Incarcerated hernia — MCCQE Part 1 MCQ

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ModerateAbdominal PainIncarcerated herniaMCCQE Part 1

58-year-old man presents with painful groin swelling and vomiting. The hernia is tender, irreducible and the abdomen is distended. Which of the following is the most appropriate next step?

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Correct answer: C — Keep nil by mouth, resuscitate and obtain urgent surgical assessment

Keep nil by mouth, resuscitate and obtain urgent surgical assessment is best because irreducible tender hernia with obstruction symptoms suggests incarceration/strangulation. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Do not repeatedly force reduction if strangulation is suspected.

Reference: Canadian Association of General Surgeons guidance