incarcerated hernias

Question 1

incarcerated means

Answer 1

irreducible

Question 2

why do they become irreducible?

Answer 2

chronic hernias become irreducible due to adhesions within the sac

Question 3

partly reducible hernias

Answer 3

inguinal

Question 4

always irreducible

Answer 4

femoral

Question 5

cough impulse

Answer 5

incarcerated hernias do not have cough impulse

meaning that coughing does not cause the hernia to move

Question 6

may be strangulated:

Answer 6

tender +/- red

Question 7

incarcerated inguinal hernias are abdominal emergencies in

Answer 7

infants and and children

Question 8

strangulated is

Answer 8

• impairment of blood supply
• uncommon in children
• common cause of acute surgical admission in boys < 2y.
• Congenital patent processus vaginalis (hernia is indirect).
• High incidence in premature babies, 40% become irreducible.
• Greater need for surgery (↑ risk for incarceration).

Question 9

clinical presentation of strangulated hernia

Answer 9

painful, tender, irreducible

firm lump in groin of crying child +/- vomiting

Bowel infarction in case of strangulation (less common).

Pressure on spermatic cord → vascular obstruction of testis.

Question 10

treatment

Answer 10

• If Painful, but systemically well, infarction unlikely.
• Elective herniotomy 48h later, when edema resolved.
• Active reduction by gentle manipulation while child is sedated with i.v. opiates.

• Urgent surgery if irreducible.