What are the pertinent questions to ask a patient with a large inguinal hernia?

Pertinent Questions for a Patient with Large Inguinal Hernia

When evaluating a patient with a large inguinal hernia, your primary focus should be identifying signs of complications—particularly strangulation and incarceration—that require emergency intervention, as these significantly impact morbidity and mortality. 1

Critical Questions to Assess for Emergency Complications

Symptoms of Strangulation or Incarceration

• Can you push the hernia back in? Irreducibility is a key sign of incarceration that may progress to strangulation 2
• When did the hernia become irreducible? Symptomatic periods >8 hours and delays >24 hours are associated with significantly higher morbidity and mortality 3, 2
• Do you have severe or worsening pain in the hernia? Increasing pain suggests possible strangulation 4
• Is there redness, warmth, or swelling over the hernia? Erythema and edema indicate potential strangulation 1, 5
• Do you have nausea, vomiting, or inability to pass gas/stool? These suggest bowel obstruction from incarceration 2
• Do you have fever or feel systemically unwell? Signs of SIRS (fever, tachycardia, elevated WBC) are common indicators of strangulated obstruction 5, 3

Symptom Severity and Impact

• How much does the hernia bother you daily? Pain interfering with normal activities affects surgical decision-making 6
• Do you have burning, gurgling, or aching in the groin? These are typical symptomatic presentations 4
• Does the hernia cause a heavy or dragging sensation that worsens throughout the day? This pattern is characteristic of symptomatic hernias 4

Questions About Hernia Characteristics

Size and Reducibility

• Does the hernia extend below the midpoint of your inner thigh when standing? This defines a giant inguinal hernia, which presents unique surgical challenges 7
• Does the hernia extend into your scrotum (males) or labia (females)? Scrotal hernias may contain significant bowel content 1, 2
• Can you normally push the hernia back in, and has this changed? Sudden irreducibility requires urgent evaluation 2

Timing and Progression

• How long have you had this hernia? Duration helps assess risk and urgency 1
• Has the hernia been getting larger? Progressive enlargement may indicate need for earlier repair 7
• Does the hernia appear or enlarge with coughing, straining, or activity? This confirms the diagnosis and assesses dynamic behavior 2, 4

Risk Factors and Comorbidities

Surgical Risk Assessment

• Do you have diabetes, heart disease, lung disease, or other chronic conditions? ASA score ≥3 and comorbidities significantly affect morbidity rates 3, 2
• Do you smoke? Smoking is an aggravating factor that affects outcomes 8
• Are you obese? Obesity complicates surgical management 8
• Do you have chronic constipation or chronic cough? These increase intra-abdominal pressure and affect outcomes 8
• Are you over 65 years old? Age is a risk factor for complications 8

Previous Surgical History

• Have you had previous groin or abdominal surgery? Prior surgery increases hernia risk and affects surgical approach 2
• Have you had a hernia repair before? Recurrent hernias require specialized management 4, 8

Functional Impact Questions

Activity Limitations

• What activities can you no longer do because of the hernia? This assesses quality of life impact 6
• What is your occupation and does it involve heavy lifting? Occupational demands affect timing of repair and return to work 9
• Are you able to exercise or perform daily activities? Functional limitation guides urgency of repair 6

Questions for Infants (if applicable)

Pediatric-Specific Assessment

• Does the bulge increase with crying or straining? This is diagnostic in infants 2
• Was the baby born prematurely? Preterm infants have 13% incidence vs 3-5% in term infants and higher complication rates 2
• In males, are both testicles in the scrotum? Testicular involvement must be assessed 2
• Is there a bulge on the opposite side? Contralateral patent processus vaginalis occurs in 64% of infants <2 months 2

Common Pitfalls to Avoid

Do not delay evaluation if any signs of strangulation are present—CT scanning with contrast can help predict bowel strangulation (56% sensitivity, 94% specificity for reduced wall enhancement), and elevated WBC with fibrinogen levels are significantly predictive of complications 1. Emergency repair must be performed immediately for suspected strangulation to prevent bowel necrosis and death 5, 3.