Incarcerated Hernia: Causes, Symptoms, Surgery and Diagnosis

Have you ever felt a bulge in your abdomen that won’t shift back in when you push it? This could be an incarcerated hernia, where part of your intestine or abdominal tissue becomes trapped in the hernia sac. Unlike a typical hernia, this condition requires prompt medical attention to prevent serious complications. In this article, we’ll explain what causes an incarcerated hernia, the symptoms to watch for, and the treatment options available.

What Causes an Incarcerated Hernia?

You may be wondering how a hernia can suddenly become “stuck.” Several factors can contribute to this condition:

• Weakness in the Abdominal Wall: Natural aging, previous surgeries, injury, or even conditions present since birth can weaken the abdominal wall. When this happens, tissue may push through, forming a hernia that is more prone to becoming trapped.
• Increased Abdominal Pressure: Everyday activities like lifting heavy objects, persistent coughing, straining during constipation, pregnancy, or carrying excess weight can all push tissue into a hernia sac and make it harder for it to move back.
• Narrow Hernia Opening or Scar Tissue: If the hernia sac has a tight neck or scar tissue around it, the tissue inside can get lodged, leading to incarceration.
• Delayed Treatment: Some people put off having a hernia checked because it feels minor. However, the hernia can increase in size over time, and the tissue inside may become trapped, increasing the risk of complications.

What Are the Symptoms of an Incarcerated Hernia?

An incarcerated hernia can cause a range of symptoms that signal trapped tissue and possible bowel obstruction. Signs to watch out for include:

• Non-Reducible Bulge: The most common sign of an incarcerated hernia is a bulge that cannot be pushed back into the abdomen. You may even notice it suddenly becoming more painful or larger.
• Nausea: Nausea arises from partial bowel obstruction caused by the trapped intestine, disrupting normal digestion and leading to discomfort.
• Vomiting: Vomiting occurs if the obstruction worsens, preventing food and fluids from passing through the bowel.
• Abdominal Pain: Sharp, constant abdominal pain at the hernia site is a key symptom of incarceration. The pain often worsens rapidly and may be accompanied by tenderness when the area is touched.
• Bloating: When tissue gets trapped, it can block the passage of gas and stool, causing the abdomen to swell and feel uncomfortable.
• Inability to Pass Gas: When intestinal tissue becomes incarcerated, normal bowel function may cease. Patients often report being unable to pass gas, which indicates potential bowel obstruction.
• Poor Bowel Movement: Difficulty passing stools or complete constipation may occur if bowel tissue is involved.

How Is an Incarcerated Hernia Diagnosed?

Diagnosis of an incarcerated hernia begins with a thorough physical examination. The doctor will examine the hernia site for characteristic signs, such as a non-reducible bulge, tenderness and changes in skin colour or temperature. During examination, patients may be asked to cough or strain to evaluate how the hernia responds to increased abdominal pressure.

Aside from physical assessments, doctors may order imaging studies to further confirm the presence of incarceration and determine the extent of tissue involvement. These tests include:

• Ultrasound
  This non-invasive imaging technique can help doctors visualise contents of the hernia, identify trapped bowel segments and assess blood flow using Doppler technology. Ultrasound is often the first imaging choice due to its accessibility and ability to provide real-time information about the hernia's characteristics.
• Computed Tomography (CT) Scans
  A CT scan provides detailed cross-sectional images, identifying the extent of incarceration and serious complications like strangulation. This imaging is particularly valuable when ultrasound results are inconclusive or when clinical suspicion for complications remains high.
• X-ray
  While X-rays alone cannot definitively diagnose incarcerated hernias, they can help confirm the presence of complications, such as bowel obstruction. These images reveal gas patterns and fluid levels that indicate intestinal blockage.

How Is an Incarcerated Hernia Treated?

Incarcerated hernias are usually considered a medical emergency that requires immediate attention. The specific approach depends on the duration of incarceration, the patient's overall condition and the presence of other complications.

Common incarcerated hernia treatments include:

• Hernia Reduction
  In some cases where incarceration is recent and there are no signs of strangulation, doctors may attempt manual reduction of the hernia. This procedure involves gently manipulating the trapped tissue back into the abdominal cavity.
• Hernia Repair
  Surgical repair is the definitive treatment for incarcerated hernias. The procedure can be performed using open surgery, which involves an incision at the site, or minimally invasive laparoscopic techniques, which use small incisions and specialised instruments with minimal tissue disruption. Both methods aim to reinforce the weakened area of the abdominal wall and prevent recurrence.

Potential Risks and Complications

Left untreated, incarcerated hernias can lead to serious complications, such as:

• Strangulation: This occurs when pressure on the trapped tissue loses its blood supply, requiring emergency surgery to prevent further damage.
• Bowel Obstruction: When bowel segments become trapped within incarcerated hernias, complete or partial bowel obstruction can develop. This complication prevents the normal passage of food, fluids and gas through the digestive system.
• Tissue Death (Necrosis): Prolonged incarceration without adequate blood supply may lead to tissue death or necrosis. Dead tissue then releases toxins that can cause systemic illness and require surgical removal to prevent infection and other serious complications.

If you notice signs of an incarcerated hernia or are experiencing related symptoms, seeking prompt medical assessment is crucial to avoid complications. Our clinic offers comprehensive evaluation and treatment for hernias. Call us at +65 6262 1226 to schedule a consultation and explore the best options for your situation.