The pattern of incarceration and strangulation of external hernias as seen at Kenyatta National Hospital Over The Period January 1994 - December 1999

Abstract

This is a retrospective study of one hundred and eighty eight patients with incarcerated/strangulated external hernia who were admitted at the Kenyatta National Hospital, Nairobi between January 1994 and December 1999. The commonest types of incarcerated/strangulated external hernias are inguinal 63.4%, umbilical 19%, epigastric 5% and femoral hernia 0.7%. An average 31 patients per year were admitted with incarcerated/strangulated external hernias (incidence). Incarceration/strangulation of external hernias predominantly occurs in males (male:female ratio of 12: 1) and mostly occur on the right side (in this study right 68.7% vs left 24.6%). Some external hernia incarcerate/strangulate more easily than others. In this study. hernias with the highest incarceration rate include femoral 33.3%, inguinals 13.33%, umbilical 7.06% and epigatric 4.26%. The mean age of patients in this study was 2 years and the commonest age group was 21- 50 years (48.4%). The commonest presenting features were local hernial site pain (98.9%) and local hernial swelling (97.9%). Age (the very young and very old) and co-morbid condition increased morbidity and mortality. In this study. 3 of the 4patients who died were agedl0 weeks and had gastroenteritis. Duration of hernia for-less than a year increased the risk or chances of incarceration/strangulation. In this study. 76% of the patients had hernia for less than one year. The commonest complication in this study included testicular edema/hematoma (3.7%) and wound sepsis 2.1%). The most prevalent associated factors include: chronic cough 12.2%.,straining at micturation 4.8% and straining at defaecation 3.7% Of 188 patients admitted. 159 (84.6%) patients had emergency surgery and 29 (15°/0) conservative management, In the latter group in S patients their hernia reduced spontaneous and in 21 patients. the hernia was reduced under sedation (pethidine/valium) especially in children. Thus it is recommended that early repair of hernia is performed in all hernias and especially in the very young. very elderly, patients with short history of hernia and certain types or hernia (inguinal hernia in children and femoral hernias in adults