A sudden tightness in the hernia gate hernial content is called a strangulated hernia. There are abdominal and strangulated diaphragmatic hernia.
Strangulated diaphragmatic hernias occur, usually after thoracoabdominal injuries. Paraesophageal hernias are less common when there is infringement of a seal, loops of intestine or stomach. Abdominal hernia, usually violated when a strong tension press, strong cough, as a result of lifting weights. Found this type of hernia is more common in men.
Usually suddenly, in the upper abdomen or the relevant part of the chest occurs a sharp pain, often radiating to the supraclavicular region. If the strangulated intestine develops strangulation obstruction (vomiting, cramping, and so on). If the infringement occurred in esophagojejunal region, vomiting (despite having the urge to it) turns out to be impossible due to the fact that is squeezing the terminal part of the esophagus or cardiac part of the stomach. Thus, there is a complete dysphagia. When the infringement of the stomach appears first vomiting, then to the stomach contents of vomit mixed with bile and blood. In addition to the sudden and sharp pain signs strangulated diaphragmatic hernia also include a feeling of pressure in the chest. The accumulation of effusion in the pleura increasing shortness of breath. When perforation disadvantaged and dead body in the region of the pleura in the chest occurs very sharp pain and develops collapse. After some time, due to the penetration of the contents of the chest to the abdominal cavity, can cause peritonitis. Common symptoms that occur immediately after the infringement are: the reduction of pressure, tachycardia, cold sweat, pallor. Later starts intoxication, the pulse becomes more frequent, the tongue is dry, the temperature rises. In the chest in the survey find the area of tympanica or blunting, which are absent or weak breathing noises, peristaltic noises are amplified. If there is infringement of the stomach, abdominal palpation becomes painful. Infringement of the abdominal external hernia (postoperative, umbilical, femoral, inguinal) manifests itself with symptoms such as severe pain in the abdomen, pain, tightness and increase hernial protrusion, nepravilnosti hernia. Often nausea and vomiting. Typically, this type of hernia is accompanied by intoxication.
If historical data are not available, the correct diagnosis contributes to a careful examination of a patient in combination with x-ray study. Diagnosis of strangulated external hernias usually does not cause difficulties. To differentiate hernia incarceration follows from the torsion of the spermatic cord, funiculitis, epididymitis, hydrocele, femoral or inguinal lymphadenitis, acute appendicitis. Infringement intestine, omentum, preperitoneal fat tissue can lead to the development of cellulitis in the field of infringement. Infringement internal abdominal hernia is manifested by symptoms of intestinal obstruction.
Patients need urgent admission to hospital. When the diagnosis of strangulated diaphragmatic hernia the only treatment is surgery. When the viability of the affected organ it lower in the abdominal cavity and produce closure of the defect. If changes are irreversible, produce resection of the affected organs.
When providing emergency care to set the hernia cannot. With the exception of patients who, because of comorbidities are in serious condition and operation for them is a greater risk than reduction of the hernia. If manual reduction fails, the patient, despite the risk, it is necessary to operate.