ROSH Gastrointestinal Practice Exam

In the case of a 33-year-old man with a painful, irreducible indirect inguinal hernia, what is the most appropriate management step if strangulation is suspected?

1. Elective hernia repair

2. Emergent herniorrhaphy

3. Hernia truss

4. Monitor for worsening symptoms

The correct answer is: Emergent herniorrhaphy

When an indirect inguinal hernia is suspected to be strangulated, immediate intervention is crucial due to the risk of compromised blood supply to the herniated tissue. Strangulation can lead to tissue necrosis, which may result in severe complications, including sepsis and even death if not promptly addressed. Emergent herniorrhaphy is the most appropriate management step in this scenario because it involves surgical intervention to not only repair the hernia but also to assess and potentially resect any compromised bowel or tissue. This immediate action is necessary to alleviate the risk of further complications that can arise from delayed treatment. In contrast, elective hernia repair is not suitable in the case of strangulation since it is not urgent and does not address the immediate risk to the tissue involved. A hernia truss, which is a supportive garment, would not be effective in treating the condition and could lead to further complications by allowing continued incarceration. Monitoring for worsening symptoms would be inappropriate as well, given the potential for rapid deterioration in the case of strangulation. Therefore, the prompt surgical intervention through emergent herniorrhaphy is the most critical step in managing a suspected strangulated indirect inguinal hernia.