Incarcerated hernia/SBO Flashcards
A 70 year old woman presents with the clinical features of distal small bowel obstruction. She is found to have an irreducible femoral hernia. How would you manage her?
Impression
This woman is presenting with a SBO, likely related to an incarcerated femoral hernia.
Goals
- rule out other differential causes of SBO,
- investigate and treat complications of incarcerated hernia (perforation, peritonitis, sepsis)
- arrange definitive treatment in timely manner
Incarcerated hernia - Assessment
Assessment
This is a surgical emergency, and patient should be assessed emergently. Would utilise an A to E approach given risk of bowel perforation and serious complications.
- call for senior assistance
- arrange gen surg consult
A - patent, maintaining
B - RR, sats. supplemental as req
C - 2xIVC, BP + ECG monitoring, temp. VBG. Take further bloods (FBC, UEC, LFT, Lipase, group + hold). Administer fluid resuscitations If harm-dynamically unstable and bridging ABx if perforation and signs of peritonism. Pre-op bloods (FBC, group + hold). Analgesia as required
D - GCS,
E - Gastro exam: signs of peritonism (guarding, rigid abdo, rebound tenderness), bowel sounds
- Hernia examination: reducible, location, cough impulse
F - Fluids, consider urinary catheter
- keep NBM
Incarcerated hernia - History
History
- sx: pain history (SOCRATES), bowel changes, urinary changes, peritonism, fevers
- HPC: recent illness,
Incarcerated hernia - Examination
Examination
- General observation + vital signs
- Gastro exam
- hernia exam
Incarcerated hernia - Investigations
Investigations
- as per A to E assessment
- imaging: ultrasound, CT abdomen (surgical planning) oral + IV contrast
Incarcerated hernia - Management
Management
- is a surgical emergency, requires surgical exploration for definitive management
Supportive
- analgesia
- fluids
- bridging Abx if indicated
Definitive
- surgical exploration +/- resection (if ischaemia)
