Monday, March 16, 2009
This is a request from a humble, lowly general surgeon in Ohio to all the talented ER docs across the country: When a patient presents with an incarcerated inguinal hernia, it's ok to gently try to reduce it in the ER. If, however, it doesn't reduce easily with some moderate pressure then you're probably better off just letting a sleeping dog lie. Don't force it. Forget the steep Trendelenburg and the IV sedation; call the surgeon and make him get his sleepy behind out of bed so the hernia can be addressed properly. Reducing a strangulated or ischemic hernia doesn't do anyone any favors.
I've had two patients over the past few years referred to me the day after having a hernia "reduced" in the ER in the middle of the night who showed up in my office with generalized peritonitis and/or sepsis on exam. A hernia is a mechanical problem; the goal isn't merely to reduce it, but to repair it and evaluate for evidence of bowel ischemia. Just a friendly public service announcement....