Irreducible Hernia

The irreducible hernia is also known as incarcerated hernia. This cannot be returned back to its original chamber. The skin overlay may appear normal, the contents are not tense and bowel sounds can be heard. Abdominal contents or the bowel omentum make up the incarcerated hernia.

Signs and Symptoms of the Irreducible Hernia

  • Painful enlargement where a previous hernia existed
  • Cannot be manipulated manually or spontaneously along the fascial defect
  • Chronic with no pain
  • Leads to strangulation cutting off of blood supply in the tissue of the hernia
  • Symptoms of bowel obstruction nausea and vomiting

Lab studies The following are some of the laboratory tests that may be conducted before the treatment of an incarcerated hernia:

  • CBC usually reveals leukocytosis with a left shift that may occur due to strangulation
  • BUN (blood, urea and nitrogen), electrolytes, creatinine assesses the hydration status of a patient especially with symptoms of nausea and vomiting.
  • Urinalysis infers differential diagnosis associated with hernia such as genitourinary causes of groin pain
  • Lactate levels elevated lactate levels may indicate hypoperfusion
  • Imaging studies – In case of imaging, the suspicion of an incarcerated hernia warrants chest films (upright) or flat-upright abdominal films are obtained. A small bowel obstruction is diagnosed or areas of bowel existing outside the abdominal cavity are identified.

A physical examination may be performed on the patient in sitting position, supine position, with a Valsalva maneuver or without.

Treatment

A suspicion of a hernia means you visit the surgeon for a consultation immediately. The need for surgery is established and an elective surgery is performed to avoid strangulation of the hernia. An irreducible and painful lump should not go unchecked. All irreducible hernias may not lead to strangulation but it is imperative that they are evaluated. Treatment measures purely depend on the length of time of the existence of the hernia. If blood supply has been cut off, then a gangrenous bowel may develop. With an irreducible hernia, the patient is at a high risk of developing strangulation and so it is important that a surgical intervention is considered.

It is a minimally invasive operation, which requires only a small incision rather than an open surgery that would require large incisions. A tiny camera is inserted through the cut to guide the surgeon. Patients can return to work in just a week or two of the procedure.