II. Indications

III. Contraindications (risk of peritonitis)

  1. Toxic appearance or signs of peritonitis
  2. Bowel Obstruction
  3. Necrotic or gangrenous tissue
  4. Strangulated Hernia

IV. Technique

  1. Positioning
    1. Abdominal Hernia
      1. Patient supine
    2. Groin Hernia (Inguinal Hernia or Femoral Hernia)
      1. Adult: Patient in 20 degrees Trandelenburg
      2. Child: Unilateral frog leg position
  2. Ice packs applied to Hernia (reduce edema)
  3. Decrease pain (with decreased abdominal guarding and intraabdominall pressure)
    1. Conscious Sedation (as needed)
    2. Opioid Analgesics
  4. Re-examine after 20-30 minutes
    1. Positioning, ice and Analgesics alone may reduce Hernia
  5. Bimanual Reduction
    1. Guide proximal Hernia through fascial defect with one hand
    2. Apply gentle pressure to distal aspect of Hernia with the other hand
      1. Avoid excessive pressure due to risk of edema and more difficult reduction
      2. Slow manual pressure over 5-15 minutes

V. Disposition

  1. Surgical Consultation
    1. Immediate if unsuccessful reduction of Incarcerated Hernia
    2. Outpatient surgical evaluation within 1-2 weeks if successful Hernia Reduction (for elective repair)

VI. References

  1. Stevens (2013) Crit Dec Emerg Med 27(9): 2

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