Incarcerated Hernia

Information

Incarcerated hernia’s can occur when fat, bowel, or other abdominal content protrude through a narrow opening causing compression. This can lead to swelling and risk of disruption to the blood supply. If untreated there is risk of ischaemia and bowel death. Most commonly seen in inguinal hernias.

Clinical Features and Epidemiology:

• Age: most at risk are infants below 3 months of age and those who are born premature.
• Acute onset of pain: may be a new or previously diagnosed hernia. Sudden onset of pain and distress.
• Associated symptoms: if bowel loops are incarcerated this can cause obstruction. Signs include abdominal distension, vomiting, and not passing gas or stool.
• Examination findings: very firm bulge in the groin, scrotum, or abdomen that cannot be pushed back into the abdomen (irreducible). There may be red/purple discolouration of the overlying skin. Painful to palpate.

Differentials:

• Reducible Hernia: lump in scrotum, groin, or abdomen. If in scrotum often can’t feel above lump. Soft to palpate. Should be able to reduce. There may be mild discomfort.
• Hydrocele: painless swelling of the testicle. Will transilluminate on examination. Often associated with viral illness in younger children and will self-resolve. Can feel above lump. See page on Scrotal Hydrocele.
• Testicular torsion: acute onset pain in scrotum associated with redness and swelling. Will not have signs of obstruction but may vomit due to pain. See page on Testicular Torsion.