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nbme24/Block 4/Question#13

A 90-year-old man has a 1-week history of ...

Incarcerated inguinal hernia

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 +4  upvote downvote
submitted by ankistruggles(6),

How do you know he has an incarcerated inguinal hernia and not fecal impaction?

sattanki  So as far as I understand, you don’t really get a bulging, defined abdominal mass with fecal impaction. Much more likely to see this with a hernia. +2  
xxabi  Fecal impaction can be palpated in the abdomen, since it'd be accumulating in the rectum and colon, not the groin. Hope that helps! +5  
pseudorosette  a little late but they also mention that the mass had bowel sounds hence it was an incarcerated bowel! :) +2  




 +0  upvote downvote
submitted by yotsubato(263),

Why is the patient not in pain. I wouldnt expect Incarcerated hernia to present with zero pain, but 1 week of constipation and swelling.

yotsubato  Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas. Like really? Why is he not in pain? +1  
medschul  I thought that inguinal hernias were reducible? +  
fahmed14  could be a femoral hernia as they are more likely to cause incarceration. They do, however, present more often in females. (FA 2019- 364) +  
wowo  incarcerated, not strangulated, thus no pain as there's no serious tissue damage/ischemia. Incarcerated hernias may progress to strangulated in which case he would have pain Under section, "complications" https://www.amboss.com/us/knowledge/Inguinal_hernia +