Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria.

OBJECTIVE

To determine the incidence, pattern and outcome of obstructed abdominal wall hernia in a semi-urban and rural community.

DESIGN

A proforma was drafted to study all consecutive patients operated for obstructed anterior abdominal wall hernia over a period of five years. Clinical findings, preoperative treatment, operative findings and postoperative outcome were documented.

SETTING

Teaching hospital located in a semi-urban community comprising mostly agrarian population.

PATIENTS

A total 110 adult patients with obstructed anterior abdominal wall hernia who had operative intervention and other postoperative management.

RESULTS

There were 110 patients with 111 obstructed hernias, accounting for 26.4% of all abdominal wall hernias. The age ranged from 19-79 years with mean of 49.7 years. Males accounted for 81%. Inguinoscrotal hernia was the commonest occurring in 75.7%, 16.2% patients presented with inguinal hernia and five patients with femoral hernia. The greater proportion of inguinal hernia occurred in female. Eighty seven patients (79%) had emergency operations and elective in 23 patients (21%) who had spontaneous reduction while awaiting surgery. Ninety two percent of inguinoscrotal/inguinal hernia were indirect. Omentum was trapped in 52 hernias (47.%), while in 15 patients (13.6%), gangrenous bowel segments were discovered. Scrotal oedema was the commonest complication accounting for 21%, while wound infection occurred in 20%. There were three deaths in elderly men with clinical symptoms and signs of acute intestinal obstruction and gangrenous bowel segments, accounting for 2.7% of the patients. Twenty eight per cent of patients were discharged within the first and second postoperative days. Two patients spent 36 and 56 days each in the hospital.

CONCLUSION

This study showed that 26.4% of abdominal hernia presented with obstruction. With inguinoscrotal hernia predominating: male accounted for 81% and 13.6% of the obstructed hernia contained gangrenous bowel segments. Post-operative complications were common, mortality occurring mainly in elderly patients with late presentation.