title: Classifications of clinical and bowel morphological changes and their relationship with characteristics of patients with incarcerated groin hernias.
abstract: BACKGROUND
  There is currently no grading standard for the degree of clinical and bowel morphological changes. The objective of this study was to define clinical and bowel morphological classifications and investigate the possible relationship with the characteristics of patients with incarcerated groin hernias.
  
  
  METHODS
  We retrospectively studied 195 patients who underwent emergency hernia repair with simultaneous bowel resection between January 1992 and January 2012. We classified the degree of clinical and bowel morphological changes into 3 grades based on the incarceration time, intestinal morphology after damage, hernia sac integrity, degree of inflammation, and the presence/absence of bacterial growth, peritonitis signs, mechanical obstruction, cellulitis, and systemic shock. We also recorded patient characteristics and analyzed their relationships with these degrees according to our grading system.
  
  
  RESULTS
  We identified 134, 42, and 19 cases of Grades I, II, and III of clinical and bowel morphological changes, respectively. Pearson's chi-squared tests revealed that advanced age (P=0.001), presence of comorbid disease (P=0.002), and high American Society of Anesthesiologists (ASA) score (P=0.017) were related to the degree. Morbidity and mortality also showed significant relationships with the degree (P<0.001, P=0.005, respectively), especially with regard to post-operative infection.
  
  
  CONCLUSIONS
  The proposed 3-stage classifications of clinical and bowel morphological changes can be used to objectively reflect the degree of bowel damage. Greater levels of the changes were associated with higher incidences of complications and increased mortality, especially for older patients with comorbid diseases and poor ASA scores. Urgent surgery should be performed to avoid bowel damage exacerbation.
authors: Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
authors: Sheng-jun
authors: SJ
authors: Duan
authors: Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
authors: Hua-shui
authors: HS
authors: Liu
authors: Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
authors: Jun
authors: J
authors: Niu
authors: Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
authors: Chun-xiang
authors: CX
authors: Wang
authors: Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
authors: Shou-hua
authors: SH
authors: Chen
authors: Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
authors: Ming-hai
authors: MH
authors: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D002681:China; D002965:Classification / Q000379:methods*; D003106:Colon / Q000473:pathology* / Q000601:surgery; D005260:Female; D006552:Hernia, Inguinal / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D012189:Retrospective Studies