Clinical Features

The majority of hernias are asymptomatic and are detected either on routine physical examination or inadvertently by the patient. Patients with incarceration frequently give a history of hernia; the patient can no longer reduce it and therefore seeks medical attention. If incarceration is acute, pain may develop suddenly. With infants, irritability may be the only presenting complaint. Incarceration may be accompanied by nausea and vomiting if partial or complete bowel obstruction has occurred. Incarcerated hernias are a leading cause of bowel obstruction, second to postoperative adhesions.

When strangulation occurs, the patient may be toxic, along with signs and symptoms of bowel obstruction. In the case of Richter hernia, however, strangulation may occur without intestinal obstruction.10 Unrelieved strangulation may result in perforation, abscess formation, peritonitis, or septic shock.

Pain and hypesthesia along the medical aspect of the thigh to the knee are associated with obturator hernias. These patients additionally have intermittent bouts of small bowel obstruction over years. Obturator hernias are more commonly seen in older women.

Physical examination of the patient with a hernia may reveal an abnormal swelling. In inguinal hernias in males, the swelling may extend into the scrotum. The consistency of the mass varies depending upon the content of the hernial sac. If incarceration is present, the swelling is usually tender due to inflammation of the bowel wall or omentum and surrounding tissues. Tachycardia and mild temperature elevation frequently also are present.

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