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Incarcerated inguinal hernia — MCCQE Part 1 MCQ

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HardAbdominal PainIncarcerated inguinal herniaMCCQE Part 1

A 62-year-old has a previously reducible groin hernia that is now irreducible with constant pain, overlying erythema, peritonism and lactate 4.0 mmol/L. What is the most appropriate management?

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Correct answer: D — Resuscitate and arrange emergency surgery for suspected strangulation

Sedate, reduce the hernia manually and observe for four hours: Taxis can be considered only in selected early incarceration without strangulation features. Schedule mesh repair after a period of bowel rest and analgesia: Elective delay risks bowel necrosis, perforation and sepsis. Apply a truss and repeat lactate after intravenous fluid treatment: A truss neither restores perfusion nor treats obstruction. Obtain CT before referring to the emergency general-surgery service: Colonoscopy has no role before emergency management of a strangulated external hernia. Resuscitate and arrange emergency surgery for suspected strangulation: IV access, fluids, analgesia, antibiotics when indicated and immediate surgical source control are required.

Reference: https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-abdominal-pain/