title: Delay in presentation and misdiagnosis of strangulated hernia: prospective study.
abstract: The purpose of this study was to examine the presentation and management of strangulated hernia. The clinical course of 54 patients was recorded. Twenty-one patients (39%) presented after 48 h from the onset of symptoms. Fifteen (28%) had a bowel resection and two (4%) died. Twenty (37%) patients had previously consulted their general practitioner about the hernia, but only seven had been referred for surgery. Five (25%) had been warned of the risk of strangulation. In the 32 (59%) patients previously aware of a hernia, delayed presentation was related to ignorance of the risk of strangulation (P less than 0.01). The strangulated hernia was misdiagnosed by the general practitioner in 17 (33%) patients (necessitating a second visit) and by the hospital registrar in eight (15%). We conclude that strangulated hernia is too often misdiagnosed and all patients who present with a hernia must be referred to a surgeon and warned about strangulation.
authors.affiliation: Department of Surgery, Trafford General Hospital, Stockport, UK.
authors.forename: G
authors.initials: G
authors.lastname: Askew
authors.forename: G T
authors.initials: GT
authors.lastname: Williams
authors.forename: S C
authors.initials: SC
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000592:standards; D005260:Female; D006547:Hernia / Q000175:diagnosis* / Q000401:mortality; D059685:Herniorrhaphy; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors; D014102:Torsion Abnormality