Ventral and incisional hernias Quiz: Ace Your Exams
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A 64-year-old man presents to the emergency department with severe abdominal pain and vomiting for one day. He has not had a bowel movement or passed gas for 24 hours. He has an incisional hernia at the site of a previous cholecystectomy. He states that the hernia typically reduces on its own, but he feels it has been “stuck” in place today. Temperature is 37.3°C (99.1°F), pulse is 110/min, respiratory rate is 22/min, and blood pressure is 162/88 mmHg. On exam, he is in significant distress due to the pain. Examination of the abdominal wall reveals a tender bulging mass in the right upper quadrant at the site of the scar. The overlying skin appears dusky with surrounding erythema. During the assessment, the patient has an episode of bilious emesis. A nasogastric tube is placed. Which of the following is the best next step in management?
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