusion

Hyponatremia should raise suspicion for underlying strangulated bowel and prompt urgent exploration in patients with incarcerated hernias.

Keywords

Ischemic bowel Incarcerated hernia Hyponatremia 

Notes

Compliance with ethical standards

Conflict of interest

JK declares no conflict of interest. AK declares no conflict of interest. DK declares no conflict of interest. BP declares no conflict of interest. AN declares no conflict of interest.

Ethical approval

The study was approved by the institutional review board.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Informed consent

For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of SurgeryHarbor-UCLA Medical CenterTorranceUSA
  2. 2.Department of Emergency MedicineHarbor-UCLA Medical CenterTorranceUSA
  3. 3.UCSF East Bay Department of SurgeryOaklandUSA

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