J A Keeley1,2, A Kaji3, D Y Kim4, B Putnam4, A Neville4. 1. 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. jessica.keeley@gmail.com. 2. UCSF East Bay Department of Surgery, 1411 East 31st Street, Oakland, CA, 94602, USA. jessica.keeley@gmail.com. 3. Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA, 90502, USA. 4. 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.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: Hyponatremia should raise suspicion for underlying strangulated bowel and prompt urgent exploration in patients with incarcerated hernias.
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION:Hyponatremia should raise suspicion for underlying strangulated bowel and prompt urgent exploration in patients with incarcerated hernias.
Authors: Haridimos Markogiannakis; Nikolaos Memos; Evangelos Messaris; Dimitrios Dardamanis; Andreas Larentzakis; Dimitrios Papanikolaou; George C Zografos; Andreas Manouras Journal: Surgery Date: 2011-03 Impact factor: 3.982
Authors: Michael P O'Leary; Angela L Neville; Jessica A Keeley; Dennis Y Kim; Christian de Virgilio; David S Plurad Journal: Am Surg Date: 2016-10 Impact factor: 0.688