Summary

An incarcerated hernia is a hernia (protrusion of tissue through a weak spot) that cannot be pushed back into place (irreducible). Think of a hernia as tissue (usually bowel or fat) pushing through a weak spot in the abdominal wall—when it gets stuck and can't be pushed back, it's incarcerated. This is a surgical emergency because the trapped tissue can become strangulated (blood supply cut off), leading to tissue death, bowel obstruction, peritonitis, and potentially death if not treated promptly. The most common sites are inguinal (groin), femoral (upper thigh), umbilical (belly button), and incisional (previous surgery site). The key to management is recognizing the incarcerated hernia (lump that can't be reduced, pain, may have bowel obstruction), assessing for strangulation (severe pain, peritonism, signs of bowel obstruction, fever), and urgent surgical repair (reduce the hernia, repair the defect, resect bowel if strangulated). Most incarcerated hernias can be reduced surgically, but if strangulated, the affected tissue may need to be removed.

Key Facts

• Definition: Hernia that cannot be reduced (irreducible)
• Incidence: Common (thousands of cases/year)
• Mortality: Low (<1%) if treated promptly, higher if strangulated and delayed
• Peak age: All ages, but varies by type
• Critical feature: Lump that can't be pushed back, pain, may have bowel obstruction
• Key investigation: Clinical diagnosis (usually), imaging if uncertain
• First-line treatment: Urgent surgical repair

Clinical Pearls

"Can't reduce = incarcerated" — If a hernia can't be pushed back into place, it's incarcerated. This is a surgical emergency—don't wait.

"Strangulation is the danger" — The trapped tissue can have its blood supply cut off (strangulation), leading to tissue death. Signs of strangulation: severe pain, peritonism, signs of bowel obstruction, fever.

"Don't try to force reduction" — Don't try to force an incarcerated hernia back—this can cause damage. Let the surgeon reduce it in the operating room.

"Time matters" — The longer a hernia is incarcerated, the higher the risk of strangulation. Urgent surgery is needed.

Why This Matters Clinically

Incarcerated hernias are surgical emergencies that can lead to strangulation, bowel obstruction, and death if not treated promptly. Early recognition, assessment for strangulation, and urgent surgical repair are essential. This is a condition that emergency clinicians and surgeons manage, and prompt treatment prevents serious complications.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal (may have signs of sepsis)
• Feel: Pulse (may be high), BP (usually normal, may be low if sepsis)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR (may be high)
• Action: Monitor if sepsis

D - Disability

• Assessment: Usually normal
• Action: Assess if severe

E - Exposure

• Look: Hernia examination, abdominal examination
• Feel: Lump, tenderness, peritonism
• Action: Complete examination

Specific Examination Findings

Hernia Examination:

• Inspection: Visible lump
• Palpation:
  • Lump: Palpable, firm
  • Irreducible: Can't be pushed back
  • Tenderness: Painful
  • Erythema: Redness (if strangulated)
• Attempt reduction: Don't force—if can't reduce, it's incarcerated

Abdominal Examination:

• Inspection: May have distension (if bowel obstruction)
• Palpation:
  • Tenderness: May have (if strangulated)
  • Guarding: May have (if peritonitis)
• Auscultation: May have absent bowel sounds (if obstruction)

Special Tests

Natural History (Without Treatment)

Untreated Incarcerated Hernia:

• High risk of strangulation: Almost certain if not treated
• Bowel obstruction: High risk
• Peritonitis: High risk
• Mortality: High if not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early surgery: Better outcomes
• Not strangulated: Better outcomes
• No bowel resection: Better outcomes
• Young, healthy: Better outcomes

Poor Prognosis:

• Delayed surgery: Higher risk of strangulation
• Strangulated: Higher mortality, may need bowel resection
• Bowel resection: Longer recovery
• Older, comorbidities: May have worse outcomes

Prognostic Factors

Key Guidelines

1. EHS Guidelines (2014) — European Hernia Society guidelines. European Hernia Society

Key Recommendations:

• Urgent surgery for incarcerated hernias
• Assess for strangulation
• Evidence Level: 1A

Landmark Trials

Multiple studies on hernia repair techniques, outcomes.

Evidence Strength

What is an Incarcerated Hernia?

An incarcerated hernia is a hernia (a bulge where tissue pushes through a weak spot) that can't be pushed back into place. Think of a hernia as tissue (usually bowel or fat) pushing through a weak spot in your abdominal wall—when it gets stuck and can't be pushed back, it's incarcerated. This is a surgical emergency because the trapped tissue can have its blood supply cut off (strangulation), leading to serious complications.

In simple terms: Your hernia has gotten stuck and can't be pushed back. This is serious and needs urgent surgery, but with prompt treatment, most people recover well.

Why does it matter?

Incarcerated hernias are surgical emergencies that can lead to strangulation (blood supply cut off), bowel obstruction, and serious complications if not treated promptly. Early recognition and urgent surgery are essential. The good news? With prompt surgery, most people recover well.

Think of it like this: It's like tissue getting stuck in a hernia—it needs to be freed urgently, but once it's fixed, most people recover well.

How is it treated?

1. Assessment:

• Examination: Your doctor will examine the hernia and check for signs of strangulation (severe pain, fever, signs of bowel obstruction)
• Tests: You may have tests if needed
• Why: To see how serious it is and plan treatment

2. Urgent Surgery:

• What: The surgeon will operate to free the trapped tissue and repair the hernia
• When: Usually within hours (if strangulated) or within 24 hours (if just incarcerated)
• Why: To free the trapped tissue and prevent complications
• What happens: The surgeon will put the tissue back, check if it's alive, remove it if it's dead (if bowel, reconnect it), and repair the weak spot

3. After Surgery:

• Recovery: You'll recover in hospital
• Antibiotics: You may continue antibiotics if the tissue was dead
• Going home: Usually within 1-2 days

The goal: Free the trapped tissue, repair the hernia, and prevent complications.

What to expect

Recovery:

• Surgery: Usually within hours to 24 hours
• Hospital stay: Usually 1-2 days (longer if bowel was removed)
• Pain: Should improve after surgery
• Full recovery: Most people are back to normal within 2-4 weeks

After Treatment:

• Wound: Small cuts that heal quickly
• Activity: You'll gradually return to activities (avoid heavy lifting initially)
• Follow-up: Usually not needed unless complications

Recovery Time:

• Simple cases: Usually 1-2 days in hospital, back to normal within 2-4 weeks
• If bowel removed: Usually longer stay, may take longer to recover

When to seek help

Call 999 (or your emergency number) immediately if:

• You have a hernia that can't be pushed back and you have severe pain
• You have a hernia and signs of bowel obstruction (vomiting, distension)
• You have a hernia and a fever
• You have a hernia and feel very unwell
• You have a hernia and your skin over it is red

See your doctor if:

• You have a hernia that can't be pushed back
• You have a hernia and pain
• You have concerns about a hernia

Remember: If you have a hernia that can't be pushed back, especially if you have severe pain, fever, or signs of bowel obstruction, call 999 immediately. Incarcerated hernias are surgical emergencies, but with prompt treatment, most people recover well. Don't try to force it back—let a surgeon do it.