Hernias Follow-up

  • Author: Bret A Nicks, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Jan 25, 2010
 

Further Inpatient Care

  • All incarcerated or strangulated hernias demand admission and immediate surgical evaluation.
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Further Outpatient Care

  • Follow-up visits with the general surgeon should be scheduled within the next 1-2 weeks for those patients with easily reducible hernias or with hernias found upon physical examination.
  • Discharge patients with umbilical hernias with close follow-up care if the defect is less than 2 cm in diameter and the hernia is not incarcerated or strangulated.
  • Educate patients to avoid those activities that increase intra-abdominal pressure.
  • Educate patients to return for inability to reduce hernia, increased pain, fever, and vomiting.
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Deterrence/Prevention

  • Counsel the patient on avoidance of activities that increase intra-abdominal pressure, such as straining at defecation or lifting heavy objects. This may require work or school-related activity restrictions and should be clearly delineated.
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Complications

  • If strangulation of the hernia is missed, bowel perforation and peritonitis can occur.
  • Hernias can reappear in the same location, even after surgical repair.
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Prognosis

  • The prognosis depends on the type and size of hernia as well as on the ability to reduce risk factors associated with the development of hernias.
  • The prognosis is good with timely diagnosis and repair.
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Patient Education

  • Counsel the patient to avoid those activities that increase intra-abdominal pressure, such as straining at defecation and lifting heavy objects.
  • Instruct the patient to apply support to the hernia. Numerous medical device companies have developed support items to assist with this process.
  • Even with asymptomatic hernias, early repair (ie, before it enlarges) is preferred. Referral to a general surgeon for discussion about type of repair is warranted as a wide variety of hernia repair options now exist with advent of new meshes and laparoscopy.
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Contributor Information and Disclosures
Author

Bret A Nicks, MD  Assistant Professor, Assistant Medical Director, Department of Emergency Medicine, Wake Forest University Health Sciences

Bret A Nicks, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Christian Medical & Dental Society, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kim Askew, MD  Assistant Professor, Department of Emergency Medicine, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Lavely, MD, JD, MS, MPH  Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  16. Ginsburg BY, Sharma AN. Spontaneous rupture of an umbilical hernia with evisceration. J Emerg Med. Feb 2006;30(2):155-7. [Medline].

 
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Anatomic locations for various hernias.
 
 
 
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