Abdominal Wall Hernia

Pt with h/o abdominal surgery presents with paroxysmal epigastric/umbilical discomfort. Pain occurs at site of protrusion extending from the abdominal wall; worse with coughing/straining. Denies fever, chills, anorexia, unintended, weight loss, change in bowel habits, diarrhea, dark/tarry stools, BRBPR. Abdominal wall protrusion reducible and resolves while pt is supine.

• CBC WNL

• Obtain ultrasound if unsure of diagnosis

• Non-incarcerated: Refer to general surgery for elective repair

• Pt counseled that smoking cessation, weight loss to achieve BMI <50 kg/m^2, and glucose control to achieve HbA1c <8% may be required prior to elective surgery

• Pt advised to contact provider if experiencing acutely increased abdominal pain associated with constipation and/or a non-reducible protrusion

Notes

• Hernias can cause pain even without palpable protrusion in exam

• Location of common hernia types

  • Associated with abdominal pain: Ventral midline

  • Sports hernias caused by twisting motion: Groin

• A CBC may be obtained if there is concern for a rectus sheath hematoma (rare)