Skip to main content
Log in

Is herniosis the single etiology of Saint’s triad?

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Background

Sixty years ago, Saint’s triad (hiatus hernia, diverticulosis of the colon, and gallbladder disease) was first described in three patients. Since then, the association of these conditions has been questioned. We tested the hypothesis that these conditions are associated, and, based on recent research, propose a common etiology.

Methods

Data from the U.S. Veterans Integrated Service Network (VISN) 16 Data Warehouse were analyzed. Chi-square tests and calculated odds ratios (ORs) were utilized to describe the magnitude of association, and multivariable logistic regression models were used to determine the variables associated with Saint’s triad.

Results

Among 637,518 patient records (1996–2005), any hernia was diagnosed among 22,181 (3.5%) patients, hiatus hernia among 1,661 (0.3%), diverticulosis of the colon among 14,375 (2.3%), and gallbladder disease among 5,284 (0.8%). The following associations were observed: diverticulosis, hiatus hernia (OR: 6.9), hiatus hernia, gallbladder disease (OR = 3.8), and gallbladder disease, diverticulosis (OR = 5.9). Patients with both diverticulosis and gallbladder disease were more likely to have hiatus hernia (OR = 3.8; P = 0.0012) or any hernia (OR = 10.7; P < 0.0001). Diseases associated with Saint’s triad (incorporating any hernia) included chronic obstructive pulmonary disease (OR = 4.3), hypertension (OR = 3.1), aortic aneurysm (OR = 2.2), and diabetes (OR = 1.8).

Conclusions

Herniosis, the systemic connective tissue disease known to cause diverticulosis and herniae, may be responsible for Saint’s triad. Diabetes, like aging, enhanced herniosis. Further research on the gallbladder wall pathology in patients with cholelithiasis or cholecystitis is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Saint CFM (1966) Saint’s triad. The origin and story of its recognition. Rev Surg 23:1–4

    PubMed  CAS  Google Scholar 

  2. Louw JH (1973) Charles F.M. Saint [obituary]. S Afr Med J 47:282

    PubMed  CAS  Google Scholar 

  3. Muller CJB (1948) Hiatus hernia, diverticula and gall stones: Saint’s triad. S Afr Med J 22:376–382

    Google Scholar 

  4. Read RC (2007) Archaic terms and dogmas impeding care of abdominal and pelvic herniation. Hernia 11:299–302

    Article  PubMed  CAS  Google Scholar 

  5. Foster JJ, Knutson DL (1958) Association of cholelithiasis, hiatus hernia, and diverticulosis coli. J Am Med Assoc 168:257–261

    PubMed  CAS  Google Scholar 

  6. Palmer ED (1962) Further experiences with Saint’s triad (hiatus hernia, gallstones and diverticulosis coli). Am J Med Sci 244:70–74

    Article  PubMed  CAS  Google Scholar 

  7. Hilliard AA, Weinberger SE, Tierney LM Jr, Midthun DE, Saint S (2004) Clinical problem-solving. Occam’s razor versus Saint’s triad. N Engl J Med 350:599–603

    Article  PubMed  CAS  Google Scholar 

  8. Klinge U, Junge K, Mertens PR (2004) Herniosis: a biological approach. Hernia 8:300–301

    Article  PubMed  CAS  Google Scholar 

  9. Read RC (2007) Pervasive co-morbidity and abdominal herniation: an outline. In: Schumpelick V, Fitzgibbons RJ (eds) Recurrent hernia: prevention and treatment. Springer, Berlin, pp 45–52

    Chapter  Google Scholar 

  10. Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347:1658–1661

    Article  PubMed  CAS  Google Scholar 

  11. Read RC (2007) Co-morbidity and interstitial herniation in the adult: an hypothesis. Hernia 11:5–8

    Article  PubMed  CAS  Google Scholar 

  12. Puri V, Kakarlapudi GV, Awad ZT, Filipi CJ (2004) Hiatal hernia recurrence: 2004. Hernia 8:311–317

    Article  PubMed  CAS  Google Scholar 

  13. El Sherif A, Yano F, Mittal S, Filipi CJ (2006) Collagen metabolism and recurrent hiatal hernia: cause and effect? Hernia 10:511–520

    Article  PubMed  Google Scholar 

  14. Wess L, Eastwood MA, Wess TJ, Busuttil A, Miller A (1995) Cross linking of collagen is increased in colonic diverticulosis. Gut 37:91–94

    Article  PubMed  CAS  Google Scholar 

  15. Hoffmann P, Layer P (1995) Pathogenesis and pathophysiology of sigmoid diverticulitis. Chirurg 66:1169–1172

    PubMed  CAS  Google Scholar 

  16. Stumpf M, Cao W, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2001) Increased distribution of collagen type III and reduced expression of matrix metalloproteinase 1 in patients with diverticular disease. Int J Colorectal Dis 16:271–275

    Article  PubMed  CAS  Google Scholar 

  17. Stumpf M, Krones CJ, Klinge U, Rosch R, Junge K, Schumpelick V (2006) Collagen in colon disease. Hernia 10:498–501

    Article  PubMed  Google Scholar 

  18. Palmer ED (1972) Saint’s triad. Am Fam Physician 6:70–73

    PubMed  CAS  Google Scholar 

  19. Fabbri LM, Rabe KF (2007) From COPD to chronic systemic inflammatory syndrome? Lancet 370:797–799

    Article  PubMed  Google Scholar 

  20. Cannon DJ, Read RC (1981) Metastatic emphysema: a mechanism for acquiring inguinal herniation. Ann Surg 194:270–278

    Article  PubMed  CAS  Google Scholar 

  21. Sørensen LT (2006) Effect of lifestyle, gender and age on collagen formation and degradation. Hernia 10:456–461

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We appreciate the efforts of Mr. Charlton Fort, who accessed the data from the Veterans Integrated Service Network (VISN) 16 Data Warehouse, thus, enabling these analyses.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. C. Read.

Additional information

M. Hauer-Jensen contributed to the study design, interpretation of results, and manuscript preparation. Z. Bursac cleaned, recoded, and analyzed the data. He wrote the statistical analysis and part of the results section. R.C. Read conceived the study. He wrote the introduction and discussion sections of the manuscript, and he compiled the reference list. All authors contributed to the critical review and revision of the manuscript. All authors have seen and approved the final version of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hauer-Jensen, M., Bursac, Z. & Read, R.C. Is herniosis the single etiology of Saint’s triad?. Hernia 13, 29–34 (2009). https://doi.org/10.1007/s10029-008-0421-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-008-0421-x

Keywords

Navigation