Are Fibrinogen and Complete Blood Count Parameters Predictive in Incarcerated Abdominal Hernia Repair?

Therapeutic delays in cases of external incarcerated hernias typically result in increasing morbidity, mortality, and health expenditures. We investigated the diagnostic role of blood fibrinogen level, white blood count (WBC), mean platelet volume (MPV), and platelet distribution width (PDW) in patients with incarcerated hernia. Two groups, each containing 100 patients, were studied. Group A underwent elective, and group B underwent incarcerated and urgent external hernia repair. We observed high fibrinogen and WBC levels but low MPV and PDW values for patients in group B. Contrary to our expectations, we found lower MPV and PDW values in the complicated group than in the elective group. The morbidity rate and cost burden were higher in group B, and the results were statistically significant. Early operation should be recommended for patients with incarcerated external hernias if their fibrinogen and WBC levels are high.Key words: Incarcerated external hernia, Fibrinogen, Complete blood countExternal strangulated hernia is one of the most common causes of intestinal obstruction especially in the elderly. Delay in treatment may be dangerous.¹ Andrews found that the need of bowel resection rate was 27% and the mortality rate was 21% when diagnosis was delayed more than 48 hours; whereas these rates were 7% and 1.4% when diagnosis was obtained in the first 24 hours.² In addition to increased morbidity and mortality rates, a delay in the treatment of strangulated external hernias is associated with extended hospital stays and an increased need for intensive care, thereby resulting in increased health costs. Of course, clinical signs and symptoms are the most important evidences in diagnosis of incarcerated hernias. In order to make correct diagnosis, we also have powerful weapons such as radiologic imaging methods. However, these clinical and radiologic evidences show complications, especially intestinal perforation due to incarceration. Awareness of probable complications is essential. In this regard, we sometimes need simple methods to alert us. The white blood count (WBC), mean platelet volume (MPV), platelet distribution width (PDW), and blood fibrinogen level have been shown to be valuable predictive parameters for ischemic events in different parts of the body.^3–9 There are probable ischemic tissues and organs in incarcerated hernia sac. So, in this study, we aimed to investigate the effectiveness of these simple blood tests in diagnosis. Generally, there is no problem in diagnosis, but sometimes the delay in treatment results in additional morbidity such as a need for bowel resection.     

Malnutrition,associated clinical factors,and depression in systemic sclerosis: a cross-sectional study

Clinical Rheumatology - The aim of this study was to evaluate the associations between malnutrition and the clinical features of the disease and depression in patients with systemic sclerosis...     

An unusual presentation of perforated appendicitis in epigastric region

INTRODUCTION

Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.

PRESENTATION OF CASE

A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.

DISCUSSION

While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.

CONCLUSION

Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.