Direct hernias occur in older patients as a result of relaxation of abdominal wall musculature and thinning of the fascia. Umbilical hernias usually occur in infants and reach their maximal size by the first month of life. Hernias also may be detected in the ED on routine physical examination. Strangulated hernia Symptoms of an incarcerated hernia present combined with a toxic appearance. Systemic toxicity secondary to ischemic bowel is possible.
Strangulation is probable if pain and tenderness of an incarcerated hernia persist after reduction.
Suspect an alternative diagnosis in patients who have a substantial amount of pain without evidence of incarceration or strangulation. Medial thigh pain as well as groin pain are possible because of the position of this hernia. Obturator hernia Because this hernia is hidden within deeper structures, it may not present as a swelling. Instead, patient may complain of abdominal pain or medial thigh pain, weight loss, or recurrent episodes of bowel or partial bowel obstruction. Pressure on the obturator nerve causes pain in the medial thigh that is relieved by thigh flexion.