Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA, 90502, USA.
UCSF East Bay Department of Surgery, 1411 East 31st Street, Oakland, CA, 94602, USA.
Hernia. 2019 Apr;23(2):277-280. doi: 10.1007/s10029-019-01884-1. Epub 2019 Jan 28.
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.
在嵌顿疝的情况下，诊断肠绞窄仍然具有挑战性。低钠血症已被确定为预测坏死性软组织感染和坏疽性胆囊炎的指标。我们假设低钠血症可预测嵌顿疝患者的肠缺血。
回顾了 5 年内 163 例嵌顿疝患者的病历。收集了术前临床、实验室和影像学检查结果以及最终的术中诊断。
36 例（22.1%）发生需要切除的缺血性肠。单因素分析确定了多个显著变量，包括血清钠水平较低（p=0.002）、碳酸氢盐水平较低（p=0.04）、血糖升高（p=0.0002）、白细胞计数升高（p=0.001）和皮肤改变（p=0.001）。在多变量模型中，皮肤改变与缺血的比值比为 3.3（1.3-8.6，p=0.02）。血清钠水平低于 135 的患者发生缺血的比值比为 3.9（1.7-9.1，p=0.004）。
低钠血症应引起对嵌顿疝患者潜在绞窄性肠的怀疑，并促使紧急探查。
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