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Hernias, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Protrusion of bodily structure or organ through a defect in tissues normally containing it.

  • Classified as external (hernia protrudes visibly to outside), internal (herniated contents ...

Diagnosis

Signs and Symptoms

History

  • Pain and swelling:

    • Localized to region of hernia

  • Persistent pain, vomiting, fever may indicate:

    • Incarceration

    • Strangulation

    • Bowel obstruction

Physical Exam

  • Vital signs:

    • Freq...

Treatment

Initial Stabilization/Therapy

  • 0.9% NS IV fluid resuscitation for dehydration, bowel strangulation, obstruction, or sepsis:

    • Adults: 1 L bolus

    • Peds: 20 mL/kg bolus

Ed Treatment/Procedures

  • Incarcera...

Follow-Up

Disposition

Admission Criteria

  • Strangulated hernias require immediate surgical intervention.

  • Incarcerated hernias require admission for urgent surgical intervention.

  • Intestinal obstruction

  • Perito...

Pearls and Pitfalls

  • Failure to recognize signs and symptoms of an incarcerated or strangulated hernia

  • Forcing reduction of incarcerated hernia

  • Reintroducing strangulated bowel back into abdominal cavity

Additional Reading

  • Derici  H, Unalp  HR, Bozdag  AD, et al. Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia.  2007;11(4):341–346.

  • Nicks  BA. Hernias: Treat...

Codes

ICD9

  • 553.00 Femoral hernia without mention of obstruction of gangrene, unilateral or unspecified(not specified as recurrent)

  • 553.9 Hernia of unspecified site without mention of obstruction or gang...

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