Ultrasound in the Diagnosis of Incarcerated Hernia

摘要

Inguinal hernias are a common entity in emergency departments. The determination of the viability of incarcerated herniated bowel is important prior to attempts at reduction, as reduction of strangulated, dead bowel can have disastrous consequences. We describe a case in which ultrasound was used to help guide treatment of an inguinal hernia. Case Report An 84 year-old male with a past medical history of hypertension and non-insulin dependent diabetes mellitus presented with a complaint of suprapubic pain. He described the pain as severe, sharp and constant, starting approximately six hours prior to arrival. He noted that the pain was located in his suprapubic region, with an associated region of discomfort to the right side. He had additional symptoms of severe nausea followed by multiple episodes of non-bilious emesis. He denied any previous occurrence of similar symptoms. His review of systems was negative for fever, chills, changes in bowel habits, or UTI symptoms. On physical exam the patient was noted to be afebrile with stable vital signs. He was in no acute distress but complained of persistent discomfort. His abdomen was soft, non-tender, and active bowel sounds were present; however, a firm, non-mobile, 4 cm mass was palpable in the right inguinal region. Examination of his stool for occult blood was negative. Laboratory analysis revealed a white blood cell count of 6.1 k/μL, a hemoglobin of 13.6 g/dL, and a urine analysis showing no nitrites and no leukocyte esterase. A diagnosis of incarcerated inguinal hernia was suspected, with concern for early strangulation. Immediate bedside ED ultrasound of the right groin was performed, demonstrating visible peristaltic motility of the incarcerated segment of bowel and thus confirming viability and lack of strangulation of the intestinal loop (Fig. 1).