Jessie is back dropping some knowledge on hernias: the different types, presentation, and what we need to worry about.
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Jessie is back dropping some knowledge on hernias: the different types, presentation, and what we need to worry about.
Barbara B. - April 18, 2023 9:37 AM
Hi, After reduction of an incarcerated hernia, if the patient feels better, can they just return home? Is there any need for urgent labs/further imaging/etc., or can you just assume if it pops back in and they feel better, they can go (for potential follow up for hernia repair in future)? (i.e. is there risk that there has been ischemic damage -- or do you trust your exam to let you know)?
Thanks
Jessie W. - April 18, 2023 9:55 AM
Thanks for your question! So technically, an incarcerated hernia is one that cannot be reduced. That is, when the contents of a hernia can't be reduced, we call it incarcerated. A strangulated hernia is when there's compromised blood supply and the contents become ischemic (surgical emergency!). So, if you're able to reduce a hernia and the patient feels well, looks good, those patients can go home.
Usually, patients with strangulation don't look great - they may have severe pain, unstable vitals, nausea, vomiting. If there are any overlying skin changes you should avoid attempting to reduce the hernia and call your surgeon buddy. Overlying erythema or discoloration of the skin is concerning for strangulation.
I usually attempt reduction if the patient looks otherwise well, with normal vital signs, no vomiting, no severe pain. Remember to use gravity to help you and some pain control. If you're able to reduce the hernia and patient feels better, they can go home without further workup.