Abstract
Internal hernia, volvulus, and closed loop bowel obstruction have a particularly high morbidity and mortality. All can occur in patients without a surgical history and are important to include in the differential diagnosis of abdominal pain and vomiting. Closed loop bowel obstructions, which can be due to internal hernias, are more prone to bowel strangulation and are considered a surgical emergency. In incarcerated hernia, time from symptom onset to surgery is important in patient outcomes, particularly in patients with symptoms >8 h, comorbid conditions, high ASA scores, presence of strangulation, and advanced age. While lactic acid is routinely used as a marker for tissue ischemia, it has poor sensitivity and specificity for diagnosing acute bowel injury.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Birindelli A, Sartelli M, Di Saverio S, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017;12:37.
Murphy K, O’Connor O, Maher M. Adult abdominal hernias. AJR Am J Roentgenol. 2014;202(6):w506–22.
Beadles C, Meagher A, Charles A. Trends in emergent hernia repair in the United States. JAMA Surg. 2015;150(3):194–200.
Derici H, Unalp HR, Bozdag AD, Nazli O, Tansug T, Kamer E. Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia. 2007;11(4):341–6. https://doi.org/10.1007/s10029-007-0226-3.
Tsumura H, Ichikawa T, Hiyama E, Murakami Y, Sueda T. Systemic inflammatory response syndrome (SIRS) as a predictor of strangulated small bowel obstruction. Hepato-Gastroenterology. 2004;51(59):1393–6.
Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg. 1983;145(1):176–82. https://doi.org/10.1016/0002-9610(83)90186-1.
Icoz G, Makay O, Sozbilen M, et al. Is D-dimer a predictor of strangulated intestinal hernia? World J Surg. 2006;30(12):2165–9. https://doi.org/10.1007/s00268-006-0138-x.
Kahramanca S, Kaya O, Ozgehan G, et al. Are fibrinogen and complete blood count parameters predictive in incarcerated abdominal hernia repair? Int Surg. 2014;99(6):723–8.
Graeber G, O’Neil J, Wolf R, Wukich D, Caffery P, Harman J. Elevated levels of peritoneal serum creatine phosphokinase with strangulated small bowel obstruction. Arch Surg. 1983;118:837–40.
Tanaka K, Hanyu N, Iida T, et al. Lactate levels in the detection of preoperative bowel strangulation. Am Surg. 2012;78(1):86–8.
Spence L, Pillado E, Kim D, Plurad D. Follow-up trends after emergency department discharge for acutely symptomatic hernias. Am J Surg. 2017;214(6):1018–21. https://doi.org/10.1016/j.amjsurg.2017.08.028.
Chick JFB, Mandell JC, Mullen KM, Khurana B. Classic signs of closed loop bowel obstruction. Intern Emerg Med. 2013;8:263.
Kulaylat MN, Doerr RJ. Small bowel obstruction. Surgical treatment: evidence-based and problem-oriented. Zuckschwerdt: Munich; 2001.
Paulson E, Thompson W. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology. 2015;275(2):332–42.
Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rectal Surg. 2012;25(4):236–44.
Scharl M, Biedermann L. A symptomatic coffee bean: acute sigmoid volvulus. Case Rep Gastroenterol. 2017;11(2):348–51.
Gündeş E, Akgul N, Mazican M, Aday U, Cetin DA, Ciyiltepe H. Acute abdomen in a mentally retarded patient: cecal volvulus. Prz Gastroenterol. 2017;12(2):159–61.
Kar S, Mohapatra C, Rath PK. A rare type of primary internal hernia causing small intestinal obstruction. Case Rep Surg. 2016;2016:3540794.
Martin L, Merkle E, Thompson W. Review of internal hernias: radiographic and clinical findings. Am J Roentgenol. 2006;186(3):703–17.
Al-Mansour MR, Mundy R, Canoy JM, Dulaimy K, Kuhn JN, Romanelli J. Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass. Obes Surg. 2015;25(11):2106–11.
Mancuso N, Sweeney M. The sick bowel obstruction patient [Internet]. 2017 [cited 2017 Sept 24]. Available from: http://www.emdocs.net/sick-bowel-obstruction-patient/
Lange H, Jäckel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg. 1994;160(6–7):381–4.
Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29(3):226–35.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Werner, J., Preotle, J. (2019). Atypical Obstructions: What Do Emergency Providers Need to Know About Incarcerated and Strangulated Hernia, Closed Loop Obstruction, Volvulus, and Internal Hernia? What Is the Prognostic Value of a Lactate?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_51
Download citation
DOI: https://doi.org/10.1007/978-3-319-98343-1_51
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98342-4
Online ISBN: 978-3-319-98343-1
eBook Packages: MedicineMedicine (R0)