Natural history and outcome of incarcerated abdominal hernias in peritoneal dialysis patients

Hernias can lead to significant morbidity in patients on peritoneal dialysis (PD). We studied the natural history and outcome of incarcerated hernia (IH), with or without bowel strangulation (IHS), in PD patients. We performed a retrospective chart review on all PD patients who developed an IH (n = 11) or an IHS (7/11) in the last 12 years. Of the 11 patients, 54% were female. The age range was 36 - 86 years (median: 61 years). Seven patients had a known history of a hernia that went on to become the index hernia that incarcerated with or without strangulation. The hernia types were umbilical (n = 8), inguinal (n = 2), and incisional in the area of the PD catheter (n = 1). Clinical presentations included painless abdominal mass (2 patients); tender and painful abdominal mass (4 patients); and abdominal pain, tenderness, and bowel obstruction (5 patients). Nine hernias were treated surgically--5 of them emergently for bowel ischemia. The other 4 patients who had incarcerated, non strangulated hernias were operated electively. One patient with IHS had the hernia manually reduced, and 1 patient with IHS had the hernia manually reduced and subsequently operated electively. Three patients with IHS and 2 with IH required temporary hemodialysis for between 4 days and 21 days. In PD patients, IHs are most commonly umbilical and have a propensity to strangulate. Patients treated operatively have an excellent prognosis and are usually able to continue PD. Abdominal wall hernias should be referred early to minimize mechanical complications.