Emergency Management of Internal Hernia

Internal hernias are one of the difficult and insidious problems in emergency general surgery. The relative rarity of the pathology, difficulty of diagnosis, non-specificity of symptoms, and need for prompt management distinguish this type of hernias from others. The physician involved in the treatment of a patient with the possible diagnosis of internal hernia should be familiar with anatomical location, types, and cause of occurrence of this pathology. It is especially necessary to remember the possible presence of internal hernia in a patient with developing picture of intestinal obstruction at the early postoperative days. Computed tomography makes it possible to establish the correct diagnosis early and with high probability regarding the exact location of the hernia. The presence of ominous sepsis signs (increasing temperature, laboratory inflammation results, tachycardia, decreasing blood pressure, appearance of peritoneal symptoms) indicates the tactics of further treatment. In the absence of systemic inflammation, nonsurgical techniques through maintenance of water balance and aspiration of gastrointestinal contents may be acceptable. When the above threatening signs appear, urgent surgical intervention should be adopted, which may consist of reduction of herniated loop, resection of ischemic segment, and hernial opening repair. High alertness, deep awareness, and correct treatment tactics make it possible to successfully cope with this pathology.