The chapter describes the case of a 55-year-old male with severe abdominal pain, nausea, and vomiting, who presents with worsening abdominal distension, pain, and two episodes of vomiting. The patient has a history of hypertension, diabetes, and asthma, and has had swelling in the groin before, but it has gotten worse, more painful, and has become “hard.” The physical examination reveals a distended, diffusely tender abdomen, bowel sounds absent, and a large right inguinal hernia that is not reducible, with overlying skin that is dusky. The patient is diagnosed with an incarcerated hernia with bowel obstruction. Critical actions include recognition of the hernia, large-bore IV access and fluid bolus, upright chest x-ray, CT abdomen pelvis with IV contrast, pain management and antiemetics, nasogastric tube placement if symptoms are not controlled, broad-spectrum antibiotics, and surgery consult. The chapter provides several pearls, including the importance of fluid resuscitation, recognition of peritoneal signs, and avoiding reduction of a strangulated hernia, which can lead to perforation and sepsis.
