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Is A Hernia Ever an Emergency?

With elective surgeries curtailed or completely halted in most hospitals throughout the country, there is some question amongst patients as to what exactly constitutes an emergency procedure – especially in general surgery – where many procedures are considered elective or semi-elective. We have discussed the urgency of hernias before and concluded that in some patients it may be OK to wait to repair the hernia. We have also been quite clear that hernias may require urgent care in certain circumstances.

However, due to the nature of the symptoms of a hernia, some patients may not know when a hernia becomes a true emergency. It is important to remember that any abdominal pain or signs of a hernia should be evaluated by a general surgeon as soon as possible, no matter how mild the symptoms may be. Some common hernia situations that may be emergencies include:

Femoral Hernias

Femoral hernias, that often occur in women, present as bulges in the upper thigh. Femoral hernias are particularly insidious because they have up to a 20% chance of strangulation – more on that below – and can therefore become an emergency situation rather quickly. While most cases do not require a rush to the ER, it is important that you contact your general surgeon to learn more about options to correct it. Depending on your risk for strangulation, urgent surgery may be indicated.

Irreducible / Incarcerated Hernias

Patients are often confused about irreducible hernias – those that do not reduce back into the abdomen when lying down. This is known as an incarcerated hernia. While incarcerated hernias can often create a good amount of pain, there are times where the pain is mild, and patients may be lulled into a sense that it is not urgent. An incarcerated hernia must always be treated very urgently as it can more easily strangulate.

Strangulated Hernias

Strangulated hernias, where the tissue stuck in the hernia defect starts to lose blood flow, is an emergency of the highest order. Whether it is intestinal or fat tissue, the contents of the hernia can begin to die within hours of being strangulated. This not only leads to a more complex hernia repair, but can also require very serious secondary surgery, including colon resection. Removing part of the diseased colon only increases the likelihood of a complication and poor outcome.

Other General Surgeries that Can Represent Emergencies

Virtually every organ in the abdomen can become diseased to the point where repair or treatment requires emergency surgery. It is why we tell our patients that any unusual abdominal pain, whether mild or moderate and especially when severe, must be discussed with a qualified primary care physician and general surgeon. While most abdominal conditions are not emergencies, benign and urgent conditions may have similar symptoms. For example, an inflamed gallbladder ready to rupture can have similar symptoms to a severe gallstone attack. Only a qualified surgeon can perform the appropriate diagnosis to rule out an emergency.

The bottom line? It’s better to be safe rather than sorry when it comes to significant abdominal conditions. You know your body best and if you believe you are having an emergency, it is imperative that you visit the ER immediately or call 911. And if you are concerned about infection due to COVID-19, rest assured that your hospital will likely have a plan in place to ensure that emergency room patients are not exposed to COVID-19 patients.

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