Predictors of ischemic bowel in patients with incarcerated hernias
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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.
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.
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).
Hyponatremia should raise suspicion for underlying strangulated bowel and prompt urgent exploration in patients with incarcerated hernias.
KeywordsIschemic bowel Incarcerated hernia Hyponatremia
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.
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
For this type of study formal consent is not required.
- 5.Falor AE, Zobel M, Kaji A, Neville A, De Virgilio C (2012) Admission variables predictive of gangrenous cholecystitis. Am Surg 78(10):1075–1078Google Scholar
- 7.O’Leary MP, Neville AL, Keeley JA, Kim DY, de Virgilio C, Plurad DS (2016) Predictors of ischemic bowel in patients with small bowel obstruction. Am Surg 82(10):992–994Google Scholar