Surgery MCQ Answer 65

Answer: b, c

Hernia incarceration denotes the condition wherein viscera are contained within a hernia sac and cannot be disgorged from the sac. Patients with an incarcerated hernia may be asymptomatic except for the presence of a bulge. Pain associated with an incarcerated hernia should be interpreted as indicative of strangulation. Many hernias are of such size that they cannot be reduced either spontaneously or manually. If the patient is asymptomatic, elective surgery should be planned. In a patient with pain, attempt at reduction is relatively safe as long as excessive force is not applied. An incarcerated hernia with discomfort or signs of bowel obstruction is best treated with urgent hernia repair, although gentle attempts at reduction may be without consequences. Reduction of a symptomatic hernia may result in reduction of gangrenous bowel into the peritoneal cavity. Reduction of bowel with necrotic areas eventuates in bowel perforation and peritonitis with an associated 10% to 30% mortality and high levels of morbidity. Vigorous attempts at reduction may result in reduction en masse, in which the viscera remain within the peritoneal sac after reduction with the entire sac and its contained viscera forced through the abdominal wall defect into the preperitoneal layer. Reduction en masse usually occurs when a small fibrous neck traps enclosed viscera and is associated with a high risk of continued entrapment and progression to obstruction or strangulation.

World-wide hernias are the leading cause of intestinal obstruction. The obstruction is almost exclusively small intestinal with only rarely the colon as the site of obstruction.

Category: Surgery MCQs