Incarcerated Inguinal Hernia

What Is It, Diagnosis, and More

Author: Corinne Tarantino, MPH

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Jillian Dunbar

What is an incarcerated inguinal hernia?

An incarcerated inguinal hernia is a type of hernia in which a part of the small bowel (i.e., small intestine) protrudes into the groin area and cannot be pushed back in. This is a specific type of inguinal hernia, which more generally refers to the protrusion of organs through a weakened area of the abdominal wall in the groin area or through an incomplete closure of the deep inguinal ring. 

Incarceration occurs when this organ cannot be pushed back into its original cavity. Incarcerated hernias are often surgical emergencies, and a clinician should be consulted early. Inguinal hernias are more common among men, and of those, incarceration is more common in hernias of the right side. Additionally, a premature infant experiencing a hernia has a higher chance of the hernia becoming incarcerated. 

Is an incarcerated inguinal hernia an emergency?

Yes, an incarcerated inguinal hernia is usually considered a medical emergency and almost always requires immediate surgery due to the risk of bowel obstruction. When bowel obstruction occurs, food is unable to pass through the intestines, and strangulation may occur. Strangulation, or the interruption of blood flow to the bowel, can lead to tissue death, tears, or infection. Promptly treating an incarcerated hernia should minimize the risk of complications.

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What causes an incarcerated inguinal hernia?

An inguinal hernia is caused by an organ pushing through a weakened tissue, which can be caused or exacerbated by pressure. There are many risk factors that can lend to increased abdominal pressure, such as chronic cough, constipation, and heavy lifting. Additionally, obesity, advanced age, smoking, and a history of hernias can increase the risk for inguinal hernias. Collagen diseases have also been associated with increased risk of incarcerated inguinal hernias. 

How do you tell if a hernia is incarcerated?

A hernia is considered incarcerated if the hernia cannot be massaged back into the original cavity. Incarcerated inguinal hernias usually cause swelling in the groin region, and some may show redness. If bowel obstruction has occurred, some additional symptoms may include sudden onset of pain, lack of appetite, irritability, and nausea or vomiting.

What is the difference between incarcerated and strangulated hernias?

An incarcerated hernia can lead to strangulation, which occurs when blood stops flowing in the herniated tissue. Strangulation can also occur from other causes, such as twisting of the bowels. Signs and symptoms of strangulation include fever, severe pain, nausea, high counts of white blood cells, tenderness around the hernia, and low blood pressure. The hernia itself may appear warm, tender, or discolored due to the decreased blood flow and lack of oxygen. Additionally, a strangulated inguinal hernia will no longer produce audible bowel sounds in the groin region.

How do you diagnose an incarcerated inguinal hernia?

In order to diagnose an incarcerated inguinal hernia, one must undergo a review of medical history and physical examination. Some incarcerated hernia symptoms are similar to testicular torsion symptoms, which may be evaluated simultaneously to determine the true diagnosis. An incarcerated hernia may be more likely if there are fluid or bowel sounds in the groin region. An ultrasound may also be used to confirm a diagnosis and to clarify whether the hernia is on only one side. If an ultrasound is inconclusive, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used. Some laboratory studies, such as a complete blood count, may be conducted to assess the occurrence of any complications. 

How do you treat an incarcerated inguinal hernia?

Incarcerated inguinal hernias are usually treated by emergency surgery. Individuals will be assessed for signs of strangulation, which requires surgical repair. If there are no signs of strangulation, a person may be placed in the Trendelenburg position, lying on their back with the table tilted downwards so the feet are raised and the head is lowered. Reduction will then be attempted, in which a clinician will put pressure on the hernia to guide the contents back through the inguinal ring. Some sedation may be used in this process. If reduction is not successful, immediate surgery may be conducted. Children often require referrals for emergency surgery even before incarceration occurs because they have a high propensity for recurrence. Surgical approaches may vary and are generally categorized as open or laparoscopic repairs. After surgery, some people may experience chronic pain, and few may have a recurrence of an inguinal hernia.

What are the most important facts to know about an incarcerated inguinal hernia?

An incarcerated inguinal hernia occurs when part of an organ protrudes into the groin region and cannot be massaged back into its respective cavity. Incarcerated hernias are often an emergency, and prompt treatment is necessary in order to avoid complications such as strangulation. Incarcerated inguinal hernias are caused by a weakened abdominal wall lining or incomplete deep inguinal ring closure, and they are often exasperated by pressure on the abdominal cavity. Other risk factors include smoking, advanced age, and obesity. An incarcerated inguinal hernia may present with a bulge in the groin area, pain, or nausea and vomiting. After a physical exam, an ultrasound is usually performed to confirm diagnosis. Surgery is often required to minimize complications and reduce the hernia

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Related links

Abdominal hernias
Inguinal hernia
Hernias: Clinical practice
Congenital gastrointestinal disorders: Pathology review

Resources for research and reference

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