eMedicine Specialties > Emergency Medicine > Gastrointestinal

Hernias: Follow-up

Author: Bret A Nicks, MD, Assistant Professor, Assistant Medical Director, Department of Emergency Medicine, Wake Forest University Health Sciences
Coauthor(s): Kim Askew, MD, Assistant Professor, Department of Emergency Medicine, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Jan 25, 2010

Follow-up

Further Inpatient Care

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

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.

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.

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis of hernia in patients who present with nausea and/or vomiting
  • Diagnosing testicular torsion as a hernia without appropriate evaluation or imaging considerations (puts the testicle at risk)
  • Reducing a strangulated bowel without recognizing it (The hernia will be reduced, but the bowel will remain ischemic.)
  • Failure to provide adequate instructions for patients with reduced hernias regarding follow-up and the need to return to the ED for worsening or persistent recurrent symptoms

Special Concerns

  • Pain after reduction of a hernia may indicate a strangulated hernia, requiring further evaluation by a surgeon.
 


More on Hernias

Overview: Hernias
Differential Diagnoses & Workup: Hernias
Treatment & Medication: Hernias
Follow-up: Hernias
Multimedia: Hernias
References
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References

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  14. Akbulut S, Cakabay B, Sezgin A. A familial tendency for developing inguinal hernias: study of a single family. Hernia. Aug 29 2009;[Medline].

  15. Smith S. Inguinal hernia reduction. In: King C, Henretig FM, eds. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008:840-847/87.

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Further Reading

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Keywords

hernia, hernia symptoms, hernia treatment, hernia causes, abdominal wall hernia, indirect inguinal hernia, indirect hernia, direct inguinal hernia, direct hernia, femoral hernia, umbilical hernia, Richter hernia, incisional hernia, spigelian hernia, obturator hernia, reducible hernia, incarcerated hernia, strangulated hernia

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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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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.

 
 
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