- Contraindications (Risk of peritonitis and other complications)
- Toxic appearance or signs of peritonitis
-
Bowel Obstruction
- Necrotic or gangrenous tissue
-
Strangulated Hernia
-
Undescended Testicle or ovary within Hernia
- Positioning
- Abdominal Hernia
- Patient supine
- Groin Hernia (Inguinal Hernia or Femoral Hernia)
- Adult: Patient in 20 degrees Trandelenburg position
- Child: Unilateral frog leg position
- Ice packs applied to Hernia (reduce edema)
- Decrease pain (with decreased abdominal guarding and intraabdominal pressure)
- Procedural Sedation (as needed)
- Consider surgeon assistance if available, and using Procedural Sedation
- Opioid Analgesics
- Anxiolysis
- Re-examine after 15-20 minutes
- Positioning, ice and Analgesics alone may reduce Hernia
- Bimanual Reduction
- Guide proximal Hernia through fascial defect with one hand
- Apply gentle pressure to distal aspect of Hernia (directed toward Hernia neck) with the other hand
- Avoid excessive pressure due to risk of edema and more difficult reduction
- Slow manual pressure over 5-15 minutes
- Failed reduction
- Repeated attempts may result in swelling, preventing further successful acute reduction
-
Bowel perforation (higher risk with Ischemic Bowel)
- Surgical Consultation
- Immediate if unsuccessful reduction of Incarcerated Hernia or if reduction contraindicated (see above)
- Outpatient surgical evaluation within 1-2 weeks if successful Hernia Reduction (for elective repair)
- Stevens (2013) Crit Dec Emerg Med 27(9): 2
- Warrington (2021) Crit Dec Emerg Med 35(7):25
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