How should I approach the management of an incarcerated umbilical hernia in an adult patient?

Management of an incarcerated umbilical hernia in an adult requires urgent surgical assessment due to the risk of strangulation and bowel ischemia. Initial approach involves prompt clinical evaluation to confirm incarceration and assess for signs of bowel compromise, such as pain, tenderness, and systemic symptoms. Imaging, typically an abdominal ultrasound or CT scan, may assist in diagnosis and surgical planning.

Definitive treatment is surgical repair. Emergency surgery is indicated to reduce the hernia contents and repair the defect. The choice between tissue repair and prosthetic mesh repair depends on the contamination risk and patient factors. In clean cases without bowel resection, mesh repair is preferred due to lower recurrence rates. However, if bowel resection is necessary or contamination is present, tissue repair may be safer to reduce infection risk.

Postoperative care includes monitoring for complications such as infection or recurrence. Elective repair is recommended for reducible umbilical hernias to prevent incarceration.

This approach aligns with UK clinical practice guidelines emphasizing urgent surgical intervention for incarcerated hernias to prevent complications NICE NG156. Supporting evidence from Abdel-Baki et al. (2007) demonstrates that prosthetic mesh repair in emergency settings for incarcerated para-umbilical hernias results in better outcomes compared to tissue repair when contamination is not present. Summers 2014 highlights the importance of timely surgical management and individualized repair technique selection. Atri et al. (2023) underscore the need for thorough evaluation as unusual contents may be present in incarcerated hernias, reinforcing the need for surgical exploration.