Obscure, Incarcerated, or Strangulated Hernia as a Cause of Intestinal Obstruction

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The diagnosis of acute intestinal obstruction in most instances is readily established. Symptoms of pain, vomiting, and failure to pass gas or feces are usually the classical triad. In addition, systemic reaction and physical findings make the diagnosis conclusive.

The etiologic factor in such cases, however, often presents a difficult problem and one that must be decided as soon as possible. Unless surgical intervention is timely, the rapid sequence of incarceration, strangulation, mesenteric thrombosis, transudation of bacteria through the intestinal wall, peritonitis, and death will follow.

Causes of acute intestinal obstruction are innumerable. Infants arc apt to have congenital anomalies, and intussusception occurs often in the first year of life. In children acute intestinal obstruction commonly results from intussesception, band adhesions, adherence of the intestine to infected retroperitoneal glands, undiagnosed appendicitis, and hernia. Common causes in adults are tumors; and in the aged, incarcerated hernia and malignant tumor. Many of the rare causes of intestinal obstruction must also be kept in mind.

Incarcerated hernia obstructs the fecal flow. Strangulated hernia impairs the blood supply as well and is usually present when the hernial tumor is painful and tender to touch. The type of acute intestinal obstruction with which this report is concerned is the obscure and frequently undiagnosed incarcerated or strangulated hernia.

Incidence. In the past six months 3 such cases have been successfully operated upon, and 1 patient died before surgical intervention. Although before operation hernia was suspected in each case except the second, in no case could incarcerated. . .



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