Prediction of bowel resection in acute irreducible inguinal hernia: a retrospective analysis of preoperative computed tomography and clinical risk factors

In acute irreducible inguinal hernias, the presence of bowel strangulation is the most critical determinant of clinical urgency and prognosis. Preoperative identification of strangulation can prompt urgent surgical intervention and potentially prevent bowel resection and its associated complications. This study aimed to identify preoperative risk factors associated with bowel resection in these patients. This retrospective observational study included patients who underwent emergency surgery for acutely irreducible inguinal hernia at our institution between 2017 and 2024. Patients were categorized into two groups based on whether bowel resection was performed. Clinical, laboratory, and radiological variables were compared between the groups. A total of 182 patients met the inclusion criteria. Bowel resection was performed in 45 cases (24.7%). These patients had significantly older age, female predominance, ASA and Charlson Comorbidity Index (CCI) scores, longer symptom and operative durations, and higher rates of femoral hernia, peritonitis signs, elevated CRP, leukocytosis, and increased neutrophil-to-lymphocyte ratio (NLR). CT findings associated with resection included smaller defect and hernia diameters, reduced sac volume and bowel enhancement, increased bowel wall thickness, and a higher incidence of ileus. Multivariate logistic regression identified CCI, NLR, peritonitis signs, intraoperative bowel obstruction, bowel wall thickness, defect diameter, and lack of enhancement as independent predictors of resection. This study identified specific preoperative clinical, laboratory, and CT features that may help identify patients at increased risk of bowel resection in acute irreducible inguinal hernias. These findings may support early risk stratification and assist operative planning in emergency settings.