Delay in presentation and misdiagnosis of strangulated hernia: prospective study

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.