Strangulated Inguinal Hernia

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History

H/O Reducible inguinoscrotal swelling, H/O recent irreducibility, Pain (site, duration, character) Absolute Constipation, Abdominal Distention.

Physical Examination

Never try to manually reduce the strangulated hernia.

Monitor Pulse, blood pressure, temperature, dehydration.

Local Examination of the Swelling:

Site, size, shape, temperature of skin surface, colour of skin over the swelling, visible scar, cough impulse, margins of swelling, consistency, transillumination, can get above the swelling.

Provisional Diagnosis

Investigations:

Haemoglobin, Serum Electrolytes (Na+, K+), Blood Sugar Fasting if patient is above 40 years of age.

Management:

  1. Maintain I/V line with Branula #18G.
  2. Draw blood samples for investigations.
  3. Analgesia:  Narcotic Analgesics.  Inj. Nalbufin 10 mg + Inj. Marzine 10 mg I/V stat slow.
  4. Start I/V Fluids.  Inj. Ringer’s Lactate I/V to correct hydration status of the patient.
  5. Start I/V Antibiotics.  1- Inj. ampicillin 500 mg I/V stat.  2- Inj. metronidazole 500 mg I/V stat.  3- Inj. gentamycin 80 mg I/V stat.
  6. Pass N/G tube and active suction.
  7. Inform the REGISTRAR and Anaesthetist and Theater Sister.
  8. Admit the patient in the ward.
  9. Take consent for operation.
  10. Shift the patient to the Operation Theater as early as possible.

Do not wait for investigation or NPO to be completed.  If the swelling gets reduced after giving analgesia, ADMIT the patient in the ward and do mesh hernioplasty on the next elective list.

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Burhan Ahmed, is currently the Editor-in-Chief at Medicalopedia.org.
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