Abstract

Dr. J. A. Jayalal*, Dr. Rajesh S., Dr. Sathik, Dr. Deepan Karthick, Dr. Poornachandran and Dr. Rajmohan

ABSTRACT

Background: COVID-19 pandemic has created a remarkable changes in the approach of patients for elective surgery for their presenting surgical diseases. Due to various physical, economic and social reasons they are not able to report early even when the red flag signs are raised, resulting in undue Complications, leading on to increased morbidity and mortality. This study is to identify the presentations of different types of hernia with complications in the emergency department and analyse the classification, presenting feature, delay in presentation and surgical outcome for hernia with complications. Methodology: It is a retrospective study involving 100 cases of acute emergency surgeries carried out for hernia with complications in a teaching hospitals. Results: In this group of 100 surgical emergencies 77 % were males and 23 % were females with male to female ratio of 3.3 The mean age group 52.8 years. The most common presentations were Inguinal hernia with complications 59%,followed by Umbilical hernia 17%,incisional hernia 9% ,paraumbilical hernia 10% and femoral hernia 5%.Intestinal obstruction was the commonest presentation in Inguinal ,Umbilical and ventral hernia ,but strangulation was common in femoral hernia. After development of complications ,there were undue delay of 24-48 hours in 45% of patients and more than 48 hours in 17 patients for reporting in the hospital. 83 % of patients had viable intestine or omentum as the contents of the sac ,but in 17 patients it was non-viable ,hence undergone bowel resection and anastomosis. The reasons cited for late reporting were ignorance, lack of public health hospitals with surgical facilities in the local area, non-availability of public transport system and fear of contracting with COVID-19 infections in this pandemic .Swelling, pain, vomiting ,constipation, obstipation and abdominal distension were the commonest presenting symptoms. All patients underwent surgery and apart from the minor complications like pain and seroma persisted in 56% and 30% patients in the post-operative period . Wound gapping was present in 7 % of patients. Mortality was 2% among this patients. Conclusion: As we are passing through a uncertainty of the pandemic ,adequate steps to be taken to make the essential surgical care made available, accessible and affordable to common public, lest to prevent undue complications arising out of late presentation resulting in increased mortality.