II. Indications
III. Contraindications (risk of peritonitis)
- Toxic appearance or signs of peritonitis
- Bowel Obstruction
- Necrotic or gangrenous tissue
- Strangulated Hernia
IV. Technique
- Positioning
- Abdominal Hernia
- Patient supine
- Groin Hernia (Inguinal Hernia or Femoral Hernia)
- Adult: Patient in 20 degrees Trandelenburg
- Child: Unilateral frog leg position
- Abdominal Hernia
- Ice packs applied to Hernia (reduce edema)
- Decrease pain (with decreased abdominal guarding and intraabdominall pressure)
- Conscious Sedation (as needed)
- Opioid Analgesics
- Re-examine after 20-30 minutes
- Bimanual Reduction
V. Disposition
- Surgical Consultation
- Immediate if unsuccessful reduction of Incarcerated Hernia
- Outpatient surgical evaluation within 1-2 weeks if successful Hernia Reduction (for elective repair)
VI. References
- Stevens (2013) Crit Dec Emerg Med 27(9): 2