Obstructed [recurrent][body structure] hernia (disorder) - new template for review

Bruce Goldberg,

Unless there are anomalous classifications (most significantly missing subtypes) I think this  looks very good.  I read your explanation to Cathy Richardson and it makes sense to me.  We want the finding sites to be as specific as possible, but not more so.

Bruce Goldberg  and Jim Case , my thinking had been that while it only the organ that is obstructed due to the herniation, the tissue that is herniated through the opening can be more than just the organ. So tissue such as adipose tissue and the omentum may also be present but not obstructed. For example, https://www.uptodate.com/contents/classification-clinical-features-and-diagnosis-of-inguinal-and-femoral-hernias-in-adults?search=intraabdominal%20hernia&topicRef=3688&source=see_link#H549554470 in the section on incarceration and strangulation mentions that bowel, bladder, ovary, omentum and other structures may be present. Bowel obstruction can be a manifestation of the strangulation. To represent this:

• the group that uses the associated morphology=herniated structure should have a finding site that includes all the tissue that can be herniated such as the omentum and adipose tissue which means  <<818983003 |Structure of abdominopelvic cavity and/or content of abdominopelvic cavity and/or anterior abdominal wall (body structure)| should be used.
• the group that uses the associated morphology=obstruction should use a more specific site <<818993005 |Structure of organ within abdominopelvic cavity (body structure) to represent the organs that can be obstructed. I note Bruce's comment (GC-620 and email) on potentially narrowing this finding site to intestinal structure but are there cases of any other hollow organs being obstructed through herniation? I haven't explored that aspect.  

Bruce, I note your comments on the hernial opening finding site to enable lumbar hernias to be subsumed as a type of1003840001 |Obstructed hernia of abdominal cavity (disorder)|. Good point. This would impact the general hernia template as well. 

Cathy Richardson,

If I understand Bruce Goldberg's reasoning correctly, since this template is specific for obstructed hernias, there would be no  need to include non-hollow tissue structures to be allowed  and in fact would be allowing non-sensical models to be created.  I would agree that for strangulation, the finding site would be relaxed to include <<818983003 |Structure of abdominopelvic cavity and/or content of abdominopelvic cavity and/or anterior abdominal wall (body structure)|.  In cases where you have multiple structures involved in the herniation, including non-hollow viscus, this would not be the correct template to use.

Cathy Richardson, I agree with Jim Case. According to what I can ascertain from the literature, an obstructed abdominal hernia specifically refers to bowel obstruction.

Cathy Richardson,

I have made some changes based on the comments that Bruce made a couple of year ago and would like to extend this template to cover the combined "obstruction and gangrene" concepts, so that we don't require another template for those concepts.  During the testing of this template and the revised model, I removed a number of DUE TO relationships, which didn't seem to be adding much to the definition and did not change the classification.  Also, as suggested by Bruce, I use the FINDING SITE = Intestinal structure for both the herniated structure and the obstructed structure.  A remaining question is in regards to the concurrent gangrene and obstruction concepts, whether to also make the gangrenous finding site  the intestine or leave it general to any organ within the abdominal cavity?  

I will have a task for you to review as you spent quite a bit of time on hernias in the past.

Hi Jim Case , New template looks good. Dropping the 'Due to' improves the modelling of this content. Suggest the gangrene finding site is the intestine. Let me know when review is ready. 

Cathy Richardson,

One change related to lumbar hernias has caused a bit of an issue with the rest of the hernia hierarchy.  In order to have lumbar hernias classify under hernia of abdominal cavity, the hernial opening and herniated structure finding sites need to move up a level to 63337009 |Structure of abdominopelvic segment of trunk (body structure)| from 818983003 |Structure of abdominopelvic cavity and/or content of abdominopelvic cavity and/or anterior abdominal wall (body structure)|, due to the fact that the lumbar triangle is not a part of the anterior abdominal wall.  

Do you see an issue with doing a batch change to the new finding site?

For this template I also constrained the obstructed finding site to 783798004 |Structure of lumen of intestine (body structure)|

Running template compliance using this template shows only one mismatch for 1542009 |Omphalocele with obstruction (disorder)|, which is a complex congenital concept.

The FINDING SITE(s) have been updated to reflect the need to include herniation of the stomach (hiatal hernias).  The sites have been made more general.