From the Guidelines
An incarcerated hernia requires immediate medical attention and treatment is primarily surgical, with emergency surgery being performed to release the trapped tissue and repair the hernia using mesh reinforcement, as delayed treatment can lead to strangulation, bowel obstruction, tissue death, and peritonitis 1.
Symptoms of an Incarcerated Hernia
- A painful, firm bulge that cannot be pushed back into the abdomen
- Nausea and vomiting
- Abdominal pain
- Inability to pass gas or stool
Treatment of an Incarcerated Hernia
While waiting for medical care, patients should:
- Not eat or drink
- Avoid pushing on the hernia
- May take pain medication like acetaminophen if needed In the emergency department, doctors may attempt:
- Manual reduction (pushing the hernia back) under sedation using medications like midazolam or propofol
- If unsuccessful, emergency surgery is performed to release the trapped tissue and repair the hernia using mesh reinforcement
Post-Surgical Care
- Patients typically stay in the hospital for 1-3 days
- Should avoid heavy lifting for 4-6 weeks
- May take prescribed pain medications like acetaminophen or ibuprofen Prompt treatment is essential as an incarcerated hernia can quickly become strangulated, which is life-threatening and requires immediate surgical intervention 1.
Importance of Early Diagnosis and Treatment
Early diagnosis of strangulated obstruction may be difficult, and delayed diagnosis can lead to septic complications, therefore, patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected 1.
Use of Biological Mesh in Contaminated Fields
Biological mesh prosthetics are most commonly used in infected fields involving large, complex abdominal wall hernia repairs, and the use of biological mesh, which becomes vascularized and remodelled into autologous tissue after implantation, may offer a low-morbidity alternative to prosthetic mesh products in these complex settings, with good results also in immune-compromised patients 1.
From the Research
Symptoms of Incarcerated Hernia
- Painful irreducible lump in the groin area 2, 3
- Concomitant symptoms and signs of bowel strangulation, such as nausea, vomiting, and abdominal tenderness 2, 4
- Longer duration of symptoms and late hospitalization can lead to unfavorable outcomes 4
Treatment of Incarcerated Hernia
- Manual reduction of incarcerated tissues from the hernia sack to its natural compartment, also known as taxis, can help delay the need for surgery 2, 5
- GPS (Gentle, Prepared and Safe) Taxis is a safe technique for manual reduction, which should be performed within 24 hours from the onset of symptoms and when concomitant symptoms and signs of bowel strangulation are absent 2
- Conscious sedation guidelines should be followed, with the most popular drug combination being intravenous morphine and short-acting benzodiazepine, both titrated carefully for optimal and safe effect 2
- Urgent surgery can be undertaken during the same admission or up to several weeks later, with a success rate of 25.4% for manual closed reduction (MCR) 5
- Elective repair of groin hernias should be done whenever possible to avoid high morbidity and mortality associated with incarceration 4
Complications and Outcomes
- Bowel resection may be required in some cases, with a rate of 12.9% in one study 4
- Overall and major morbidity rates can be high, at 41.5% and 9.6% respectively, with a mortality rate of 3.4% 4
- Recurrent incarceration can occur in up to 23% of cases, with 60% of these undergoing successful repeated MCR and the others undergoing emergency surgery 5