Incarcerated Hernia: Are you sure, doctor?

Groin and abdominal wall hernias constitute a frequent condition and contribute substantially to both elective and emergency surgery. Incarcerated hernias, given their dangerous potential, are usually admitted and operated upon on an emergency basis. Occasionally, a patient suspected of having an incarceration is rushed to the theater. During operation, often a condition other than a hernia is found. These misdiagnosed cases are the subject of this retrospective study, in which the records of 952 operations performed for hernia of any kind during a 2-year period were reviewed: the misdiagnosed cases were identified (postoperative diagnosis other than hernia), and their physical findings and history, pre- and postoperative diagnosis, and type of anesthesia were compared and analyzed. The investigation revealed that 17.5% of all the emergency operations (57 in total) were misdiagnosed and rushed to theater. In 90% of these cases, local or regional anesthesia would have sufficed if operated upon for the correct pathology - found intraoperatively. In our opinion, such a frequent condition as groin and abdominal hernias should represent no diagnostic dilemma, and every effort should be done to avoid unnecessary risks and complications. A brief literature review offers the correct approach to anamnesis, physical examination, and differential diagnosis of hernias while emphasizing the importance of proper preoperative diagnosis, particularly in the emergency setting.